空心钉联合同种异体腓骨内固定治疗中青年股骨颈骨折临床初步观察

目的探讨空心钉联合同种异体腓骨内固定治疗中青年股骨颈骨折的初步疗效。方法采用同种异体腓骨植入股骨头前外侧，并以两枚AO空心钉固定治疗中青年股骨颈骨折。结果经临床应用40例40个髋关节，初步随访24～84个月，平均48．5个月，15例出现坏死症状，5例晚期塌陷，塌陷率12．5％，3例塌陷进展行全髋关节置换，髋关节Harris功能评分，优良率92．5％。结论空心钉联合同种异体腓骨内固定治疗中青年股骨颈骨折具有以下优点：（1）促进股骨颈骨折愈合预防骨不连及股骨颈短缩；（2）增加股骨头负重区软骨下骨的机械支撑，分散传导局部应力，提供有效的头内稳定性，利于坏死修复，尽早预防股骨头坏死后塌陷或塌陷进展；（3）增加固定稳定性，可早期下地活动。该手术方法简单、疗效可靠，尤其适用于中青年股骨颈移位或粉碎性骨质缺损骨折。

Preliminary clinical observation of cannulated screw and fibular allograft fixation in treatment of femoral neck fractures in young and middle-aged patients

Objective To explore the preliminary efficacy of cannulated screw and fibular allograft fixation in the treatment of femoral neck fracture in the young and middle-aged patients. Methods 40 cases of femoral neck fracture was treated by the fibular allograft implantation at the anterolateral site of the femoral head, and two cannulated screws were used for the internal fixation during the surgery. Results 40 patients were followed up for 24 to 84 months with an average time of 48.5 months. 15 patients had symptoms of osteonecrosis, and the advanced collapse occurred in five patients. The collapse rate was 12. 5%. Three of the collapse cases underwent total hip arthroplasty （ 7.5% ）. According to the Harris score, the excellent and good rate was 92. 5 %. Conclusion The cannulated screw and fibular allograft fixation in the treatment for the femoral neck fractures of the young and middle-aged patients has the following advantages ： （ 1 ） promoting healing, preventing nonunion and shortening of the femoral neck ; （ 2 ） improving the mechanical support of the subcondral bone in the weight-bearing area of the femoral head, so to disperse the local stress, provide effective head stability, and promote repairment of necrosis, which may prevent the collapse after the avascular necrosis of the femoral head; （3） increasing the fixation stability and benefiting the early ambulation weight-bearing activities. The surgical method is simple, reliable and effective, especially suitable for the femoral neck fracture with bone defects.