带血管蒂髂骨膜瓣移植术治疗儿童股骨颈陈旧性骨折临床分析

Clinical efficiency of vascularized iliac periosteal bone-flaps graft in treatment of old fractures of femoral neck in children

目的探讨带血管蒂髂骨膜瓣移植联合内固定治疗儿童股骨颈陈旧性骨折并评估其临床疗效。方法选择2009年5月至2013年4月儿童股骨颈陈旧性骨折共9例,其中合并股骨头坏死5例;年龄9-18（13.7±3.0）岁;男性6例,女性3例。Garden分型：Ⅲ型4例,Ⅳ型5例。手术先切开复位空心钉内固定,再采用带旋髂深血管髂骨瓣移植治疗4例,部分带阔筋膜张肌骨膜瓣移植治疗5例。结果 9例全部获得随访,平均随访40.8（11-94）个月;9例患儿X线片提示股骨颈骨折愈合良好,5例股骨头坏死患儿股骨头修复。按Ratliff标准评价：优4例（44.4%）,良5例（55.6%）。结论带血管蒂髂骨膜瓣治疗儿童股骨颈陈旧性骨折是一种有效的好方法;部分带阔筋膜张肌骨膜瓣移植治疗儿童股骨颈骨折及儿童股骨头坏死是一种损伤小、特别适合儿童的新手术。

Objective To evaluate the clinical efficiency of vascularized iliac periosteal bone-flaps graft accompanied by internal fixation in treating old fractures of femoral neck in children. Methods From May 2009 to April 2013,a total of 9 children（5 with the avascular necrosis of femoral head） suffering from old fractures of femoral neck were enrolled in this study. There were 6 boys and 3 girls. The mean age was 13. 7years（ranging from 9 to 18 years）. According to Garden classification,4 hips were identified as type Ⅲ and 5as type Ⅳ. Iliac periosteal bone-flaps graft with deep circumflex iliac vessel was performed in 4 patients and iliac periosteal bone-flaps graft with partial tensor fasciae lata in 5. Results All patients were followed up over a mean period of 40. 8 months（ ranging from 11 to 94 months）. All the fractures were healed. According to Ratliff evaluation criteria,4 patients were assessed as excellent and 5 as good. Conclusion The vascularized iliac periosteal bone-flaps graft accompanied by internal fixation is an effective method to treat old fractures of femoral neck in children. Iliac periosteal bone-flaps graft with partial tensor fasciae lata is a new and effective procedure with small trauma to treat fractures of femoral neck and avascular necrosis of femoral head in children.