Ilizarov技术与Masquelet技术治疗股骨感染性骨不连的疗效

目的 探讨Ilizarov技术与Masquelet技术治疗股骨感染性骨不连的疗效。 方法 回顾性分析2014年1月～2018年1月我院收治的63例股骨感染性骨不连患者的临床资料，根据不同手术方式分为Ilizarov组（n=34）与Masquelet组（n=29）。比较两组手术次数、治疗费用、生命质量评分、并发症、愈合时间及治疗效果。 结果〓两组治疗手术总次数无明显差异（P＞0.05），但Ilizarov组治疗缺损手术次数更多（P＜0.05），而Masquelet组患者治疗感染手术次数更多（P＜0.05）；Masquelet组治疗费用明显低于Ilizarov组（P＜0.05）；治疗后，两组患者生命质量评分均提高，且Masquelet组提高幅度大于Ilizarov组（均P＜0.05）；两组并发症发生率无明显差异（P＞0.05）；Masquelet组治愈时间明显短于Ilizarov组（P＜0.05）；治疗后，两组患者疗效总优良率无明显差异（P＞0.05），但Ilizarov组治疗效果评级为优的患者明显多于Masquelet组（P＜0.05）。 结论 Ilizarov技术可修复、重建较长骨段缺损，感染、复发率低，愈合时间短，但操作难度大，治疗费用高，对患者日常活动影响大；Masquelet技术适用于骨缺损长度较短且自体供骨量充足患者，操作简单，安全性好，但对软组织要求较高，因此应根据患者实际情况合理选择临床术式，帮助患者更好康复。     

Treatment of neglected femoral neck fracture

Intra-capsular femoral neck fractures are seen commonly in elderly people following a low energy trauma. Femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Various authors have described a wide array of options for treatment of neglected/nonunion (NU) femoral neck fracture. There is lack of consensus in general, regarding the best option. This Instructional course article is an analysis of available treatment options used for neglected femoral neck fracture in the literature and attempt to suggest treatment guides for neglected femoral neck fracture. We conducted the “Pubmed” search with the keywords “NU femoral neck fracture and/or neglected femoral neck fracture, muscle-pedicle bone graft in femoral neck fracture, fibular graft in femoral neck fracture and valgus osteotomy in femoral neck fracture.” A total of 203 print articles were obtained as the search result. Thirty three articles were included in the analysis and were categorized into four subgroups based on treatment options. (a) treated by muscle-pedicle bone grafting (MPBG), (b) closed/open reduction internal fixation and fibular grafting (c) open reduction and internal fixation with valgus osteotomy, (d) miscellaneous procedures. The data was pooled from all groups for mean neglect, the type of study (prospective or retrospective), classification used, procedure performed, mean followup available, outcome, complications, and reoperation if any. The outcome of neglected femoral neck fracture depends on the duration of neglect, as the changes occurring in the fracture area and fracture fragments decides the need and type of biological stimulus required for fracture union. In stage I and stage II (Sandhu''s staging) neglected femoral neck fracture osteosynthesis with open reduction and bone grafting with MPBG or Valgus Osteotomy achieves fracture union in almost 90% cases. However, in stage III with or without AVN, the results of osteosynthesis are poor and the choice of treatment is replacement arthroplasty (hemi or total).     

股骨转子下骨折术后不愈合并内固定断裂1例

患者,女,69岁,既往高血压病史,慢性胃溃疡30余年,无糖尿病、冠心病、肝炎等病史。患者于13个月前从约1.5 m高处摔落致右大腿上部疼痛肿胀,伴髋部活动受限,在当地医院行X线检查,诊断为右股骨转子下骨折,AO分型32-A2型(见图1A)。于当地医院行切开复位动力髋螺钉内固定术治疗,术后X线片显示对位对线良好(见图1B)。术后患者能缓慢行走,定期当地门诊复查,见折端骨痂生长,但愈合迟缓,右侧股骨有逐渐内翻趋势。3 d前晨起时突发右侧大腿疼痛肿胀,中段可扪及异物感,行走困难,遂于2017年1月20日至我院门诊就诊。行X线检查提示:右股骨转子下骨折,内固定术后改变,折端部分愈合,股骨上段内固定钢板外移,螺钉断裂(见图1C)。