Nagi O N, Dhillon M S, Goni V G
Department of Orthopaedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Bone Joint Surg Br. 1998 Sep;80(5):798-804. doi: 10.1302/0301-620x.80b5.8703.
Neglected fractures of the femoral neck, common in young adults in underdeveloped countries, may be complicated by nonunion or avascular necrosis (AVN). We treated 52 cases by open reduction, fixation by compression screw and a free fibular graft. The mean delay between injury and operation was 5.1 months. Of 40 fractures assessed at a mean of 58.8 months (24 to 153), 38 were found to be united and two, owing to surgical errors, were not. Seven of eight heads which were avascular before operation revascularised without collapse, while seven others developed AVN after the procedure. At the last follow-up considerable collapse was apparent in five femoral heads, and 11 hips had developed coxa vara. The fibular graft had fractured in four cases. The hip had been penetrated by the screw in six cases and by the graft in three. Hip function was excellent in seven patients, good in 21 and fair in seven. Five patients had poor results. Incorporation of the fibular graft was seen after four years: in many cases the graft had been almost completely resorbed. We recommend this procedure for the treatment of neglected fractures of the neck of the femur in young adults to reduce resorption of the neck, AVN and nonunion.
股骨颈陈旧性骨折在不发达国家的年轻人中较为常见，可能并发骨不连或股骨头缺血性坏死（AVN）。我们采用切开复位、加压螺钉固定及游离腓骨移植术治疗了52例患者。受伤至手术的平均间隔时间为5.1个月。在平均58.8个月（24至153个月）时对40例骨折进行评估，发现38例骨折愈合，2例因手术失误未愈合。术前8个股骨头缺血的患者中，8例中有7例股骨头再血管化且未塌陷，而另外7例在手术后发生了AVN。在最后一次随访时，5个股骨头出现了明显的塌陷，11个髋关节出现了髋内翻。4例腓骨移植发生骨折。6例螺钉及3例移植骨穿透髋关节。7例患者髋关节功能优，21例良，7例可。5例患者效果差。4年后可见腓骨移植融合：在许多病例中，移植骨几乎完全被吸收。我们推荐该手术用于治疗年轻人的股骨颈陈旧性骨折，以减少股骨颈吸收、AVN和骨不连。
