陈旧性股骨颈骨折的手术治疗(附62例报告)

目的应用带血管蒂髂骨瓣转移、BMP人工骨植入加空心钉内固定治疗62例陈旧性股骨颈骨折。探讨其术后骨折愈合率及骨不连、股骨头缺血性坏死发生情况。方法应用带血管蒂髂骨瓣转移、BMP人工骨植入加纯钛空心钉治疗陈旧性股骨颈骨折62例，术后随访8个月～5年6个月，对其临床功能、X线片进行评估。结果功能优良者51例(82．2％)，骨折不愈合5例(8．1％)，股骨头缺血性坏死6例(9．7％)，骨折不愈合和股骨头缺血性坏死者均二次行全髋人工关节置换，愈合良好。结论血管蒂髂骨瓣转移、BMP人工骨植入加空心钉内固定治疗陈旧性股骨颈骨折，术后发生骨不连和股骨头缺血性坏死机率低，内固定稳定性强，手术时间短，临床并发症少，是治疗股骨颈骨折较为理想的手术方法。

Treatment of Old Femoral Neck Fracture by the Combination of the Implantation of the Vascularized Illiac Bone Flap,BMP and Internal Fixation with the Hollow Screw

Objective Sixty-two cases of old femoral neck fracture were treated with the combination of the implantation of the vascularized iliac bone flap,BMP and the internal fixation with a hollow screw.Postoperative union,nonunion and INFH occurrence rate with this treatment were discussed.Methods They were followed-up from 1 year 8 months to 5 years 6 months.The patients were treated by above methods and their clinical function and x-ray photograph were evaluated.Results Forty one cases had good function and the good to excellent rate was 82.2%,bone nonunion were taken place in 5 cases(8.1%),necrosis of the femoral head in 6 cases(9.7%),which underwent followed total hip replacement and its outcome were good.Conclusion The postoperative bone nonunion and INFH rate of femoral fracture is low with this procedure,the internal fixation of the hollow screw made the fracture more stable and strong.It also shorten operative time,and reduce postoperative complications.Thereby,the combination of the implantation of the vascularized iliac bone flap,BMP and the internal fixation with a hollow nail is an ideal procedure for treating old femoral neck fractures.