空心加压螺钉联合缝匠肌髂骨瓣移植治疗中青年股骨颈骨折的疗效观察  

Clinical efficacy of hollow compression screw combined with grafting scartorius muscle iliac bone flap in young and middle-aged femoral neck fractures

作　　者：肖波[1] 何爱咏[1] 曹志远 XIAO bo;HE Ai-yong;CAO Zhi-yuan(Department of Orthopaedics,the Second Xiangya Hospital,Central South University,Changsha Hunan 410011,China)

机构地区：[1]中南大学湘雅二医院骨科,湖南长沙410011

出　　处：《局解手术学杂志》2019年第2期148-151,共4页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的观察空心加压螺钉联合缝匠肌髂骨瓣嵌入治疗股骨颈骨折的临床疗效。方法 2010年3月至2017年10月我科收治的26例股骨颈骨折患者均行Smith-petersen入路股骨颈骨折切开复位,2～3枚空心加压螺钉内固定术后患肢穿中立位鞋固定,保持外展30°,术后第1天开始下肢肌肉等长收缩,踝泵锻炼。观察患者术后3 d、术后1、2、3、6、12、24个月髋关节正侧位X射线片,评价骨折愈合情况,并于末次随访行髋关节Harris评分。结果平均手术时间100 min,术中出血约150 m L。所有病例伤口均甲级愈合,无伤口感染。住院期间患者无内固定松动断裂、克氏针退出断裂、骨折移位、深静脉血栓、肺栓塞等并发症。26例股骨颈骨折患者随访6～96个月,其中2例患者术后3个月因活动不当致克氏针断裂,复查X射线明确髂骨瓣固定在位、愈合良好,遂取出断裂克氏针。所有病例骨折全部愈合,愈合率100%;愈合时间3～10个月;其中2例患者骨折愈合后,于术后2年内出现股骨头缺血坏死,坏死率为7. 69%。术后髋关节Harris评分:优10例,良13例,可1例,差2例,优良率为88. 46%。结论空心加压螺钉联合缝匠肌髂骨瓣嵌入治疗股骨颈骨折能有效重建股骨近端血运,促进股骨颈骨折的愈合,降低股骨头缺血坏死发生率。Objective To observe the clinical effect of hollow compression screw combined with the iliac bone flap for the treatment of femoral neck fracture.Methods From March 2010 to October 2017,26 cases of femoral neck fracture in our department were treated by open reduction via Smith-petersen approach for femoral neck fracture,patients put on neutral position of shoes to keep abduction angle 30°after internal fixation with 2~3 hollow compression,and trained for the isometric contraction of lower limb muscle and ankle pump.The adem position X-ray of hip joint in 3 days,1,2,3,6,12,24 months after surgery were observed to evaluate the fracture healing,and the Harris score of the hip was evaluated at the last followed up.Results The average operation time was 100 minutes,the intraoperative blood loss was approximately 150 mL.All wound healing by first intention without infection.During hospitalization,no internal fixation loosening or breakage,Kirschner wire breakage,fracture displacement,deep vein thrombosis,lung embolism and other complications occurred.All 26 cases of femoral neck fractures were followed up for 6~96 months.Among them,2 patients suffered from Kirschner wire breakage due to improper activity in 3 months after surgery.The X-ray showed that the iliac bone flap was fixed in position and healed well.The broken Kirschner wire was taken out.All fractures healed and the healing rate was 100%,the healing time was ranged from 3 to 10 months;of whom 2 patients suffered from avascular necrosis of the femoral head after fracture healing within 2 years after operation,the necrosis rate was 7.69%.Postoperative Harris score of hip joints was excellent in 10 cases,good in 13 cases,moderate in 1 case,poor in 2 cases.the excellent and good rate was 88.46%.Conclusion Hollow compression screw combined with the iliac bone flap can effictively reconstruct proximal femoral blood for patients with femoral neck fracture,promote the healing of femoral neck fracture and decrease the incidence of avascular necrosis of femoral head.

关 键 词：股骨颈骨折 缝匠肌髂骨瓣 空心加压螺钉 股骨头缺血坏死 骨瓣 移植 股骨颈 

分 类 号：R687.3[医药卫生—骨科学]