带旋髂深血管蒂骨膜瓣植入治疗未成年股骨颈骨折术后股骨头缺血性坏死  

PEDICLED ILIAC PERIOSTEAL FLAP GRAFT FOR AVASCULAR NECROSIS OF FEMORAL HEAD AFTER FEMORAL NECK FRACTURE IN ADOLESCENTS

作　　者：吴敏[1] 官建中[1] 肖玉周[1] 周建生[1] 张长春[1] 代秀松[1] 王晓盼[1] 王照东[1] 

机构地区：[1]蚌埠医学院第一附属医院骨科组织移植安徽省重点实验室,安徽蚌埠233003

出　　处：《中国修复重建外科杂志》2015年第3期275-279,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨带旋髂深血管蒂骨膜瓣植入治疗未成年股骨颈骨折术后股骨头缺血性坏死（avascular necrosis of femoral head,ANFH）的疗效。方法 2006年12月-2011年8月,采用带旋髂深血管蒂骨膜瓣植入术治疗9例（9髋）未成年股骨颈骨折术后ANFH。其中男6例,女3例;年龄10-18岁,平均14.7岁。骨折原因：交通事故伤5例,高处坠落伤3例,摔伤1例。骨折后3-16 d行克氏针或空心螺钉内固定术,术后10个月内股骨颈骨折均愈合。术后10-42个月,平均24.4个月发生ANFH。骨坏死影像学评估按照Steinberg分期标准：Ⅲb期1例,Ⅲc期2例,Ⅳa期1例,Ⅳb期3例,Ⅳc期2例。根据手术前后髋关节功能Harris评分变化和Steinberg分期改变进行临床评价和影像学评估。结果术后患者切口均Ⅰ期愈合,无感染、下肢深静脉血栓形成、供区麻木、疼痛及其他手术相关并发症发生。9例均获随访,随访时间38-76个月,平均52个月。患者患髋或膝内上疼痛缓解,肢体无明显短缩,行走步态改善,患髋关节活动度增加。末次随访时,髋关节功能Harris评分为（92.7±9.9）分,与术前（62.8±3.6）分比较差异有统计学意义（t=—12.244,P=0.000）;获优5例、良3例、差1例;治疗成功率为88.89%（8/9）。末次随访时,除1例术前Ⅲb期进展至Ⅳb期外,其余患者分期改善或稳定,影像学成功率为88.89%（8/9）。结论带旋髂深血管蒂骨膜瓣植入治疗未成年股骨颈骨折术后ANFH,能为股骨头提供良好的成骨及血管重建。Objective To assess the effectiveness of pedicled iliac periosteal flap graft for treatment of avascular necrosis of the femora/head （ANFH） after femora/neck fracture in adolescents. Methods Between December 2006 and August 2011, 9 patients （9 hips） with ANFH after femoral neck fracture were treated with pedicled iliac periosteal flap graft. There were 6 males and 3 females with an average age of 14.7 years （range, 10-18 years）. Fractures were caused by traffic accident injury （5 cases）, falling injury from height （3 cases）, and fall injury （1 case）. The time from injury to internal fixation with Kirschner wires or cannulated screws was 3-16 days, and all fractures healed within 10 months after internal fLxation. The interval between fracture fixation and ANFH was 10-42 months （mean, 24.4 months）. According to Steinberg staging system, 1 hip was classified as stage IIIb, 2 hips as stage IIIc, 1 hip as stage IVa, 3 hips as stage IVb, and 2 hips as stage IVc. The Harris scores and Steinberg classification were compared between at pre- and post-operation to assess the outcomes clinically and radiologically. Results All incisions healed by first intention. No complications of infection, deep venous thrombosis of lower limb, and pain and numbness of donor site were observed during or after operation. All patients were followed up 38-76 months （mean, 52 months）. Joint pain was relieved; no leg length discrepancy was observed; the walking gait was improved and range of motion of hips was increased. The Harris score was significantly increased from 62.8±3.6 at pre-operation to 92.7±9.9 at last follow-up, showing significant difference （t= -12.244, P=0.000）. The hip function was excellent in 5 hips, good in 3 hips, and poor in 1 hip, and the excellent and good rate was 88.89%. Post-operative radiological assessment demonstrated that only 1 hip （stage Ⅲb） had had further collapse of the femoral head, the other hips had no incidence of deterioration. The radiological succ

关 键 词：股骨颈骨折 股骨头缺血性坏死 带血管蒂骨膜瓣 未成年患者 

分 类 号：R687.3[医药卫生—骨科学]