切开复位内固定联合旋髂深血管束髂骨瓣移植治疗青壮年股骨颈骨折

Treatment of Open Reduction and Internal Fixation Combined with Vascularized Iliac Grafting for Displaced Femoral Neck Fractures in Young Adults

目的探讨应用切开复位空心螺钉内固定联合旋髂深血管束髂骨瓣移植治疗青壮年移位型股骨颈骨折的临床疗效。方法对21例年龄15~35岁的青壮年股骨颈骨折(GardenⅢ、Ⅳ型)患者,采用髋部Smith-Peterson切口进行骨折切开复位,空心加压螺钉内固定,将旋髂深血管束髂骨瓣移植固定于股骨头颈前部的骨槽内,观察股骨颈骨折愈合情况,骨不连、股骨头缺血坏死等并发症发生情况。结果本组21例术后伤口全部甲级愈合,均无感染及骼骨瓣移位,植入的空心螺钉均无退钉。所有患者均获得随访,平均随访24(12~72)个月。所有骨折均在术后6~9月时获得骨性愈合,无骨折不愈合出现,无股骨头缺血坏死病例。1例患者出现股外侧皮神经损伤症状,术后6月时基本恢复正常。髋关节功能Harris评分结果显示优15例,良5例,一般1例,优良率达95.2%。结论切开复位内固定联合旋髂深血管束髂骨瓣移植治疗青壮年移位股骨颈骨折临床效果满意,是治疗年轻患者股骨颈移位骨折的一种较好的方法。

Objective To study the clinical effect of open reduction and internal fixation of compression screws combined with vascularized iliac grafting to treat displaced femoral neck fracture in young adults. Method 21 patients with femoral neck fractures（Garden III or Ⅳ） aged from 15 to 35 years old were treated by open reduction,internal fixation with compression screw and vascularized iliac grafting.Results All wounds of 21 patients cured without infection,iliac displacement and screw loose. All cases were followed-up for 12 to 72 months with an average of 24 months. Bone union was achieved in all cases6 to 9 months after the surgery,and no fracture nonunion and avascular necrosis of femoral head occurred.The lateral femoral cutaneous nerve injury was found in 1 case,and restored 6 months after the surgery.According to the Harris hip score（HSS）,the hip joint function evaluation revealed excellence in 15 cases,good in 5 cases,fair in 1 case,and the fineness rate was 95. 2 %. Conclusion The treatment of open reduction,internal fixation of compression screws combined with vascularized iliac grafting is effective for femoral neck displacement fractures in young patients.