Nagi O N, Dhillon M S, Gill S S
Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Orthop Trauma. 1992;6(3):306-13. doi: 10.1097/00005131-199209000-00007.
Seventeen transcervical/basal femoral neck fractures in children were treated by free fibular graft and cancellous lag screw. Two cases were failures of a previous surgery, and 15 had been untreated for 3 weeks or more. Four cases had radiological evidence of avascular necrosis of the head and one of the neck preoperatively; five cases had neck resorption. At an average of 48.1 months postsurgery all fractures had united and there was only one new case of avascular necrosis. Four cases had coxa vara, and four cases had premature epiphyseal closure. There were 13 good, three fair, and one poor result(s) using Ratliff's criteria. We recommend this procedure in cases with delayed initial appearance or failed previous surgery. Complications of the procedure such as long screw/graft and fibular fracture are preventable. The incidence of coxa vara in cases with neck resorption may be reduced by adding subtrochanteric osteotomy to the procedure.
17例儿童经宫颈/股骨颈基底骨折采用游离腓骨移植和松质骨拉力螺钉治疗。2例为既往手术失败，15例未经治疗3周或更长时间。4例术前有股骨头缺血性坏死的影像学证据，1例术前有股骨颈缺血性坏死；5例有股骨颈吸收。术后平均48.1个月时，所有骨折均已愈合，仅1例出现新的缺血性坏死病例。4例出现髋内翻，4例出现骨骺过早闭合。根据Ratliff标准，结果为优13例，良3例，差1例。对于初次就诊延迟或既往手术失败的病例，我们推荐此手术方法。该手术的并发症如长螺钉/移植骨和腓骨骨折是可以预防的。通过在手术中增加转子下截骨术，可降低股骨颈吸收病例中髋内翻的发生率。
