Zahid Mohammad, Bin Sabir Aamir, Asif Naiyer, Julfiqar Mohammad, Khan A Q, Ahmad Sohail, Siddiqui Yasir S
Department of Orthopedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
J Orthop Surg (Hong Kong). 2012 Aug;20(2):191-5. doi: 10.1177/230949901202000211.
To evaluate the use of fibular grafting for fresh femoral neck fractures with posterior comminution.
18 women and 15 men aged 20 to 60 years underwent osteosynthesis and fibular strut grafting supplemented with 7.0-mm cannulated hip screws for Garden grades III (n=21) and IV (n=12) femoral neck fractures associated with posterior comminution. All fractures were reduced by closed methods, and no hip was aspirated. Clinical and radiological outcomes were evaluated.
The mean delay in presentation after injury was 3.2 (range, 1-12) days. The mean delay in operation was 8.8 (range, 5-21) days. The mean follow-up period was 2 (range, 1-4) years. According to the Harris hip score, outcome was good to excellent in 20 patients, fair in 7, and poor in 6. 27 of the 33 patients achieved bone union after a mean of 4.7 (range, 4.2-7) months. In 5 patients, the bone was united with a mean of 10º of varus collapse and a mean of 1 cm of shortening. Six patients had non-union. Other complications included screw migration in the joint space (n=1), graft migration into the joint space (n=3), and screw pullout (n=5). No patient had avascular necrosis of the femoral head.
Osteosynthesis and fibular grafting for freshly displaced femoral neck fractures with posterior comminution is an inexpensive and technically less demanding procedure for retaining a stable, painless, mobile, and functional hip.
评估腓骨移植在新鲜股骨颈骨折伴后方粉碎性骨折中的应用。
18名女性和15名男性，年龄在20至60岁之间，因Garden III级（n = 21）和IV级（n = 12）股骨颈骨折伴后方粉碎性骨折接受了接骨术和腓骨支撑移植，并辅以7.0毫米空心髋螺钉。所有骨折均采用闭合方法复位，未进行髋关节抽吸。对临床和影像学结果进行评估。
受伤后至就诊的平均延迟时间为3.2天（范围1 - 12天）。手术的平均延迟时间为8.8天（范围5 - 21天）。平均随访期为2年（范围1 - 4年）。根据Harris髋关节评分，20例患者结果为优至良，7例为中，6例为差。33例患者中有27例在平均4.7个月（范围4.2 - 7个月）后实现骨愈合。5例患者骨愈合时伴有平均10°的内翻塌陷和平均1厘米的缩短。6例患者出现骨不连。其他并发症包括螺钉移入关节间隙（n = 1）、移植骨移入关节间隙（n = 3）和螺钉拔出（n = 5）。无患者发生股骨头缺血性坏死。
对于新鲜移位的股骨颈骨折伴后方粉碎性骨折，接骨术和腓骨移植是一种成本低廉且技术要求较低的手术方法，可保持髋关节稳定、无痛、活动且功能良好。
