Vallamshetla Venkat Ram Prasad, Sayana Murali Krishna, Vutukuru Ravindranath
Osmania General Hospital, Hyderabad, AP, India.
Acta Orthop Traumatol Turc. 2010;44(4):257-61. doi: 10.3944/AOTT.2010.2371.
Intracapsular femoral neck fracture with delayed presentation in young patients can pose surgical challenge. Such scenarios are rare in developed countries, but common in developing countries.
We retrospectively reviewed the records and radiographs of 42 patients (28 males and 14 females) with ununited intracapsular femoral neck fracture who presented late to our unit. These subjects were managed by open reduction and internal fixation that was supplemented with cortico-cancellous bone graft from posterior iliac crest as well as quadratus femoris muscle pedicle bone graft.
The mean delay in presentation was 9 months (range 3-18 months) after the fracture. The mean age of the patients at index procedure was 34 years (range 24-51 years). Radiological union occurred on average at 6 months (range 3-13 months). Thirty-six hip fractures (86%) proceeded to union. Six patients (14%) had non-union and needed revision surgery. Complications included varus union in 9 patients and leg length discrepancy with a mean of 1.5 cm (range 1 to 2.5 cm) in 10 patients.
For the ununited intracapsular femoral neck fracture, favorable results can be achieved by anatomical reduction of the fracture, cortico-cancellous bone grafting to reconstruct the femoral neck, internal fixation with cancellous screws, and augmentation with quadratus femoris muscle pedicle bone graft.
年轻患者出现延迟就诊的囊内股骨颈骨折会带来手术挑战。这种情况在发达国家较为罕见，但在发展中国家很常见。
我们回顾性分析了42例（28例男性和14例女性）囊内股骨颈骨折不愈合且延迟就诊于我院的患者的病历和X线片。这些患者接受了切开复位内固定治疗，并辅以取自髂后嵴的皮质松质骨移植以及股方肌蒂骨移植。
骨折后平均延迟就诊时间为9个月（范围3 - 18个月）。接受手术时患者的平均年龄为34岁（范围24 - 51岁）。平均在6个月（范围3 - 13个月）时出现影像学骨愈合。36例髋部骨折（86%）实现了愈合。6例患者（14%）出现骨不愈合，需要进行翻修手术。并发症包括9例患者出现内翻愈合，10例患者出现平均1.5厘米（范围1至2.5厘米）的肢体长度差异。
对于囊内股骨颈骨折不愈合，通过骨折的解剖复位（解剖复位骨折）、皮质松质骨移植以重建股骨颈、使用松质骨螺钉进行内固定以及股方肌蒂骨移植加强，可以取得良好的效果。
