切开复位空心钉内固定及其联合带血管蒂骨组织瓣移植术治疗股骨颈骨折的临床研究  

Clinical research of open reduction and internal fixation with cannulated screws combined with vascularized bone graft for femoral neck fractures

作　　者：安宁[1] 赵德伟[1] 黄诗博[1] 王朝强[1] 杨帆[1] 

机构地区：[1]大连大学附属中山医院骨科,辽宁省大连市116013

出　　处：《中国骨与关节损伤杂志》2013年第10期901-903,共3页Chinese Journal of Bone and Joint Injury

基　　金：国家自然科学基金资助项目(30970699)

摘　　要：目的比较切开复位空心钉内固定与切开复位空心钉内固定联合带血管蒂骨组织瓣移植术治疗股骨颈骨折的临床效果。方法97例股骨颈骨折采用切开复位3枚空心钉内固定（对照组，45例）或切开复位2枚空心钉内固定联合带血管蒂骨组织瓣移植术（骨瓣治疗组，52例）治疗，综合评估患者术后髋关节功能Harris评分。结果92例获平均7．28（1-20）年随访，其中对照组42例，骨瓣治疗组50例。术后6、12个月及末次随访时骨瓣治疗组平均Harris评分均高于对照组，差异有统计学意义（P〈0．05）。对照组骨折不愈合发生率9．5％，股骨头缺血性坏死发生率14．3％；骨瓣治疗组股骨头缺血性坏死发生率2．0％，未发生骨折不愈合。与对照组相比，骨瓣治疗组骨折不愈合及股骨头缺血性坏死发生率更低（P〈0．05）。结论采用空心钉内固定联合带血管蒂骨组织瓣治疗股骨颈骨折远期疗效优于单纯空心钉内固定术，且骨折不愈合及骨坏死发生率较低。Objective To investigate the clinical effect of open reduction and internal fixation with cannulated screws combined with vascularized bone graft for femoral neck fractures. Methods Ninety seven cases of femoral neck fracture were treated by open reduction and internal fixation with cannulated screws （control group, 45 cases） or open reduction and internal fixation with cannulated screws combined with vascularized bone graft （flap treatment group, 52 cases）. All the patients were evaluated by Harris score after operation. Results Ninety two cases （42 cases of control group and 50 cases of flap treatment group） were followed up for 1 to 20 years, with 7.25 years on average. At 6, 12 months after surgery and the last follow up, the Harris score of flap treatment group were all higher than control group, there＇s significant difference （P 〈0.05）. In the control group nonunion incidence rate was 9.5%, incidence of avascular necrosis of femoral head was 14.3%; incidence of avascular necrosis of femoral head of flap treatment group was 2%, with no nonunion. Compared with the control group, the incidence of nonuion and avascular necrosis of femoral head was lower （P 〈0.05）. Conclusion The cannulated compression screw in combination with bone graft is an optimal treatment for femoral neck fracture with low nonunion rate and a low incidence of bone necrosis and better long-term effect.

关 键 词：股骨颈骨折 内固定 带血管蒂骨组织瓣 空心钉 

分 类 号：R683.42[医药卫生—骨科学]