缝匠肌骨瓣转移在青壮年陈旧性股骨颈骨折中的应用  

Sartorius Musculoskeletal Flap Transfer for Treating Old Femoral Neck Fracture Among Young Adults

作　　者：吴剑[1,2] 张柘[1] 秦星星[1] 胡锋[1] 陈沼飞 赵泉[1] 蔡贤华[3] 鲍同柱 

机构地区：[1]咸宁市中心医院湖北科技学院附属第一医院骨科,湖北咸宁437100 [2]南方医科大学,广东广州510515 [3]广州军区武汉总医院骨科,湖北武汉437000 [4]宜昌市中心医院骨科,湖北宜昌420500

出　　处：《实用骨科杂志》2017年第5期400-403,共4页Journal of Practical Orthopaedics

摘　　要：目的研究分析应用缝匠肌肌骨瓣转移治疗青壮年陈旧性股骨颈骨折的近中期临床效果。方法自2009年7月至2016年7月我科共收治青壮年陈旧性股骨颈骨折11例,男7例,女4例,平均年龄32.8岁(18~46岁),受伤时间平均10.3周(8~18周)。致伤原因:交通伤9例,高处坠落伤2例。Garden分型:Ⅰ型0例,Ⅱ型1例,Ⅲ型7例,Ⅳ型3例。均经Smith-petersen入路切开复位、3枚空心拉力螺钉内固定,以股骨颈前侧骨折线为中心凿取4.0cm×1.5cm×1.0cm骨槽,将缝匠肌骨瓣植入骨槽内,全螺纹可吸收螺钉固定。术后3d内、术后1个月、3个月、6个月、12个月、24个月复查髋关节正侧位片评价骨折愈合情况及髋关节Harris评分。结果 11例患者中1例术后1个月因故死亡失访,10例获得完整随访,平均随访时间38.3个月(13~83个月)。股骨颈骨折均得到了骨性愈合,平均愈合时间为11.2个月(9~15个月),1例12个月复查时发现股骨头外上方塌陷,无关节间隙变窄但髋关节疼痛明显,行人工全髋关节置换术。术后3d、1个月、3个月、6个月、12个月、24个月患髋平均Harris评分分别为73.4分、76.1分、75.3分、86.6分、89.6分、90.7分。结论缝匠肌血供呈节段性,血管可保留,可以采用缝匠肌肌骨瓣转移植骨改善骨折端的血运,促进青壮年陈旧性股骨颈骨折的愈合。Objective To explore the early and medium-term effect of sartorius musculoskeletal flap transfer for treating old femoral neck fracture among young adults.Methods 11 cases （7 males and 4 females） with old femoral neck fracture were admitted to our department from July 2009 to July 2016,with a mean age of 32.8 years old （18-46 years old） and a mean time of injury of 10.3 weeks（8-18 weeks）.Injury causes included traffic accident （9 cases） and high falling accident （2 cases）.Garden classification was as follows：I （0 case）,Ⅱ （1 case）,Ⅲ （1 case） and Ⅳ （3 cases）.All patients underwent open reduction and internal fixation with 3 hollow lag screws through Smith-Petersen approach.A bone groove of 4.0 cm ×1.5 cm×1.0 cm was made with the anterior facture line of femoral neck as the center,then a sartorius muscle iliac flap was transplanted into the groove and fixed with full thread absorbable screws.Anteroposterior and lateral X-ray films of the hip joint were observed to evaluate facture healing and Harris hip score within 3 days,1 month,3 months,6 months,12 months and 24 months after operation,respectively.Results Among the 11 patients,1 patient died in an accident and lost to follow up,while 10 patients were followed up completely,with an average follow-up period of 38.3 months （13-83 months）.Femoral neck fracture was healed in these 10 patients,with a mean healing time of 11.2 months （9-15 months）.Lateral-superior femoral head collapse was found in 1 patient at 12 month follow-up,with no joint space narrowing.However,due to obvious hip joint pain,the patient underwent total hip replacement.The average Harris scores of the affected hip joint three days,1 month,3 months,6 months,12 months and 24 months after operation were 73.4,76.1,75.3,86.6,89.6 and 90.7,respectively.Conclusion Sartorius muscle blood supply appears to be segmental and vessels can be reserved.It is possible to perform sartorius musculoskeletal flap transfer in order to improve the blood supply of the

关 键 词：陈旧性 股骨颈骨折 缝匠肌肌骨瓣 空心拉力螺钉 内固定 

分 类 号：R683.42[医药卫生—骨科学]