手术治疗陈旧性股骨颈骨折及创伤性股骨头坏死

Surgical Treatment of the Old Fracture of Femoral Neck and the Traumatic Necrosis of Femoral Head

采用自身对照方法对18条成熟雄性家犬的36侧髋关节,分别制成陈旧性股骨颈骨折和股骨头坏死模型,两周后进行吻合血管腓骨移植,术后通过X线片、病理组织学,电镜,ECT和四环素荧光标记等实验。临床应用吻合血管腓骨移植治疗陈旧性股骨颈骨折及创伤性股骨头坏死56例,对54例经过1～9年随访,除1例失败外,其余均取得满意疗效。结果表明:吻合血管腓骨移植为创伤性股骨头坏死提供了新的血供,参与股骨头缺血坏死的修复,刺激成骨细胞活跃,促进骨折愈合。

The authors adopted an auto-control experimental research on 18 male strong adult dogs with 36 sides femoral necks which were divided into two groups. They were made the models of old fracture of femoral neck and avascular necrosis of femoral head respectively. Two weeks later, the free fibula with microvascular anastomosis was transplanted. All experimental dogs were examined with X-ray, pothohistologic methods, electron microscopy, 99mtc-MDP scanning and tetracycline labeling. Fifty-six cases of old fracture of femoral neck and the traumatic avascular necrosis of femoral head were treated with free vascularized fibular graft. Fifty-four cases were followed up from 1 year to 9 years. All the cases were in good condition except one who was poor result because of the internal fixation ineffectiveness. The experimental study and clinical review showed that the free fibular graft with microvascular anastomosis could provided a new system for necrostic femoral head. The hard free fibula had a support role and could activate the osteoblast. The periosteum of the transplanted fibula also took part in the repair of necrostie femoral head. (Original article on page 260)