空心钉联合带旋髂深血管蒂髂骨瓣治疗青壮年股骨颈骨折疗效分析

Efficacy of cannulated screws combined with vascularized iliac bone flap based on the deep iliac circumflex vessels graft in managing femoral neck fractures in young adults

目的探讨空心钉联合带旋髂深血管蒂髂骨瓣治疗青壮年股骨颈骨折的方法及疗效。方法回顾性分析郑州仁济医院创伤骨科2016年3月—2020年3月收治的23例采用空心钉联合带旋髂深血管蒂髂骨瓣治疗的青壮年股骨颈骨折患者临床资料,男性17例,女性6例;年龄23~51岁,平均34.5岁;左侧15例,右侧8例;道路交通伤7例,高处坠落伤11例,摔伤4例,其他1例。观察骨折愈合时间、髋关节功能恢复状况,采用Harris评分对末次随访髋关节功能进行评估,优≥90分,良80~89分,一般70~79分,差<70分。结果术后23例均获得12~36个月随访,平均15.5个月,切口均Ⅰ期愈合。术后骨折愈合时间6~15个月,平均8.5个月,患者均骨性愈合,无股骨头缺血性坏死、再骨折发生。髋关节功能恢复满意,按照Harris评价标准:优15例,良6例,一般2例,优良率为91.3%。结论采用空心钉联合带血管蒂髂骨瓣治疗青壮年股骨颈骨折利于骨折愈合,是一种有效的治疗方法。

Objective To investigate the efficacy of cannulated screws combined with vascularized iliac bone flap based on the deep iliac circumflex vessels graft to manage femoral neck fractures in young adults.Methods A retrospective analysis of the clinical data was conducted on 23 young adults with femoral neck fractures treated in the department of traumatic orthopedics,Zhengzhou Renji Hospital from Mar.2016 to Mar.2020,by cannulated screws combined with vascularized iliac bone flap based on the deep iliac circumflex vessels graft.There were 17 males and 6 females,aged 23-51 years,mean 34.5 years.The fractures involved the left side in 15 cases and right side in 8 cases,with the injury mechanisms being road traffic crashes in 7 cases,falls from height in 11 cases,falls in 4 cases and others in 1 case.The time of fracture healing was recorded and the recovery of hip functions was evaluated by Harris score at the last follow-up:excellent≥90,good 80-89,fair 70-79 and poor<70.Results All the 23 cases were followed up for 12-36 months,mean 15.5 months.All the incisions healed at stageⅠ.The postoperative fracture healing time was 6-15 months,8.5 months on average.All patients had osseous healing,and no avascular necrosis of the femoral head or re-fracture occurred.Harris score showed an excellent result in 15 cases,good in 6 cases and fair in the rest 2 cases,with the good-to-excellent rate being 91.3%.Conclusion The methods of cannulated screws combined with vascularized iliac bone flap in the treatment of femoral neck fractures in young adults is effective,which benefit fracture healing.