股骨颈重建术51例远期疗效评价

A Surgery of Reconstructing the Femoral Head for the Middle -aged and Young Men′Femoral Neck Fracture,Ununited and Absorbed Neck with Necrotic Head

目的 为中青年股骨颈骨折不连、颈吸收伴股骨头坏死寻求保留自身髋关节的治疗方法。方法 在多条血管束植入为主的手术方法治疗股骨头缺血性坏死的基础上 ,设计并应用了股骨颈重建术。具体方法 :采用带缝匠肌蒂的髂骨瓣或游离的髂骨瓣重建股骨颈 ,用鹅颈三翼钉做内固定 ,将血管束植入到股骨头与重建颈部。结果 本文报告 5 1例 ,平均 43岁 ,随访时间为5～ 12年 (平均 8.7年 )。按自拟的疗效评价标准 :优 2 0例 ,良 18例 ,可 8例 ,差 5例 ,优良率为 74.5 %。结论 本手术能最大限度恢复股骨头颈的正常解剖 ,并同时恢复股骨头的血运 ,使股骨头缺血性坏死得以恢复 ,能够延缓或避免股骨头的人工关节置换 ,是中青年患者的理想方法。该手术的技术关键在于固定是否牢靠与血运是否充分。

Objective OnthebasisofthesurgeryofimplantingmultiplebloodvesselsbundlestotreatANFH ,wedesignedandper formedasurgeryofreconstructingthefemoralnecktotreatthemiddle-agedandyoungmen’femoralneckfracture ,ununitedandab sorbedneckwithnecrotichead .Methods Theconcreteprocedureistoreconstructthefemoralneckwithasartoriusmusclepedicleilli umgraftorfreeilliumgraftsfixedbyagoose -necktrifin ,then ,multiplebloodvesselsbundlesareimplantedtothenecroticfemoralhead andreconstructedneck .Inthearticle,fifty-onecaseshavebeenreportedinwhichagedfrom 18to 5 4andaverage 43 .Allcaseswere followedupfor 5to 12 years (average 8.7years) .Results Theresultwasevaluatedaccordingtothemarkcriterionformulatedby ourselvesandshowedthatexcellentwastwentycases,bettereighteen ,goodeight,unchangedfive ,andtherateofexcellentandgood was 74.5 percent.Conclusion Weholdthatthesurgeryisagoodmethodformiddle-agedandyoungmen’femoralneckfracture,u nunitedandabsorbedneckwithnecroticheadbecauseitcannotonlyrestorethenormalanatomytothegreatestextent,butalsosupply adequatebloodtothenecroticfemoralheadsoastorecoverANFHanddelayoravoidthehiparthroplasty .Thekeypointsofthesurgery lieinstrongfixationandadequatebloodtothenecroticfemoralhead .