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通过髋关节Ganz手术脱位,使用股骨头骨水泥模板辅助髂骨移植和可生物降解螺钉治疗股骨头骨折:一例报告

Femoral Head Fracture Fixation Using Femoral Head Cement Templating for Iliac Bone Graft and Biodegradable Screws via Ganz Surgical Dislocation of the Hip: A Case Report.

作者信息

Hazli Muhammad Ikmal, Mohd Raziff Abdul Qayyum, Ab Rahman Zamri

机构信息

Orthopedics and Traumatology, Hospital Universiti Kebangsaan Malaysia, Cheras, MYS.

Orthopedics, Hospital Tuanku Ja'afar Seremban, Negeri Sembilan, MYS.

出版信息

Cureus. 2024 Sep 29;16(9):e70429. doi: 10.7759/cureus.70429. eCollection 2024 Sep.

Abstract

A 22-year-old Malaysian male presented with a closed posterior dislocation of the right hip with femoral head fracture (Pipkin II) after an alleged motor vehicle accident (MVA). This type of injury may pose future complications, such as avascular necrosis, post-traumatic osteoarthritis, or heterotopic ossification to the hip joint, and later affect joint function. After an immediate closed reduction of the hip, the patient underwent Ganz Surgical dislocation of the hip - a surgical method used to aid the reconstruction of the bony defect of the femoral head. Using bone cement templating, right iliac bone graft was harvested to support the bony defect of the femoral head, and biodegradable screws were inserted to reconstruct the femoral head. The use of absorbable screws eliminated the need for a second surgery to remove hardware, reducing complications. At eight months post-operatively, the patient was able to ambulate without walking aid and fully bear weight on his right hip without pain. Imaging confirmed proper alignment and healing, with no indication for further surgery. This favorable outcome highlighted the efficacy of biodegradable screws in maintaining femoral head integrity while minimizing future surgical intervention. One year later, the patient regained excellent functional capacity, achieving a Lower Extremity Functional Scale (LEFS) score of 96.3%, indicating near-complete recovery with minimal limitations. This case report illustrates the success of using cement-templated iliac bone graft combined with biodegradable screws in femoral head fixation. The approach not only achieved structural stability but also led to a high functional outcome without the need for additional procedures. These findings support the use of absorbable fixation in complex orthopedic cases such as hip dislocations with femoral head involvement.

摘要

一名22岁的马来西亚男性在据称遭遇机动车事故(MVA)后,出现右髋关节后脱位合并股骨头骨折(Pipkin II型)。这种损伤可能会引发诸如股骨头缺血性坏死、创伤后骨关节炎或髋关节异位骨化等未来并发症,并随后影响关节功能。在对髋关节进行立即闭合复位后,患者接受了髋关节Ganz手术脱位——一种用于辅助重建股骨头骨缺损的手术方法。采用骨水泥模板,取自右侧髂骨进行植骨以支撑股骨头的骨缺损,并插入可生物降解螺钉以重建股骨头。使用可吸收螺钉避免了二次手术取出内固定物的需要,减少了并发症。术后八个月,患者能够无需辅助行走,右髋完全负重且无疼痛。影像学检查证实对位及愈合良好,无需进一步手术。这一良好结果凸显了可生物降解螺钉在维持股骨头完整性同时将未来手术干预降至最低方面的有效性。一年后,患者恢复了出色的功能能力,下肢功能量表(LEFS)评分达到96.3%,表明几乎完全恢复且限制极小。本病例报告说明了使用骨水泥模板髂骨植骨联合可生物降解螺钉进行股骨头固定的成功。该方法不仅实现了结构稳定性,还在无需额外手术的情况下带来了较高的功能预后。这些发现支持在诸如涉及股骨头的髋关节脱位等复杂骨科病例中使用可吸收固定。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b518/11520265/0f6de817af14/cureus-0016-00000070429-i01.jpg

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