两种带蒂骨瓣在青壮年股骨颈骨折治疗中的应用观察

Clinical effect of two kinds of pedicle bone flap in the treatment of femoral neck fracture in young adults

目的比较股骨大转子骨瓣和股方肌骨瓣两种不同带蒂骨瓣转移在治疗新鲜青壮年股骨颈骨折中的临床效果。方法两组患者均为青壮年,均采用髋关节后外侧入路行切开复位中空拉力螺钉内固定。股方肌骨瓣组15例,采用股方肌骨瓣转移至股骨颈后方;大转子骨瓣组9例,采用带血管蒂大转子骨瓣转移至股骨颈后方。比较两组病例切口长度、手术时间、手术失血量,以及转移骨块与股骨颈的融合时间、股骨颈骨折愈合时间、股骨头坏死发生率、髋关节Harris评分等。结果股方肌骨瓣组的手术失血量多于大转子骨瓣组,平均多出120 mL;转移骨瓣与受区融合时间,大转子骨瓣组比股方肌骨瓣组平均缩短1.6个月;骨折愈合时间,大转子骨瓣组比股方肌骨瓣组平均缩短1.9个月;差异均有统计学意义(P<0.05)。结论带血管蒂大转子骨瓣比股方肌骨瓣更适用于存在有股骨颈后方塌陷缺损的严重类型的股骨颈骨折。

Objective To compare the clinical effect between vascularized greater trochanter bone flap and quadratus femoris muscle pedicle bone flap in the treatment of femoral neck fracture in young adults.Methods All cases,who were younger than 50 years in two groups,were treated by open reduction,internal fixation using hollow lag screws and posterolateral approach of hip joint.At the same time 15 cases in group A were treated by transposition of quadrates femoris muscle pedicle bone flap to posterior aspect of femoral neck,and 9 patients in group B by vascularized greater trochanter bone flap.Several factors,including incision length,operation time,blood loss,time of the fusion between bone flap and femoral neck,healing time of femoral neck fracture,incidence of the femoral head necrosis,Harris＇ s score,and so on,were taken into consideration as criteria for evaluating clinical effect of two kinds of transposition methods.Results Blood loss in group A was more than that in group B,the average of additional blood loss was 120 mL;the fusion time between bone flap and femoral neck in group B was shortened by 1.6 months as compared with group A;the healing time of the bone fracture in group B was shortened by 1.9 months as compared with group A.Conclusion Vascularized greater trochanter bone flap transposition is more competent than quadrates femoris muscle pedicle bone flap when applied in treatment for serious femoral neck fracture with posterior comminution or defect.