带血管蒂大转子骨瓣移位修复青壮年股骨颈骨折  

The treatment of serious femoral neck fractures with vascularized great trochanter bone flap transposition in young adults

作　　者：潘振宇[1] 喻爱喜[1] 余国荣[1] 祝少博[1] 邓凯[1] 

机构地区：[1]武汉大学中南医院显微骨科,武汉大学医学院显微外科研究所,武汉市430071

出　　处：《中华显微外科杂志》2008年第4期253-255,I0005,共4页Chinese Journal of Microsurgery

摘　　要：目的观察带血管蒂大转子骨瓣移位治疗青壮年股骨颈严重骨折的疗效。方法青壮年股骨颈严重骨折29例，其中GardenⅢ型10例，Ⅳ型19例。新鲜骨折12例，陈旧性骨折17例。陈旧性骨折病例中，合并股骨头坏死者7例。入院后即行胫骨结节牵引。手术方式均为开放复位空心拉力螺钉固定同时行带血管蒂大转子骨瓣移位。结果随访39—84个月。新鲜股骨颈骨折和陈旧性骨折病例均在4．5个月全部愈合。但合并有股骨头坏死者修复时间明显延长，平均12．5个月。未合并股骨头坏死的陈旧性骨折病例10例中，出现股骨头坏死3例。髋关节功能完全恢复正常15例，部分受限12例，髋关节屈曲严重受限2例。新鲜骨折术后的髋关节功能明显优于陈旧性骨折。依Harris髋关节评分标准，术后平均89．2分。股骨颈短缩得到较好纠正。结论带血管蒂大转子骨瓣移位可有效治疗青壮年股骨颈严重骨折。Objective To observe the curative effect of the treatment of serious femoral neck fractures with vascularized great trochanter bone flap transposition in young adults. Methods Twenty-nine cases were investigated. In which Garden type Ⅲ were 10 and type Ⅳ 19. There were 12 cases of fresh fractures and 17 old fractures. According to the X-ray films of old fractures, caput femoris necrosis occurred in 7 patients. Tibial tubercle traction was carried out as preoperative preparation as soon as the patients were sent to hospital. The operation was performed by combining hollow-lag-screws fixing with vascularized great trochanter bone flap transposition. Results The follow-up lasted 39 to 84 months, with an average of 54 months. The patients suffering from fresh femoral neck fractures all recovered and no necrosis was found. The healing time was between 4 to 6 months, with an average of 4.5 months or so. And old fractures were all healed up almost within the same time. The recovery time of patients who suffered from fractures and necrosis was with an average of 12.5 months. Of 10 cases of old fractures without caput femoris necrosis prior to operation, necrosis occurred in 3 cases. The functions of hip joints of 15 cases completely recovered, and 12 patients were partially restricted. Another 2 patients could not squat because the flexion function was seriously restricted. The crispation of limbs was well corrected. According to Harris standard, the postoperative mean score is 89.2. Conclusion It is good for treatment of serious femoral neck fractures with vascularized great trochanter bone flap transposition in young adults.

关 键 词：股骨颈骨折 骨瓣 移植 显微外科手术 

分 类 号：R687.3[医药卫生—骨科学]