摘要
目的 探讨带旋髂深血管蒂骨膜瓣植入治疗青少年陈旧性股骨颈骨折的疗效. 方法 2005年6月至2013年12月,采用带旋髂深血管蒂骨膜瓣植入治疗15例（15髋）青少年陈旧性股骨颈骨折.其中男11例,女4例;年龄12- 18岁,平均15.8岁.骨折分型：头下型5例,经颈型8例,基底型2例.伤后早期明确诊断9例,漏诊6例.既往治疗方法：下肢牵引6例,闭合穿克氏针固定2例,闭合穿空心钉固定1例,未行任何治疗6例.骨折至此次手术时间为1-19个月,平均4.8个月.15例X线检查骨折端均有不同程度的移位,断端骨质吸收,未见明显骨痂,其中2例合并股骨头坏死,骨坏死影像学评估按照Steinberg分期标准：1例Ⅲb期,1例Ⅳa期. 结果 术后患者切口均Ⅰ期愈合.15例均获随访,随访12 - 90个月,平均46个月.末次随访时,Harris评分由术前（48.7±8.3）分提高为（91.3±6.1）分,差异有统计学意义（P＜0.01）.1例术后10个月骨折仍不愈合并发生股骨头坏死,改行全髋关节置换术;其余14例骨折均愈合,愈合时间3-6个月,平均4个月.2例术前发生股骨头坏死患者1年后1例Ⅲb期改善至Ⅱb期,1例Ⅳa期改善至Ⅲa期,其余未见股骨头坏死发生. 结论 带旋髂深血管蒂骨膜瓣成骨能力强,有效改善了骨折端的血运,促进了青少年陈旧性股骨颈骨折愈合.
Objective To assess the effectiveness of pedicled iliac periosteal flap graft for treatment of old femoral neck fracture in adolescents.Methods Between June,2005 and December,2013,15 patients （15 hips） of old femoral neck fracture in adolescents treated with vascular pedicled iliac periosteal.There were 11 males and 4 females with an average age of 15.8（range 12 to 18） years.Based on the location of fracture,there was 5 cases of subcapital,8 cases of transcervical and 2 cases of basal.6 cases were treated with lower limb traction,3 cases with internal fixation and 6 just without any treatment.The average duration from injury to the second operation was 4.8 （range 1 to 19） months.There were 2 cases of femoral head necrosis after femoral neck fracture.Open reduction,pedicled iliac periosteal flap grafting and cannulate screw fixation were performed.Results All incisions healed by first intention.All patients were followed up 12 to 90 months （mean,46 months）.The HHS was increased from （48.7 ± 8.3） pre-operation to （91.3 ± 6.1） at last followed-up,indicating a significant difference between before and after operation （P 〈 0.01）.One patient underwent total hip arthroplasty at 10 months after operation because of fracture nonunion and femoral head necrosis.Fracture healed successfully in 14 cases and the average time of fracture healing was 4 （range 3 to 6） months.Certain extent of remodelling and bulge of the head were observed in 2 cases of collapsed heads.Conclusion Pedicled iliac periosteal flap graft can provide good osteogenesis and vascular reconstruction for femoral head and promote fracture healing in treatment for old femoral neck fracture in adolescents.
出处
《中华显微外科杂志》
CSCD
北大核心
2015年第3期238-241,共4页
Chinese Journal of Microsurgery
关键词
股骨颈骨折
陈旧性
带血管蒂骨膜瓣
青少年
移位
显微外科手术
Femora｜ neck fracture, old
Vascular periosteal flap
Adolescent
Tranfer
Microsurgical operation
