自体髂骨混合rhBMP-2植骨联合内侧支撑钢板与空心钉内固定治疗中青年陈旧性股骨颈骨折  

Autologous iliac crest and rhBMP-2 graft in combination with medial buttress plate augmented hollow screw fixation for treatment of old femoral neck fractures in middle-aged and young adults

作　　者：武振方 王远荣 遆云帆 刘磊 周浩 许斌 孙国静 WU Zhenfang;WANG Yuanrong;TI Yunfan;LIU Lei;ZHOU Hao;XU Bin;SUN Guojing(Department of Orthopaedics,General Hospital of Eastern Theater Command of PLA,Nanjing,Jiangsu 210002,China)

机构地区：[1]中国人民解放军东部战区总医院骨科,江苏南京210002 [2]罗山县人民医院骨科,河南信阳464200 [3]中国人民解放军联勤保障部队第九○一医院骨科,安徽合肥230000

出　　处：《中国骨与关节损伤杂志》2023年第10期1014-1018,共5页Chinese Journal of Bone and Joint Injury

基　　金：江苏省卫生健康委科研课题(H2018024);后勤科研专项课题(21XLS19);中国人民解放军东部战区总医院院管课题(YYZD2021003)。

摘　　要：目的观察自体髂骨混合重组人骨形态发生蛋白-2(Recombinant human bone morphogenetic protein-2,rhBMP-2)植骨联合内侧支撑钢板与空心钉内固定治疗中青年陈旧性股骨颈骨折的临床疗效。方法回顾性分析自2018-01—2020-06诊治的13例中青年陈旧性股骨颈骨折,髋关节前侧入路显露骨折端彻底清除瘢痕组织及硬化骨,于股骨粗隆下外侧呈倒三角形置入3枚空心钉,取自体髂骨混合rhBMP-2于骨折断端填充植骨;将塑形后的3.5 mm重建钢板置于股骨颈前内侧,并置入螺钉固定。结果13例术后均获得随访,随访时间为16~37个月,平均21.5个月。所有患者均未出现切口感染、下肢深静脉血栓形成、股外侧皮神经损伤、骨折不愈合、内固定失效等并发症。骨折愈合时间为5~9个月,平均6.4个月。末次随访时髋关节功能Harris评分为79~95分,平均91.8分;优7例,良5例,可1例。1例术后13个月出现股骨颈短缩畸形(短缩长度<2 cm),末次随访时髋关节功能Harris评分为84分,尚未明显影响日常生活。1例术后11个月出现股骨头缺血性坏死(ARCO分期为Ⅲ期),对症治疗后股骨头坏死未进一步发展,末次随访时髋关节功能Harris评分为79分。结论采用自体髂骨混合rhBMP-2填充植骨联合内侧支撑钢板与空心钉内固定治疗中青年陈旧性股骨颈骨折可以获得良好的临床疗效,术后骨折愈合良好,骨折不愈合与股骨头缺血性坏死发生率明显降低。Objective To observe the clinical effect of autologous iliac crest and rhBMP-2 graft in combination with medial buttress plate augmented hollow screw fixation for the treatment of old femoral neck fractures in middle-aged and young adults.Methods A retrospective analysis was performed on 13 middle-aged and young adults with old femoral neck fractures treated from January 2018 to June 2020.Three hollow screws were inserted laterally below the femur trochanter in an inverted triangle,and the scar tissue and hardening bone were completely removed from the anterior hip joint approach.Autologous iliac crest and rhBMP-2 graft were mixed to fill the fracture end.The reconstructed plate(3.5 mm)was placed on the anterior medial femoral neck and fixed with screws.Results All the cases were followed up for 16-37 months,an average of 21.5 months.There were no complications such as wound infection,deep vein thrombosis of lower extremity,lateral femoral cutaneous nerve injury,fracture nonunion,and internal fixation failure in all patients.Fracture healing time was 5-9 months(mean 6.4 months).At the last follow-up,the Harris score of hip function ranged from 79 to 95(mean,91.8).Seven cases had excellent Harris score,5 cases good and 1 case fair.One patient developed femoral neck shortening deformity(shortening length<2 cm)13 months after operation,and the Harris score of hip function was 84 at the last follow-up,which hardly affected the daily life.Another one patient developed avascular necrosis(ARCO stage II)of the femoral head at 11 months after surgery,the femoral head avascular necrosis gradually stabilized after symptomatic treatment,and the Harris score of hip function was 79 at the last follow-up.Conclusion Autologous iliac crest and rhBMP-2 graft in combination with medial buttress plate augmented hollow screw fixation for the treatment of old femoral neck fractures in young adults can obtain good clinical curative effect.Postoperative fracture healing is good.The fracture nonhealing and incidence of ischemic necrosis

关 键 词：陈旧性股骨颈骨折 空心钉 内侧支撑钢板 内固定 重组人骨形态发生蛋白-2 自体髂骨 

分 类 号：R687.3[医药卫生—骨科学]