腓骨柱植骨支撑固定防治股骨颈骨折术后股骨头坏死的机理和临床疗效

The Mechanism and Clinical Outcome of the Prevention to Postoperative Femoral Head Necrosis of Femoral Neck Fractures by Fibula Bone Graft and Internal Fixation

目的:探讨腓骨柱植骨支撑固定防治股骨颈骨折术后股骨头坏死机理研究和临床疗效。方法:随访符合标准的56例患者,记录骨折的Garden分型、内固定的全程稳定性、股骨头坏死的发生和演变等指标,并采用SPSS18.0进行统计分析。结果:56例患者均恢复解剖复位,在术后3-6月骨折愈合,平均4个月,愈合率为100%;Harris功能评分51-100分,平均分为84.6分,其中优者(≥90.0分)37髋,良者(80.0~89.9分)14髋,中者(70.0~79.9分)者1髋,差者(<70.0分)4髋,Harris功能评分优良率为91.10%,没有发生内固定失效和骨折不愈合;22例根据MRI表现出股骨头坏死症状,坏死率39.30%,其中17例影像学坏死能够在随访期内维持为ARCOⅠ-Ⅱ期或者完全修复。其余的5例进展为临床坏死;晚期出现塌陷4例(7.15%)。Garden Ⅰ、Ⅱ级和GardenⅢ、Ⅳ级相比较,两组股骨头坏死率有统计学差异(P<0.05),且两组的晚期塌陷率比较也有统计学差异(P<0.05)。结论:空心加压螺钉与腓骨柱的所具有的生物力学稳定效能,能提供全程可靠的抗挤压、抗拉伸及抗旋转三维度稳定性,可以提供强大的机械稳定性;同时腓骨柱具有较强的生物学修复能力,为股骨头骨头血运重建和坏死区修复持续稳定的血供及持续有效的生物学修复能力。生物学愈合后腓骨柱在软骨下形成一个较大接触面积的支撑效果,可以预防股骨头坏死后塌陷。

Objective：To study the mechanism and clinical outcome of the prevention to postoperative femoral head necrosis of femoral neck fractures by fibula bone graft and internal fixation.Methods：56 cases who were accorded with the inclusion criteria were followed up.The Garden classification of fractures,internal fixation stability,necrosis of the femoral head in the whole process of the occurrence and evolution of indicators were collected.SPSS18.0 software was used to statistical analysis.Results：56 cases obtained anatomical reduction,and fracture healed 3-6 months after surgery,with an average of 4 months.The rate of union was 100％.The Harris score ranged from 51 to 100,with an average of 84.60 point.Among these,excellent group had 37 cases,good group had 14 cases,medium group had 1 cases,poor group had 4 cases.The rate of excellence and good accounted for 91.10％.No internal fixation failure or fracture nonunion happened.The necrosis rate was 39.20％ （22 cases） in imaging,17 cases maintained for ARCO Ⅰ-Ⅱ or restored completely,the rest of the 8.90％ （5 cases） progressed for clinical necrosis.4 cases （7.50％） collapsed at the end stage.Compared with Garden type Ⅲ and Ⅳ group,the rate of necrosis of femoral head in Garden type Ⅰ and Ⅱ group had statistically difference （P＜0.05）.Besides,the rate of collapse at the end stage between two group also had statistically difference （P＜0.05）.Conclusion：Cannulated screws and fibula bone graft performed biomechanical stability,which can provide reliable resistance to pressure and rotation in three dimensional;Fibula bone graft provides strong biological repair ability for repairing necrosis area of femoral head bone by revascularization of blood,and leads to the steady and sustained and effective biological repair ability.The cartilage supported by healed bone is to form a larger contact area,which can prevent the collapse of femoral head necrosis.