带旋髂深血管蒂髂骨瓣植骨治疗青壮年陈旧性股骨颈骨折  

Deep circumflex iliac arterial vascularized iliac bone grafting to delayed femoral neck fractures in young patients

作　　者：张建国[1] 肖湘[1] 张铁良[1] 

机构地区：[1]天津市天津医院创伤骨科,300211

出　　处：《中华骨科杂志》2006年第7期468-471,共4页Chinese Journal of Orthopaedics

摘　　要：目的应用带旋髂深血管蒂髂骨瓣植骨治疗青壮年陈旧性股骨颈骨折,探讨其早中期随访结果。方法1997年1月至2003年12月,收治31例陈旧性股骨颈骨折患者,其中有完整随访资料者26例。男19例,女7例;年龄15～38岁,平均25岁。致伤原因:交通伤17例,高处坠落伤9例。Garden骨折分型:Ⅲ型11例,Ⅳ型15例。保守治疗骨折不愈合11例,术后骨折不愈合15例(闭合复位骨圆针固定6例、切开复位螺纹钉或骨圆针固定9例)。受伤时间6～17个月,平均8.5个月。多数患者存在不同程度的肢体短缩及髋关节活动功能受限。X线片显示股骨颈骨折移位17例,股骨颈不同程度吸收9例。手术采用切开复位,带旋髂深血管蒂髂骨瓣植骨及螺纹钉、空心螺钉或骨圆针固定。术后6～8个月开始部分负重,术后11个月开始完全负重。结果26例随访28～69个月,平均41个月。骨折全部愈合,愈合时间11～15个月,平均12.5个月。随访期间2例发生股骨头坏死。5例患肢短缩超过3cm的患者术后无进一步短缩。Harris髋关节功能评分平均为82.8分。结论带旋髂深血管蒂髂骨瓣植骨可以改善骨折端的血运,促进青壮年陈旧性股骨颈骨折的愈合。Objective To evaluate the early and middle outcome of deep circumflex iliac arterial vascularized iliac bone grafting to delayed femoral neck fractures in young patients. Methods Thirty-one delayed femoral neck fractures were treated from January 1997 to December 2003. Complete data were available in 26 cases （19 males and 7 females）. The patients＇ age ranged from 15 to 38 years old with the average of 25 years old. 17 cases suffered from traffic accidents and 9 cases from falling injury. There were 11 cases in Garden type Ⅲ and 15 cases in type Ⅳ. 11 cases exhibited nonunion after conservative treatment and another 15 nonunion cases had previous surgery history. The initial operation included closed reduction and steinmann pin fixation or open reduction and threaded pin or steinmann pin fixation. The average duration from injury to the second operation was 8.5 months （range from 6 to 17 months）. Most of the patients presented shorten limbs and limited hip function in difference degree. Open reduction, deep circumflex iliac artery vascularized iliac hone grafting and cannulate screw fixation were performend. Partial weight hearing started on 6 to 8 months postoperatively and full weight bearing on 11 months postoperatively. Results The mean duration of follow up was forty-one months （range from 28 to 69 months）. Fracture healed successfully in 26 cases. The average time of fracture healing was 12.5 months （range from 11 to 15 months）. Two femoral head necroses were noted during the follow-up period. The 5 cases of obvious shortened limbs stop progressing after surgery. Harris hip joint function score was on average 82.8. Conclusion Deep circumflex iliac artery vascularized iliac bone grafting can improve the blood supply to fractured femoral head. As a result, it＇s an effective way to enhance delayed femoral neck fracture.

关 键 词：股骨颈骨折 不愈合 骨移植 

分 类 号：R687.3[医药卫生—骨科学]