股骨近端空心钉锁定板内固定联合缝匠肌骨瓣移植术治疗股骨颈骨折不愈合  

Clinical study on the treatment of nonunion femoral neck fractures using proximal femoral tube screw locking plate internal fixation combined with sartorius iliac bone graft transplantation

作　　者：陈凯腾 庞有旺 郑季南 洪庆南 方钧 李达 CHEN Kai-teng;PANG You-wang;ZHENG Ji-nan;HONG Qing-nan;FANG Jun;LI Da(Department of Orthopedics,the 180 Hospital of Chinese PLA,Quanzhou,Fujian 362000,China)

机构地区：[1]解放军180医院骨科,福建泉州362000

出　　处：《创伤外科杂志》2018年第10期749-752,共4页Journal of Traumatic Surgery

摘　　要：目的评价股骨近端空心钉锁定板内固定联合缝匠肌骨瓣移植术治疗股骨颈骨折不愈合的临床效果。方法 2010年6月—2016年7月解放军180医院采用股骨近端空心钉锁定板内固定联合缝匠肌骨瓣移植治疗的股骨颈骨折不愈合患者26例,男性18例,女性8例;年龄28～64岁,平均34. 5岁。左髋15例,右髋11例。前期行空心钉内固定术治疗20例,非手术治疗6例,且均在前期治疗6个月内明确诊断股骨颈骨折不愈合。术后嘱患者定期来院摄片随访,并在术后6、9、12个月按Harris评分标准进行疗效评价。结果术后患者切口均I期愈合。26例患者均获定期随访,随访时间12～24个月,平均18. 2个月。全部患者股骨颈均获骨性愈合,愈合时间5～8个月,平均6. 3个月,未出现内固定物松动、断裂。但有2例患者在1年内并发股骨头缺血性坏死,存在关节面塌陷并出现患肢短缩。按Harris评分系统评估髋关节功能:优14例,良10例,差2例,优良率92. 31%。结论股骨近端空心钉锁定板内固定联合缝匠肌骨瓣移植术是治疗股骨颈骨折不愈合的有效方法,术后骨折愈合率高,髋关节功能恢复良好。Objective To investigate the clinical efficacy of sartorius iliac bone graft transplantation combined with proximal femoral tube screw locking plate internal fixation in the treatment of nonunion femoral neck fractures. Methods Twenty-six patients with nonunion femoral neck fracture were treated with open reduction of joint capsule,fixation of fractures with proximal femoral tube screw locking plate and transplantation of sartorius iliac bone graft from Jun. 2010 to Jul. 2016. There were 18 males and 8 females with an average age of 34.5 years（28-64 years）.Fifteen were on the left and 11 were on the right side. There were 20 cases treated by pre-operative internal fixation with hollow nails and 6 cases treated with non-operation,and the nonunion of femoral neck fracture was definitely diagnosed within 6 months before treatment. The hip joint function were evaluated according to the Harris score at 6,9 and 12 months during the postoperative follow-ups. Results All incisions got stage I healing. The patients were followed up for 12-24 months with an average of 18.2 months. Fractures of all patients healed smoothly in 5-8 months with an average of 6.3 months. No patients developped loosening or breakage of internal fixation,but two patients had avascular necrosis of femoral head and underwent artificial and limb shortening. According to Harris score for hip joint function,14 cases obtained excellent results,10 good,2 poor,so the excellent and good rate was 93.21%. Conclusion The proximal femoral screw locking plate internal fixation combined with sartorius iliac bone graft transplantation is an effective method to treat nonunion of femoral neck fractures,with the advantages of high rate of bone union and good recovery of postoperative hip joint function.

关 键 词：股骨颈骨折 不愈合 空心钉 锁定钢板 内固定 植骨术 

分 类 号：R683.42[医药卫生—骨科学]