青壮年新鲜股骨颈骨折的手术治疗

Operative treatment of fresh femoral neck fracture in the youth and middle-aged

目的探讨新鲜青壮年股骨颈骨折的手术治疗方法。方法本组72例,平均34.4(20～48)岁。其中头下型32例,经颈型12例,基底型28例,均用多枚钛合金空心钉固定。闭合复位51例,切开复位同时分别联合应用股方肌骨瓣或带旋髂深血管的髂骨瓣21例。平均随访3年4个月。结果5例复位不良,其中4例出现骨折不愈合,共10例发生股骨头坏死。结论新鲜股骨颈骨折的治疗原则是应力求早期解剖复位,牢固固定。钛合金空心钉呈等腰三角形平行固定可获得良好的固定效果,有动力加压作用,创伤小,愈合率高,并发症少,可以长期存留体内,是目前比较理想的股骨颈骨折治疗手段。带肌蒂或血管蒂的髂骨瓣植入可以改善局部的血运。良好的骨折复位、早活动晚负重,有利于降低青壮年股骨颈骨折不愈合和股骨头缺血坏死的发生率。

Objective To retrospectively study the operative treatments for the young and middle aged cases of fresh femoral neck fractures. Methods There were 72 cases in the group, with an average age of 34.4 years (20 48 years). 22 cases were sub head fractures, 32 cases trans neck ones and 18 cases basal neck ones. They were all fixated by 3 titanium alloy cannulated screws. 51 cases were treated by closed reduction, 21 cases by open reduction together with either bone graft with quadratus femoris or iliac graft with deep circumflex iliac vessels. Patients were followed up for an average of 3 years and 4 months. Results 5 cases obtained poor reduction (4 cases nonunion), and 10 cases suffered from femoral head necrosis. Conclusions The principles for the treatment of fresh femoral neck fracture are early treatment, anatomic reduction and rigid fixation. The treatment with 3 titanium alloy cannulated screws in the form of isosceles triangle possesses the merits of excellent fixation, dynamic compression, high healing rate, less lesion and fewer complications, and the screws can be kept in the body for a long time. Iliac graft pedicled with muscle or blood vessel can efficiently improve local blood supply. Better fracture reduction, earlier activities and later weight bearing will decrease the incidence of femoral head necrosis.