带旋髂深血管蒂髂骨瓣移植治疗青壮年移位股骨颈骨折  

Grafting of Vascularized Iliac Bone Flap with Deep Iliac Circumflex Vessel for Displaced Femoral Neck Fracture of Young Patients

作　　者：孙晓新[1] 宋海友[1] 苗强[1] 周伟[1] 

机构地区：[1]河北省唐山市第三医院骨科,063021

出　　处：《中国骨与关节损伤杂志》2010年第6期493-495,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的研究带旋髂深血管蒂髂骨瓣移植治疗青壮年移位股骨颈骨折的临床疗效,探讨其临床应用价值。方法收治76例青壮年移位股骨颈骨折患者,随机分为植骨联合内固定组和单纯内固定组,每组38例。植骨联合内固定组行切开复位带旋髂深血管蒂髂骨瓣移植并加压空心螺钉固定治疗;单纯内固定组仅行切开复位加压空心螺钉固定。术后对两组骨折平均愈合时间,Harris髋关节功能评分及并发症发生率等进行对比研究。结果所有病例随访19～73个月,平均42.8个月。植骨联合内固定组骨折平均愈合时间3.6个月,Harris评分84.6分,1例骨折不愈合,3例股骨头坏死,2例畸形愈合,并发症发生率为15.8%,术后功能及影像学结果满意。单纯内固定组骨折平均愈合时间为4.8个月,Harris评分75.3分,术后发生骨折不愈合3例,股骨头坏死7例,畸形愈合3例,并发症发生率为34.2%,两组差异有统计学意义(P<0.05)。结论带旋髂深血管蒂髂骨瓣移植可以改善股骨头和股骨颈的血运,加速骨折愈合并减少并发症发生,是治疗青壮年移位股骨颈骨折的理想方法之一。Objective To study the clinical effect of the grafting of iliac bone flap with deep iliac circumflex vessel on the displaced femoral neck fracture of young patients and to explore the clinical value. Methods Seventy-six young patients with displaced femoral neck fracture were randomly divided into bone grafting combined with internal fixation group （n=38） and internal Fixation group （n=38）. The bone grafting combined with internal fixation group was treated by internal fixation with hollow compression screws and iliac flaps grafting with deep iliac circumflex vessel. The internal fixation group was treated by open reduction and internal fixation with hollow compression screws only. The mean time of fracture union as well as the postoperative Harris hip score and the incidence of complication were compared between the bone grafting combined with internal fixation group with the internal fixation group. Results All cases were fol- lowed up. Mean follow-up was 42.8 months （range： 19-73 months）. The mean union time of fracture in iliac grafting combined with internal fixation group was 3.6 months. The mean Harris hip score was 84.6. Fracture nonunion was confirmed in 1 patient, femoral head necrosis in 3 patients and fracture mal-union in 2 patients. The general incidence rate of postoperative complication was 15.8%. Functional and radiographic results were satisfactory in this group. The mean union time of fracture in internal fixation group was 4.8 months. The mean Harris hip score was 75.3. Nonunion were found in 3 patients, femoral head necrosis in 7 patients and fracture mal-union in 3 patients. The incidence rate of postoperative complication was 34.2%.Conclusion The results of this study strongly suggest that iliac grafting with deep iliac circumflex vessel may improve the blood circulation of femoral head and femoral neck, hasten fracture healing, reduce incidence of comnlicntion and it＇s an ideal measure for displaced femoral neck fracture of young patients.

关 键 词：股骨颈骨折 旋髂深血管 髂骨瓣 移植 

分 类 号：R683.42[医药卫生—骨科学]