股方肌骨瓣结合髂骨或股骨大转子植骨治疗股骨颈骨不连

Treatment of femoral neck nonunion with quadratus femoris muscle pedicle bone grafting combined with iliac or femoral trochanter bone graft

目的观察股方肌骨瓣结合髂骨或股骨大转子植骨治疗股骨颈骨不连的疗效。方法 2006年8月至2016年3月,收治股骨颈骨折骨不连患者33例,男23例,女10例,年龄19~48岁,平均31.5岁,均为GardenⅣ型。术后采用Harris髋关节评分标准进行髋关节评分:总分100分,90~100分为优,80~90分为良,70~80分为可,70分以下为差。结果 33例患者术后获2~12年随访,平均(38.65±25.90)个月,患者全部临床愈合,愈合时间为4~16个月,平均愈合时间为(6.53±2.71)个月。术后无内固定松动失败,1例患者术后伤口感染,给伤口清创,放置万古霉素骨水泥棒后感染愈合。31例患者双下肢等长,无髋内外翻畸形;2例患者出现股骨颈短缩,髋内翻畸形。无股骨头坏死发生,末次随访,Harris髋关节评分标准评分65~95分,平均(88.54±7.46)分:优26例,良3例,可2例,差2例,优良率为89.9%。结论股方肌骨瓣结合髂骨或股骨大转子植骨治疗股骨颈骨不连是一种操作简单、疗效确切的治疗方法。

Objective To observe the curative effect of quadratus femoris muscle pedicle bone grafting combined with iliac or femoral trochanter bone graft for the treatment of femoral neck nonunion. Methods From August 2006 to March 2016,33 cases of the femoral neck nonunion were treated. There were 23 males and 10 females, aged from 19 to 48 years,with an average age of 31.5 years. According to the Garden classification, all of them were type Ⅳ. Postoperative hip scores were assessed using the Harris hip score. The total score is 100 points, 90-100 is excellent, 80-90 is good, 70-80 is fair, and below 70 is poor. Results All patients were followed up for 2 to 12 years, with an average of(38.65±25.90)months. All the patients were healed. The healing time was 4-16 months, and the average healing time was(6.53±2.71)months. There was no failure of internal fixation loosening after operation. One patient had postoperative wound infection,debrided the wound, and healed after placing vancomycin cement stick. Thirty-one patients had equal length of lower limbs, no hip valgus deformity, and 2 patients had femoral neck shortening and hip varus deformity. There was no femoral head necrosis. At the last follow-up, the Harris hip score was 65-95(88.54±7.46) points. The results were excellent in 26 cases, good in 3 cases, fair in 2 cases, and poor in 2 cases. The excellent and good rate was 89.9%.Conclusion The treatment of femoral neck nonunion with quadratus femoris muscle pedicle bone grafting combined with iliac or femoral trochanter bone graft is a simple and effective treatment.