摘要
目的探讨应用带血管蒂髂骨瓣移位治疗股骨颈骨折术后股骨头缺血性坏死(avascular necrosis of femoral head,ANFH)的疗效。方法 2002年6月-2006年12月,采用带血管蒂髂骨瓣移位治疗股骨颈骨折内固定术后ANFH 22例22髋。男18例,女4例;年龄28～48岁,平均37.5岁。左髋16例,右髋6例。骨折后2～31 d行内固定术,术后12个月内股骨颈骨折均愈合;术后15～40个月确诊为ANFH,平均22个月。ANFH确诊至此次入院时间为3～11个月,平均8个月。骨坏死影像学评估按照国际骨循环学会(ARCO)分期标准:Ⅱa期2例,Ⅱb期3例,Ⅱc期3例,Ⅲa期3例,Ⅲb期7例,Ⅲc期4例。Harris髋关节功能评分(HHS)为(64.10±5.95)分。结果术后患者切口均Ⅰ期愈合,无肺栓塞、坐骨神经损伤、下肢深静脉血栓形成及髂骨取骨区麻木、疼痛等并发症发生。22例均获随访,随访时间2.5～6.3年,平均4.8年。术后骨折愈合时间8～12个月,无再骨折发生。末次随访时HHS评分为(90.20±5.35)分,与术前比较差异有统计学意义(t=—18.447,P=0.000)。其疗效根据HHS评分评定为优11例,良10例,可1例,优良率为95.5%。末次随访时,骨坏死根据ARCO分期标准与术前相比,4例发生分期进展,稳定率为81.8%。结论应用带血管蒂髂骨瓣移位治疗股骨颈骨折术后ANFH,具有操作简便、血供恢复确切、可提供新生骨等优点,疗效较好。
Objective To explore the effectiveness of pedicled iliac bone graft transposition for treatment of avascular necrosis of femoral head（ANFH） after femoral neck fracture.Methods Between June 2002 and December 2006,22 cases（22 hips,16 left hips and 6 right hips） of ANFH after femoral neck fracture were treated with iliac bone graft pedicled with ascending branch of the lateral femoral circum flex vessels.There were 18 males and 4 females with an age range from 28 to 48 years（mean,37.5 years）.The time from injury to internal fixation was 2-31 days,and all fractures healed within 12 months after internal fixation.The ANFH was diagnosed at 15-40 months（mean,22 months） after internal fixation.The ANFH duration was 3-11 months（mean,8 months）.According to Association Research Circulation Osseous（ARCO） staging system,2 hips were classified as stage IIa,3 hips as stage IIb,3 hips as stage IIc,3 hips as stage IIIa,7 hips as stage IIIb,and 4 hips as stage IIIc.The preoperative Harris hip score（HHS） was 64.10±5.95.Results All incisions healed by first intention and the patients had no complication of lung embolism,sciatic nerve injury,lower limb deep venous thrombosis,and numbness and pain of donor site.All patients were followed up 2.5 to 6.3 years（mean,4.8 years）.The fracture healing time was 8-12 months,and no femoral neck fracture recurred.The HHS was 90.20±5.35 at last follow-up,showing significant difference when compared with the preoperative value（t=—18.447,P=0.000）.The hip function were excellent in 11 hips,good in 10 hips,fair in 1 hip,and the excellent and good rate was 95.5%.Four hips were radiographically progressed in ARCO staging,18 hips remained stable with a stable rate of 81.8%.Conclusion Pedicled iliac bone graft transposition is an ideal option for treatment of ANFH after internal fixation of femoral neck fracture for the advantages of femoral head revascularization,sufficient cancellous bone supply,and relatively simple procedure.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2011年第5期526-529,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
股骨颈骨折
股骨头缺血性坏死
带血管蒂髂骨瓣
移位
Femoral neck fracture Avascular necrosis of femoral head Pedicled iliac bone graft Transposition
