带旋髂深血管骨瓣转移及解剖锁定钢板加空心钉固定治疗青壮年陈旧性股骨颈骨折

Transplantation of pedicled bone flap with deep iliac circumflex artery, anatomical locked plate plus hollow screw fixation in treatment of femoral neck fracture in young adults

目的探讨带旋髂深血管骨瓣转移及解剖锁定钢板加空心钉固定治疗青壮年陈旧性股骨颈骨折的疗效。方法2011年2月~2018年4月,本院共收治19例青壮年陈旧性股骨颈骨折,年龄25~44岁,平均35.2岁,按骨折部位分型:头下型9例,经颈型8例,基底型2例。按Garden分型,Ⅲ型12例,Ⅳ型7例。经髋关节改良Smith-Petersen入路,显露并处理股骨颈骨折断端,行髋关节Watson-Jones入路,骨折复位前,从该切口预置解剖锁定钢板与空心螺钉,并从骨折断端确定螺钉分布合理后,更换长螺钉确切固定股骨颈骨折,股骨颈开槽,取旋髂深血管骨瓣植入骨槽内。术后观察患者骨折愈合时间,发生骨不连及股骨头坏死情况,术后1年进行患髋Harris功能评分。结果19例患者均获得随访,最短1年2个月,最长8年4个月,平均3年6个月,2例GardenⅣ颈下型分别出现骨不连及股骨头坏死,其余均完全骨性愈合,根据髋关节Harris功能评分,优良率89.5%。结论带旋髂深血管转移及解剖锁定钢板加空心钉固定可有效治疗青壮年陈旧性股骨颈骨折,降低并发症的发生。

Objective To investigate the effect of transplantation of pedicled bone flap with deep iliac circumflex artery,anatomical locked plate plus hollow screw fixation in treatment of femoral neck fracture in young adults.Methods From February 2011 to April 2018,a total of 19 young adults with old femoral neck fractures,who were aged from 25 to 44 years,with an average age of 35.2 years,were treated.Typed by fracture site:There were 9 patients of the subcapital type,8 patients of the cervical type,and 2 patients of the basal type.Typed by Garden:There were 12 patients of typeⅢ,and 7 patients of typeⅣ.Through the hip-modified Smith-Petersen approach,the broken end of femoral neck fracture was exposed and treated,and the hip joint Watson-Jones approach was performed.Before the fracture restoration,the anatomical locked plate and hollow screws were pre-placed at the incision.After the screw distribution was determined to be reasonable,the long screws were used to accurately fix the femoral neck fracture.The femoral neck was grooved,and circumflex iliac deep hip bone flap was transplanted into the bone groove.The fracture healing time,occurrence of bone nonunion and femoral head necrosis were observed after operation.The Harris scoring was performed for the affected hip 1 year after operation.Results All the 19 patients were followed up,for a minimum of 1 year and 2 months and for a maximum of 8 years and 4 months,with an average of 3 years and 6 months.Two patients with GardenⅣbelowfemur-head fracture developed nonunion and femoral head necrosis,and other patients achieved complete bone healing.According to the hip joint function scoring,the excellent and good rate was 89.5%.Conclusion Transplantation of pedicled bone flap with deep iliac circumflex artery,as well as anatomical locking plus hollow screw fixation,can effectively treat old femoral neck fractures in young adults and reduce complications.