【摘要】 背景:临床中成人股骨颈骨折较为常见,多数经手术或保守治后可骨性愈合,但少数可发展成为陈旧性骨折,目前对于成人陈旧性股骨颈骨折尚缺乏明确有效的治疗手段。目的:探讨股骨近端锁定钢板内固定联合缝匠肌蒂髂骨瓣治疗成人陈旧性股骨颈骨折的临床疗效。方法:选择股骨近端锁定钢板内固定联合缝匠肌蒂髂骨瓣治疗成人陈旧性股骨颈骨折患者12例,男9例,女3例;年龄18-47岁,平均33.5岁;Garden分型:Ⅰ型0例,Ⅱ型1例,Ⅲ型7例,Ⅳ型4例。全部行Smith-petersen(S-P)入路切开,骨刀凿取髂前上脊带外缘2/3缝匠肌蒂髂骨瓣,约4.0 cm×1.0 cm×1.0 cm大小,复位后行股骨近端钢板螺钉内固定,最后缝匠肌蒂髂骨瓣植入股骨颈缺损处并固定。术后3,6,12,24个月复查X射线片评价骨折愈合情况,采用髋关节Harris评分评估髋关节功能恢复情况。结果与结论:①12例患者均获得完整随访,至少随访24个月;②患者患肢术前平均髋关节功能Harris评分为(46.3±6.1)分,术后3,6,12,24个月患髋平均Harris评分分别为(54.4±6.4),(68.7±6.8),(82.3±4.2)及(90.3±4.6)分,术后3,6,12,24个月的Harris评分均显著高于术前(P <0.05);③所有患者均无切口不愈合、感染、静脉血栓形成等并发症发生;其中11例患者最后达到骨性愈合;1例患者术后28个月骨折不愈合并股骨头缺血性坏死(ARCO分期Ⅳ期),后行人工髋关节置换,术前Harris评分38分,术后3个月Harris评分98分;④结果证明,股骨近端锁定钢板内固定联合缝匠肌蒂髂骨瓣治疗成人陈旧性股骨颈骨折的愈合率高,股骨头坏死率低,不失为临床上一种较好的治疗方法。更多还原

【Abstract】 BACKGROUND: The fracture of femoral neck in adults is very common. Most of them can be cured by operation or conservative treatment, but a few can develop into old fracture. At present, there is no clear and effective treatment for old fracture of femoral neck in adults. OBJECTIVE: To explore the clinical effect of sartorius pedicle iliac bone flap combined with proximal femoral locking plate in the treatment of old femoral neck fracture in adults. METHODS: Twelve adult patients with old femoral neck fracture were treated with sartorius pedicle iliac bone flap combined with proximal femoral locking plate, 9 males and 3 females, aged 18-47 years, with an average age of 33.5 years. Garden classification: type I in 0 cases, type Ⅱ in 1 case, type III in 7 cases, and type Ⅳ in 4 cases. All of them were incised by Smith Petersen(S-P) approach. The 2/3 sartorius pedicle iliac bone flap of the anterior superior iliac spine was chiseled with a bone knife, about 4.0 cm×1.0 cm×1.0 cm in size. After reduction, the proximal femur was fixed with steel plate and screw. Finally, the sartorius pedicle iliac bone flap was implanted into the defect of the femoral neck and fixed. At 3, 6, 12, and 24 months after the operation, X-ray films were reexamined to evaluate the fracture healing and Harris score of hip joint was used to evaluate the recovery of hip joint function. RESULTS AND CONCLUSION:(1) Twelve patients were followed up for at least 24 months.(2) Harris scores of hip were significantly higher at 3, 6, 12, and 24 months after surgery(54.4±6.4, 68.7±6.8, 82.3±4.2, 90.3±4.6) than those before surgery(46.3±6.1)(P < 0.05).(3) There were no complications, such as wound nonunion, infection, or venous thrombosis. Finally, 11 patients finally achieved bony healing at the fracture site. One patient had nonunion at 28 months postoperatively with avascular necrosis of the femoral head(ARCO stage Ⅳ), followed by artificial hip replacement. Harris score before operation was 38, and Harris score at 3 months postoperatively was 98.(4) The results show that the combination of sartorius pedicle iliac bone flap and proximal femoral locking plate is a good method for the treatment of old femoral neck fracture in adults, with high healing rate and low necrosis rate of femoral head.更多还原