Chen Zhenqiu, He Wei
Department of Hip Disease, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510405, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2008 Oct;22(10):1169-72.
To explore an ideal operative treatment to preserve the hip joint for the old femoral neck fracture in young and middle-aged patients.
Between January 2002 and June 2006, 28 cases of old femoral neck fracture, 23 males and 5 females, aged 19-55 years old (37.6 on average), were reconstructed with free iliac grafts and fixed by dynamic hip screws (DHS) and/or cannulated screws. Multiple vascular bundles derived from lateral circumflex femoral vascular were implanted in 19 cases. All the 28 cases were close fractures, with 17 of left hip and 11 of right hip. In terms of the fracture site, 4 cases were infer-head, 17 were per-neck and 7 were fundamental-form. The Harris score was 25-72 (49.6 on average) before operation. No callus formation was found on X-ray films in all cases; sclerosis and cyst were found in 4 cases and osteonecrosis of femoral head (ONFH) was confirmed by MRI. The duration between initial injury and surgery was 1-21 months (8.6 months on average).
No deep infection was observed in all 28 cases, and paralysis of the lateral cutaneous nerve of the thigh was observed in 5 cases, and was better 6 months after operation with no special treatment. All 28 cases were followed up for 20-72 months (35.8 months on average). A total of 25 fractures healed within 4-8 months, with the healing rate of 89.3%; 3 fractures had nonunion and received artificial hip replacement. During the follow-up, 7 cases (25%) developed ONFH confirmed by MRI within 18 months, and 5 cases (17.9%) developed femoral head collapse. The Harris score was 27-100 (82.7 on average). Leg length discrepancy was not observed and the gait was fairly normal.
The femoral neck reconstruction procedure can restore the normal anatomy of femoral head and neck and the blood supply, so as to promote fracture healing as well as delay or avoid the artificial joint replacement. Therefore, it is an important treatment to preserve the hip joint for the old femoral neck fracture in young and middle-aged patients.
探索一种理想的手术治疗方法，以保留中青年陈旧性股骨颈骨折患者的髋关节。
2002年1月至2006年6月，对28例陈旧性股骨颈骨折患者进行治疗，其中男性23例，女性5例，年龄19 - 55岁（平均37.6岁），采用游离髂骨移植重建，并使用动力髋螺钉（DHS）和/或空心螺钉固定。19例患者植入了多条旋股外侧血管的分支血管束。28例均为闭合性骨折，左侧髋关节17例，右侧髋关节11例。按骨折部位分类，头下型4例，经颈型17例，基底型7例。术前Harris评分25 - 72分（平均49.6分）。所有病例X线片均未见骨痂形成；4例可见硬化及囊肿，MRI确诊为股骨头坏死（ONFH）。受伤至手术时间为1 - 21个月（平均8.6个月）。
28例均未发生深部感染，5例出现股外侧皮神经麻痹，术后6个月未经特殊治疗好转。28例均获随访，随访时间20 - 72个月（平均35.8个月）。25例骨折于4 - 8个月愈合，愈合率为89.3%；3例骨折不愈合，行人工髋关节置换术。随访期间，7例（25%）在18个月内MRI确诊为ONFH，5例（17.9%）出现股骨头塌陷。Harris评分27 - 100分（平均82.7分）。未观察到肢体长度差异，步态基本正常。
股骨颈重建术可恢复股骨头、颈的正常解剖结构及血供，促进骨折愈合，延缓或避免人工关节置换。因此，该术式是保留中青年陈旧性股骨颈骨折患者髋关节的重要治疗方法。
