带蒂髂骨瓣空心钉固定青壮年股骨颈移位骨折

Pedicled iliac flap combined with cannulated screw fixation for displaced femoral neck fractures in middle-age adult

摘要:

[目的] 探讨带蒂髂骨瓣空心钉固定青壮年股骨颈移位骨折的中期临床疗效分析。[方法] 回顾性分析2014 年1 月—2020 年9 月采用带蒂髂骨瓣空心钉固定治疗的19 例中青年移位型股骨颈骨折患者的临床资料，评价临床及影像资料。[结果] 所有患者均顺利完成手术，手术时间（129.3±9.8） min，切口长度（16.7±1.7） cm，术中出血量（50.5±6.7） ml，住院时间（10.1±1.0） d。随访时间（60.1±7.8） 个月，完全负重时间为（12.2±4.3） 周。与术后1 个月相比，末次随访时VAS 评分[(3.1±1.8) vs (1.5±2.3), P=0.015]、髋屈伸ROM [( 113.3±7.3)° vs (129.2±8.3)°, P=0.018]、髋内-外旋ROM [( 76.3±3.2)° vs (89.5±2.7)°, P＜0.001]、Harris 评分[(79.4±2.3) vs (90.6±4.6), P=0.024] 均显著改善。影像方面，骨折临床愈合时间平均（4.5±6.7） 个月，与术后1 个月相比，末次随访时Garden 指数无显著变化（P＞0.05），但T?nnis 评级显著进展（P＜0.05），骨折愈合超过2 年后2 例出现股骨头坏死（Garden Ⅳ型）。[结论] 青壮年移位型股骨颈骨折采用带蒂髂骨瓣空心钉固定，中期临床疗效满意。

Abstract:

[Objective] To present the medium-term clinical outcome of pedicled iliac flap combined with cannulated screw fixationfor displaced femoral neck fractures in middle-age adult. [Methods] A retrospective study was performed on 19 middle-aged patients whounderwent pedicled iliac flap combined with cannulated screw fixation for displaced femoral neck fractures from January 2014 to Septem-ber 2020. The clinical and imaging data were evaluated. [Results] All patients were successfully operated on, with operation time of (129.3±9.8) min, incision length of (16.7±1.7) cm, intraoperative blood loss of (50.5±6.7) ml, and the hospital stay of (10.1±1.0) days. All of themwere followed up for the average of (60.1±7.8) months, and regained full weight-bearing activity in a mean of (12.2±4.3) weeks. Comparedwith those 1 month after surgery, VAS scores [(3.1±1.8) vs (1.5±2.3), P=0.015], hip flexion-extension ROM [(113.3±7.3)° vs (129.2±8.3)°,P=0.018], hip internal-external rotation ROM [(76.3±3.2)° vs (89.5±2.7)°, P＜0.001], Harris score [(79.4±2.3) vs (90.6±4.6), P=0.024] sig-nificantly improved by the time of the latest follow-up. Radiologically, the mean fracture healing time was (4.5±6.7) months in an average.Compared with those 1 month after surgery, Garden index remained unchanged at the last follow-up (P＞0.05), whereas the Tonnis scale fordegeneration significantly deteriorated (P＜0.05), with femoral head necrosis in 2 cases (GardenⅣ type) more than 2 years after fracturehealing. [Conclusion] Pedicled iliac flap combined with cannulated screw fixation does achieve satisfactory clinical consequence for dis-placed femoral neck fractures in middle-age adult.