摘要
目的探讨采用空心拉力螺钉加内侧支撑钢板固定结合缝匠肌蒂骨瓣治疗青壮年股骨颈骨折的临床疗效。方法回顾分析2013年2月—2019年2月收治的11例青壮年股骨颈骨折患者临床资料。男7例,女4例;年龄32~58岁,平均45岁。致伤原因:高处坠落伤6例,交通事故伤4例,运动损伤1例。左髋7例,右髋4例。Pauwels角55°~75°,平均64°。均采用空心拉力螺钉加内侧支撑钢板固定结合缝匠肌蒂骨瓣进行治疗。术后复查骨盆X线片以及髋关节侧位X线片、CT及三维重建,评估骨折愈合及内固定物在位情况。采用Harris评分评价髋关节功能恢复情况。结果术后切口均Ⅰ期愈合,均未出现感染、股外侧皮神经损伤等症状。术后次日复查示骨折对位、对线良好,内固定物位置良好。11例患者均获随访,随访时间18~36个月,平均29个月。骨折均获骨性愈合,愈合时间16~23周,平均18.2周。术后30个月1例患者(9.1%)发生股骨头坏死(osteonecrosis of the femoral head,ONFH)。末次随访时采用Harris评分评价髋关节功能,获优9例、良1例、可1例,优良率90.9%。结论空心拉力螺钉加内侧支撑钢板固定结合缝匠肌蒂骨瓣治疗青壮年股骨颈骨折生物力学稳定性强,能够有效改善术后股骨头、颈血运,减少ONFH发生,但须严格掌握手术适应证。
Objective To evaluate the effectiveness of medial buttress plate augmented hollow lag screws fixation in combination with sartorius pedicled iliac flap for the treatment of femoral neck fractures in young adults.Methods The clinical data of 11 young adult patients with femoral neck fractures between February 2013 and February2019 were analyzed retrospectively. There were 7 males and 4 females with a mean age of 45 years(range, 32-58 years).Fractures were caused by falling from height in 6 cases, by traffic accident in 4 cases, and by sports injury in 1 case. There were 7 cases in the left hip and 4 cases in the right hip. The mean Pauwels angle was 64°(range, 55°-75°). All patients were treated by medial buttress plate augmented hollow lag screws fixation and sartorius pedicled iliac flap. The X-ray film of pelvis, lateral X-ray film of hip joint, CT scan and three-dimensional reconstruction of hip joint were taken after operation to assess fracture healing and position of the internal fixators. The postoperative hip function was evaluated according to the Harris score. Results All the incisions healed by first intention, and no complication such as incision infection and lateral femoral cutaneous nerve injury happened. Re-examination on the second day after operation showed that reduction and fixation of fractures was good. All patients were followed up 18-36 months(mean, 29 months). All fractures achieved bony union. The time of bony union was 16-23 weeks, with an average of 18.2 weeks. One patient(9.1%) got osteonecrosis of the femoral head(ONFH) at 30 months after operation. At last follow-up, Harris score was used to evaluate hip joint function, 9 cases were excellent, 1 case was good, 1 case was fair, and the excellent and good rate was90.9%. Conclusion Medial buttress plate augmented hollow lag screws fixation in combination with sartorius pedicled iliac flap for the treatment of femoral neck fractures in young adults has the advantage of strong biomechanical stability and can effectively improve the blood supply of femoral head and neck, which subsequently reduce the incidence of ONFH. However, the surgical indication should be fully considered.
作者
王海
叶君健
陈春永
吴贵
陈尧清
谢昀
WANG Hai;YE Junjian;CHEN Chunyong;WU Gui;CHEN Yaoqing;XIE Yun(Department of Orthopedic Trauma&Ankle Surgery,Fujian Trauma Medical Center,First Affiliated Hospital of Fujian Medical University,Fuzhou Fujian,350004,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2022年第2期163-169,共7页
Chinese Journal of Reparative and Reconstructive Surgery
基金
福建省科协科技创新项目(FJKX-A2034)。
关键词
股骨颈骨折
青壮年
内固定
缝匠肌蒂骨瓣
股骨头坏死
Femoral neck fracture
young adult
internal fixation
sartorius pedicled iliac flap
osteonecrosis of the femoral head
