带股方肌肌蒂骨瓣治疗青壮年股骨颈骨折

TREATMENT OF FRACTURE OF FEMORAL NECK IN YOUNG ADULTS WITH UNITING MUSCULART QUADRATUS FEMORIS-BONE FLAP

目的 评价带股方肌肌蒂骨瓣治疗青壮年股骨颈骨折的效果。方法 本组 32例患者均为Garden3～ 4型股骨颈骨折 ,术前证实有股骨头血液回流障碍。全部采用手术切开复位 ,加压螺纹钉内固定联合带股方肌肌蒂骨瓣移植 ,术后制动 1 2周。平均随访时间 3年 9个月。结果 股骨颈骨折全部愈合 ,时间 6～ 9个月。 3例发生股骨头坏死 ,1例于术后 6个月在X线片上出现股骨头坏死像 ,1例于术后 9个月出现坏死像 ,1例术后发生感染 ,经清创后 ,于术后 6个月出现股骨头坏死的X线表现。其中前 2例为Garden4型 ,术前检查 ,股骨头部完全无静脉回流。结论 带股方肌肌蒂骨瓣移植加压螺纹钉内固定术治疗青壮年股骨颈骨折 ,具有血供丰富 。

Objective To assess the treatment effect of the uniting muscular quadratus femoris-bone flap for the fracture of the femoral neck in the young and middle adults. Methods 32 cases were found with fracture of Garden 3 or 4 femoral neck and vein bloody reflux disturbance was confirmed before operation. All cases were treated by open reduction and compressive screw and uniting muscular quadratus femoris-bone flap. The patients were immobilized for 12 weeks after operation and were followed up for 3 years and 9 months. Results Fracture of the femoral neck for all the cases were healed with the healing time between 6～9 months. 3 cases resulted in necrosis of the femoral head; 1 case shows the necrosis by X-ray 6 months after the operation; 1 case showed necrosis 9 months after the operation and still 1 case was infected immediately after operation and showed necrosis 6 months after the operation. Yet 2 cases displayed non-vein reflux of the femoral head before the operation with Garden 4 type. Conclusion Compressive screw and uniting muscular quadrtus femoral flap has the effect in supplying enough blood, reducing trauma and decrecing the rate of femoral head necrosis.