空心螺钉内固定加带旋髂深血管蒂髂骨瓣移植治疗陈旧性股骨颈骨折26例.docVIP

空心螺钉内固定加带旋髂深血管蒂髂骨瓣移植治疗陈旧性股骨颈骨折26例【摘要】目的：探讨用空心螺钉内固定加带旋髂深血管蒂髂骨瓣移植治疗陈旧性股骨颈骨折的疗效。方法：采用改良Smith-peterson切口复位，多枚空心螺钉内固定加带旋髂深血管蒂髂骨瓣移植治疗陈旧性股骨颈骨折26例。结果：术后经2~6年随访，21例骨连接成功（80%），疗效满意。结论：带旋髂深血管蒂髂骨瓣具有充足血供，加上多枚空心螺钉内固定，能明显提高股骨颈骨折的治愈率，减少股骨头无菌坏死的发生，对陈旧性股骨颈骨折具有重要的价值。但晚期股骨头坏死率不低（20%），应从严掌握手术指征。 【关键词】股骨颈骨折；内固定；髂骨瓣 文章编号：1009-5519（2007）24-3649-02 中图分类号：R6 文献标识码：A Analysis of 26 cases of old femoral neck fracture treated by hollow screw internal fixation and transplantation of iliac lamella with circumflex ilium profunda artery ZHANG Lin-cun，LI Fa-jun，LI Ji-qing，et al. (Department of Orthopedics，The 477th Hospital of PLA，Xiangfan 441021，China) 【Abstract】Objective：To investigate the curative effect of hollow screw internal fixation and transplantation of iliac lamella with circumflex ilium profunda artery in treating the old femoral neck fracture.Methods：With the reposition of modified Smith-peterson incision，26 cases of old femoral neck fracture were treated by multiple hollow screws internal fixation and transplantation of iliac lamella with circumflex ilium profunda artery.Results：During a follow-up of 2 to 6 years after operation，21 cases were healed successfully(80%),the curative effect was satisfactory.Conclusion：The iliac lamella with circumflex ilium artery which plossesses adequate supply of blood combined with multiple hollow screws internal fixation can obviously improve the cure rate of femoral neck fracture and reduce the incidence of aseptic necrosis of femoral head，it is a valuable method to treat the old femoral neck fracture.But the rate of late necrosis of femoral head can not be neglected(20%)，the operative indication should be grasped strictly. 【Key words】Femoral neck fracture；Internal fixation；Iliac lamella 股骨颈骨折的难题是骨连接和股骨头缺血性坏死，陈旧性股骨颈骨折则由于不同程度的骨吸收造成骨缺损，更容易导致骨不连接和股骨头缺血性坏死。临床上处理较为棘手。我院1990~2002年间共收治各类股骨颈骨折286例，其中对26例陈旧性股骨颈骨折作了切开复位，多枚空心螺钉内固定加带旋髂深血管蒂髂骨瓣移植术，现总结如下。 1 资料与方法 1.1 一般资料：本组26例，其中男12例，女14例，左侧11例，右侧15例。年龄22~76岁，平均52岁。伤后至接受手术治疗的时间最长19