一期截骨内固定治疗股骨颈骨折

目的 :应用一期截骨内固定治疗青壮年股骨颈囊内骨折。方法 :切开复位、粗隆间截骨、1 30°双翼钢板 (4～ 6孔 )内固定 ;Linton’s角 <50°粗隆间内移截骨 2 6例 ,>50°粗隆间外展截骨 1 5例 ,术后不用外固定 ,分期适时功能锻炼。结果 :1 996年 4月始 3年内共 41例 ,术后 1 2月以上 41例骨折 39例愈合 ,股骨头无菌性坏死 8例 ,占 2 0 % ,31例无肢体短缩。结论 :一期截骨内固定可提高愈合率 ,但对无菌性坏死发生率无明显降低 ,有待积累更多病例观察     

股骨转子间外翻截骨治疗股骨颈骨折不愈合

根据生物力学分析，骨折线的倾斜角度不同，造成骨折处剪切力和压力大小相异。剪切力越大，骨折越不稳定，愈合困难。股骨转子间外翻截骨，将关节负荷变成单纯功能性应力，促进骨折愈合，本组１５例手术后超过６个月全部愈合。该术适应于中青年患者，甚至伴有不严重的股骨头无菌坏死时，亦为适宜。     

外翻截骨治疗儿童Pauwels Ⅲ型陈旧性股骨颈骨折

[目的]评价外翻截骨治疗儿童陈旧性股骨颈骨折疗效分析.[方法]2016-2021年对4例Pauwels Ⅲ型陈旧性股骨颈骨折的患者行股骨外翻截骨、LCP-PHP固定.总结临床与影像资料.[结果]4例患者均顺利完成手术,手术时间(161.25±51.05)min,切口长度(10.75±2.98)cm,术中失血量(192....     

带血供骨瓣移植治疗青壮年股骨颈骨折

目的 探讨应用带血供骨瓣移植结合内固定治疗青壮年股骨颈骨折的临床疗效。 方法 1998年4月-2009年10月,收治的青壮年股骨颈骨折45例,分别采用切开复位内固定并带旋髂深血管蒂髂骨瓣21例,股方肌蒂骨瓣移植24例,分析骨折愈合、髋关节功能及股骨头缺血性坏死的发生情况。 结果 应用旋髂深血管蒂髂骨瓣移植组手术时间较股方肌蒂骨瓣手术组明显延长,出血量较后者明显增加。术后随访共4例延迟愈合,旋髂深血管蒂髂骨瓣组2例发生股骨头坏死,Harris评分优良率61.9％,股方肌蒂骨瓣组3例发生股骨头坏死,Harris评分优良率87.5％。在骨折愈合、预防术后股骨头坏死方面效果两种方法均满意,但髋关节功能评分有显著性差异。 结论 采用带血供骨瓣移植并内固定治疗青壮年股骨颈骨折,能显著降低股骨头缺血性坏死的发生,且股方肌蒂骨瓣移植手术方法简单、创伤小,术后患者髋关节恢复较好。     

骨水泥型假体髋关节置换术治疗老年不稳定型股骨颈骨折效果分析

目的探讨骨水泥型假体髋关节置换术治疗老年不稳定型股骨颈骨折的效果。方法选取襄城县人民医院2016-03—2017-06间收治的36例老年不稳定型股骨颈骨折患者,依照不同术式分为2组,各18例。对照组采取生物型假体髋关节置换术,观察组采取骨水泥型假体髋关节置换术。结果 2组术中出血量、手术时间差异均无统计学意义(P0.05)。观察组住院时间、术后1个月和6个月Harris评分、末次随访WHOQOL-100评分等指标比较,均优于对照组,差异有统计学意义(P0.05)。结论对老年不稳定型股骨颈骨折患者实施骨水泥型假体髋关节置换术,可缩短住院时间、显著改善髋关节功能和提升生活质量。     

DHS结合空心螺钉植骨内固定治疗青壮年股骨颈骨折

目的探讨DHS结合空心钉有限切开植骨内固定治疗青壮年股骨颈骨折的临床疗效及意义。方法回顾性分析我院2007年7月~2010年9月收治的29例青壮年股骨颈骨折患者的临床资料,均采用DHS结合空心钉行有限切开植骨内固定。结果本组29例患者均获随访,平均时间32.5(24~65)个月。无螺钉松动、退钉或断裂发生,1例发生延迟愈合,2例发生股骨头缺血性坏死,其余26例患者骨折均愈合,无肢体短缩、髋内翻畸形等其他并发症,骨折愈合时间平均4.5(3~17)个月。按Harris髋关节功能评分标准评定疗效,优22例(75.9%),良5例(17.2%),差2例(6.9%),优良率为93.1%。结论牵引床闭合复位DHS结合空心钉有限切开植骨内固定治疗青壮年股骨颈骨折,疗效肯定,解剖复位、坚强固定是获得满意疗效的关键,且可减少并发症的发生。     

青壮年不稳定股骨颈骨折的治疗

目的：探讨不稳定型骨颈骨折的手术方法及如何减少并发症。方法：采用Moore入路,应用股方股骨瓣 Knowels钉内固定治疗不稳定型青壮年股骨颈骨折26例。结果：随访1年2月至6年,骨折全部愈合,1例出现股骨头坏死。结论：股方肌骨瓣 Knowels钉内固定是治疗青壮年不稳定型股骨颈骨折的非常有效的方法。预防并发症的关键是：解剖复位,坚强内固定,肌骨瓣改善血供和充填骨缺损,晚负重。     

Complications of femoral neck fracture in young adults

Femoral neck fractures are uncommon but serious injuries in young adults, with high rates of nonunion and avascular necrosis reported. This study was undertaken to examine the relationship between the mechanism and severity of injury, anatomic site of fracture, health status, and method of therapy on the incidence of these complications in young adults. The hospital records of 32 skeletally mature patients between the ages of 15 and 50 years (mean, 33) treated for femoral neck fracture between 1975 and 1982 were reviewed, and data analyzed for the 25 patients with a minimum 2-year followup (mean, 61 months). Data pertaining to the cause of injury, fracture pattern, prior health status, overall injury severity, method of fracture treatment, and long-term outcome were analyzed. Nonunion of the fracture site was observed in five (20%); avascular necrosis in nine (36%). Of patients with subcapital fracture 83% developed nonunion or avascular necrosis, compared to 21% with true femoral neck fracture (p = 0.05). There was no difference in cause of injury, overall injury severity, degree of comminution, displacement, method of treatment, or prior health status between those with and without complications. In this study, high rates of nonunion and avascular necrosis were seen after all types of femoral neck fracture in young adults, but were more often associated with subcapital fracture. These complications of hip fracture appeared to be independent of health status, method of treatment, or mechanism or severity of injury.     

闭合复位股骨近端空心钉锁定板固定治疗青壮年移位股骨颈骨折

目的 :探讨闭合复位股骨近端空心钉锁定板固定治疗青壮年移位股骨颈骨折的临床疗效。方法 :2010年8月至2014年8月采用闭合复位股骨近端空心钉锁定板固定治疗青壮年移位股骨颈骨折54例,男34例,女20例;年龄18~55岁,平均39.8岁。对股骨颈骨折的愈合率及短缩情况进行了记录观察,并按Harris评价标准对髋关节功能进行评价。结果:54例均获随访,时间4~24个月,平均11.3个月。骨折愈合率94.4%,愈合时间3~6个月,平均4.1个月。骨折愈合的51例患者,股骨颈短缩中位数0.8 mm,平均(0.48±0.46)mm。随访期间无感染、内固定物移位、脱出等并发症。按Harris标准评价:优40例,良9例,可2例,差3例。结论:闭合复位股骨近端空心钉锁定板固定可靠,有效避免了股骨颈短缩,骨折愈合率高,功能恢复好,是治疗青壮年移位股骨颈骨折的一种有效方法。     

青壮年股骨颈骨折手术治疗的回顾性分析

目的 探讨治疗青壮年股骨颈骨折的手术方法及临床疗效. 方法对2005年1月至2008年6月行手术治疗并获得随访的41例青壮年股骨颈骨折患者按照"难治性骨折的治疗研究随访表"进行随访,从骨折类型、手术时机、骨折复位质量、置入物类型、卧床时间以及髋关节功能等方面进行评估. 结果 41例患者获得10～52个月随访,平均30.5个月.37例(90.2%)患者在伤后2～5d内行手术治疗,平均3.6 d,Garden Ⅱ、Ⅲ型骨折采用闭合复位钛合金空心钉内固定术,Garden Ⅳ型及陈旧性骨折、病理性骨折采用切开复位钛合金空心钉内固定加髂骨瓣植骨术.术中复位评价平均4.83分,术后平均卧床时间3.5个月.髋关节功能按照Harris评分标准:优21例,良15例,可3例,差2例,优良率为87.8%.Garden Ⅳ型骨折优良率较Ⅱ、Ⅲ型骨折优良率低,但差异无统计学意义(χ2=1.35,P=0.25). 结论早期手术、解剖复位、多枚钛合金空心钉坚强内固定是青壮年股骨颈骨折手术治疗的关键,Garden Ⅳ型骨折髂骨瓣植骨、合理的早活动和晚负重是预防股骨头缺血坏死的有力保证.根据骨折的严重程度制定科学规范的治疗方案和合理的术后康复策略,对提高临床疗效具有极其重要的意义.     

Valgus intertrochanteric osteotomy for neglected femoral neck fractures in young adults

Twenty cases of neglected (more than 1 month old) displaced femoral neck fractures in young adults were treated with a valgus intertrochanteric osteotomy. A fracture union rate of 85% (17 cases) was achieved. Two of the healed cases developed avascular necrosis. After 30 months 15 patients (75%) had achieved good to excellent results. We believe that intertrochanteric osteotomy provides good alternative management for neglected femoral neck fractures.     

股方肌骨瓣移植治疗青壮年股骨颈骨折

目的 探讨股方肌骨瓣移植治疗青壮年头下型和经颈型股骨颈骨折的疗效。方法 26例全部采用可折断螺钉固定加股方肌骨瓣移植。结果 26例随访时间3-8年，疗效评定按童星杰等制定的标准，优19例（73.1%)。良6例（23.1%)。差1例（3.8%)。结论 采用可折断螺钉固定股方肌骨瓣移植治疗青壮年头下型和经颈型股骨颈骨折，疗效较好。尤其适合于经颈型股骨颈骨折。     

Treatment of neglected femoral neck fractures in young adults

Sixteen young adults with neglected femoral neck fractures were treated from 1974 to 1981. The ages ranged from 16 to 43 years. The periods of delay after fracture were three months to two years. Most of the patients were initially treated by a "Chinese bone setter" with subsequent development of leg shortening, upward displacement of the distal fragment, and a variable degree of absorption of the femoral neck or head. Treatment included skeletal traction followed by open or closed reduction, internal fixation, or angulation osteotomy with or without bone graft. Two to eight years later, there were no cases of nonunion. Four hips developed avascular necrosis with one requiring still further surgical treatment. Thirteen patients (81%) had good to excellent results. Preservation of the patients' own hip joints was worthwhile. A defeatist attitude toward the "unsolved" fracture should be qualified.     

带血管蒂肌骨瓣结合空心螺纹钉治疗青壮年股骨颈骨折

1991～2007年,笔者采用带血管蒂肌骨瓣结合空心加压螺纹钉治疗青壮年股骨颈骨折68例,疗效满意. 1 材料与方法 1.1 病例资料本组68例(69髋),男44例,女24例.年龄18～52岁.单侧67例,双侧1例.骨折类型:头下型17髋,经颈型36髋,基底型16髋.按Garden分型:Ⅲ型47髋,Ⅳ型22髋.     

Evaluation of valgus intertrochanteric osteotomy in neglected fracture neck femur in young adults

BackgroundFemoral neck fractures in young adults have always presented a difficult problem with high rates of non-union and avascular necrosis. At our centre we have been using the traditional Pauwels intertrochanteric osteotomy for neglected un-united femoral neck fractures in young adults. We have made certain modifications in this procedure to suit our resources and so we evaluated the outcome of this procedure at our institute.MethodsThe study included fifty consecutive cases of neglected femoral neck fractures treated at our centre between February 1996 and October 2012. Patients in whom internal fixation had failed were excluded. The average age of the patients was 37 years (range: 17–55 years). Eleven of the patients were female & Thirty-nine were male. Fifteen patients belonged to Pauwels grade 1, Twenty-six patients belonged to grade 2, and nine belonged to grade 3. The interval between the injury and operation ranged from 1 to 12months (average: 4.3 months). The cases were operated on a normal table using a Watson Jones Approach. The fracture ends were freshened and fixed using a 6.5mm screw followed by a valgus osteotomy which was fixed by a double angle (120 degree) blade plate.ResultsA fracture union rate of 90% (45 cases) was achieved. Two of the healed cases developed avascular necrosis. Results were graded using Askin and Bryan's criteria. Overall, an excellent result was seen in 35 patients, good in 5, fair in 5 and poor in 5. Of the five patients having poor result (3 non-union, 1 implant breakage, 1 implant cut out), two refused revision surgery. In remaining three, one underwent total hip arthroplasty and in two revision osteotomy was performed.ConclusionWe believe that intertrochanteric osteotomy provides a good outcome for neglected femoral neck fractures. Performing the procedure on a routine table, with Watson Jones approach and fixing with double angle blade plate is a good option.