带旋髂深血管髂骨瓣和股方肌骨瓣移植治疗青壮年GardenⅢ-Ⅳ型股骨颈骨折的比较  

Case control study on the iliac bone flap transplantation with deep circumflex iliac artery and quadratus femoris bone flap transplantation for the treatment of Garden Ⅲ / Ⅳ femoral neck fracture of young and middle aged patients

作　　者：张学全 樊仕才[2] 黎惠金 谢延华 罗鹏刚[3] 

机构地区：[1]河源市中医院创伤骨科河源市创伤救治中心,广东河源517000 [2]南方医科大学第三附属医院骨科中心广东省骨科研究院,广东广州510630 [3]广东医学院附属高明医院骨科,广东佛山528500

出　　处：《中国骨伤》2015年第9期802-807,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的 ：对比髋关节前侧S-P入路联合带旋髂深血管髂骨瓣植骨及后侧K-L入路联合带股方肌骨瓣植骨治疗青壮年股骨颈GardenⅢ/Ⅳ型骨折的疗效差异。方法：2004年1月至2011年1月收治46例青壮年GardenⅢ/Ⅳ型股骨颈骨折患者,其中20例采用前侧S-P入路联合带旋髂深血管髂骨瓣植骨（S-P组）,男12例,女8例,年龄（32.1±7.3）岁,骨折GardenⅢ型12例,Ⅳ型8例;26例采用髋关节后侧K-L入路联合应用带股方肌骨瓣植骨（K-L组）,男20例,女6例,年龄（37.8±6.9）岁,GardenⅢ型16例,Ⅳ型10例。观察比较两组患者住院观察指标（住院时间、住院总费用、手术时间、术中出血量、术后并发症）、手术质量指标（骨折复位质量、内固定置入质量、骨折愈合时间、骨折不愈合、股骨头缺血性坏死）以及髋关节功能Harris评分。结果：46例患者术后获得随访,时间28~41个月,平均32个月。患者术中出血量：S-P组为（92.3±10.4）ml,K-L组为（132.4±11.2）ml,两组比较差异有统计学意义（P〈0.05）;手术时间：S-P组为（81.4±9.2）min,K-L组为（67.1±4.5）min,两组比较差异有统计学意义（P〈0.05）。术后S-P组有1例患者出现内科并发症,而K-L组有9例;在骨折愈合时间上,S-P组（83.5±7.3）d,K-L组（103.2±12.6）d,两组比较差异有统计学意义（P〈0.05）;术后30个月两组Harris评分差异有统计学意义（P〈0.05）。结论：采用髋关节前侧S-P入路治疗青壮年Ⅲ/Ⅳ股骨颈骨折,具有解剖清晰、操作便利的特点,与后侧K-L入路相比较,该入路能较好的保留股骨颈残留血供,联合带旋髂深血管髂骨瓣植骨能较好重建股骨颈血供,利于骨折愈合。Objective：To compare the clinical effects between hip anterior S-P approach combined with iliac bone flap transplantation with deep circumflex iliac artery and posterior K-L approach combined with quadratus femoris bone flap transplantation for the treatment of femoral neck fracture of Garden Ⅲ-Ⅳ in young and middle aged patients. Methods：From January 2004 to January 2011,46 patients with femoral neck fractures were treated by two kinds of operation. Among them,20 cases were treated with anterior S-P approach combined with iliac bone flap transplantation with deep circumflex iliac artery,included 12 males and 8 females with an average age of（32.1±7.3） years old,involved 12 cases of Garden Ⅲ and 8 cases of Garden Ⅳ. The other 26 cases were treated with posterior K-L approach combined with quadratus femoris bone flap transplantation,included 20 males and 6 females with an average age of（37.8±6.9） years old,involved 16 cases of Garden Ⅲand 10 cases of Garden Ⅳ. The index of hospitalization（hospitalization time,total cost,operative time,intraoperative blood loss,postoperative complications）,the quality index of operation（fracture reduction,position of internal fixation,fracture healing time,nonunion and femoral head necrosis） of two groups were observed and compared. Hip joint function were evaluated by Harris score. Results：All patients were followed up from 28 to 41 months with an average of 36 months. The intraoperative blood loss of group S-P（92.3±10.4） ml was less than that of group K-L（132.4±11.2） ml,there was significant difference between two groups（P〈0.05）. The operation time of group S-P（81.4±9.2） min was more than that of group K-L（67.1±4.5） min,the difference was statistically significant（P〈0.05）. One case in group S-P and 9 cases in group K-L appeared postoperative complications,there was significant difference between two groups（P〈0.05）. The fracture healing time of S-P group（83.5±7.3） d was shorter than that of group K-L（1

关 键 词：股骨颈骨折 骨折固定术 内 外科手术 

分 类 号：R687.34[医药卫生—骨科学]