Xie Xuetao, Zhang Changqing, Jin Dongxu, Chen Shengbao, Gao Youshui
Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Hip Int. 2012 May-Jun;22(3):319-23. doi: 10.5301/HIP.2012.9247.
Neglected femoral neck fractures in young adults pose a great challenge to orthopedic surgeons because of the high risks of nonunion and osteonecrosis. We attempted to determine whether free vascularised fibular grafting through an anterior approach could enhance bone union, improve hip function and reduce complications in the treatment of such fractures. Thirteen patients with neglected femoral neck fractures were treated with a free vascularised fibular graft through an anterior approach between 2004 and 2008. The mean age was 30.9 years (range, 17-47 years). The average delay between injury and operation was 6.7 months (range, 1.5-22 months). All 13 cases had ununited fractures but without osteonecrosis of the femoral head on plain radiographs before coming under our care. The average follow-up was 51.2 months (range, 36-75 months). All patients had fracture union within an average of 4.8 months (range, 3-9 months). Postoperatively, 9 patients had coxa vara of 10 to 20 degrees and leg discrepancy between 0.5 to 1.5 cm. One patient had coxa vara deformity of 25 degrees and 2-cm leg discrepancy. No patients developed osteonecrosis of the femoral head or donor-site morbidity. The mean Harris hip score improved from 55.5 points preoperatively to 84.8 points postoperatively (p<0.01). This procedure may be useful and safe in the treatment of neglected femoral neck fractures in young adults, but further studies with a large number of patients are needed.
青壮年股骨颈骨折的漏诊给骨科医生带来了巨大挑战，因为骨不连和股骨头坏死的风险很高。我们试图确定经前路带血管游离腓骨移植能否促进骨愈合、改善髋关节功能并减少此类骨折治疗中的并发症。2004年至2008年间，13例青壮年股骨颈骨折漏诊患者接受了经前路带血管游离腓骨移植治疗。平均年龄为30.9岁（范围17 - 47岁）。受伤至手术的平均延迟时间为6.7个月（范围1.5 - 22个月）。在接受我们治疗之前，所有13例患者均为骨折未愈合，但X线平片显示股骨头无坏死。平均随访时间为51.2个月（范围36 - 75个月）。所有患者平均在4.8个月（范围3 - 9个月）内实现骨折愈合。术后，9例患者出现10至20度的髋内翻，下肢不等长0.5至1.5厘米。1例患者髋内翻畸形25度，下肢不等长2厘米。无患者发生股骨头坏死或供区并发症。Harris髋关节评分平均从术前的55.5分提高到术后的84.8分（p<0.01）。该手术在青壮年股骨颈骨折漏诊的治疗中可能是有效且安全的，但需要对大量患者进行进一步研究。
