旋髂深血管髂骨骨膜瓣移植治疗股骨颈骨折

目的 回顾分析旋髂深血管髂骨骨膜瓣移植治疗股骨颈骨折的远期疗效。探讨其临床应用价值，并与同期采用人工股骨头置换术及经皮三棱钉固定治疗股骨颈骨折的疗效进行对比研究。方法 切开复位股骨颈开槽，施行旋髂深血管髂骨骨膜瓣移植，三棱钉固定29例，经皮三棱钉固定27例，人工股骨头置换34例。结果 旋髂深血管髂骨骨膜瓣移植治疗组随访3－7年，骨折平均愈合时间3.5个月，1例出现股骨头坏死，其余病例髋关节功能恢复满意；经皮三棱钉固定组随访3－6年，骨折平均愈合时间为7.4个月，6例发生并发症；人工股骨头置换组随访4－7年，9例发生并发症。结论 旋髂深血管髂骨骨膜瓣血管位置恒定，切取容易，疗效可靠，应作为股骨颈骨折治疗的首选，各种方法的经皮穿针内固定虽具有骨折愈合时间长，少数患者可发生骨折不愈合及股骨头坏死的缺点，但由于操作简便，仍为临床常用。而人工股骨头置换目前尚有难以克服的并发症，且疗效随着时间的延长而降低，一旦发生并发症处理非常困难，应严格掌握手术适应证。

Grafting of iliac bone flap with deepiliac circumflex vessel in treatment of femoral neck fracture

Objective To retrospect the results and probe into the clinical applied vallue of the pedicled bone flap with deep iliac circumflex artery to the treatment of the femoral neck fracture and femoral neck fracture Methods Eight cases of femoral neck fracture and 21 cases nonunion treated by bone and periost flaps with deep iliac circumflex vessel35 casses treated by closure reduction and fixed with 3 trianglar nails,34 cases by arthroplastyThe results of 3 kinds of methods were contrasted and anslysed Results Twenty-nine cases treated by iliac bone and periost flaps with deep iliac circumflex artery were fellowed from 3 to 7 years,the fracture healed 35 months averagely. One case was avascular necrosis of femoral head after 9 month after operation,others received good results35 cases were treated by 3 nails fixtion healed 74 months averagely and 6 case had complications 37 casese treated by arthroplasty had complications in 8 patients,4 cases need walking-stich for walk. Conclusion Femoral neck fracture were treated by transplantation of the pedicled bone and periost flaps with deep iliac circumflex vessel is keeping with the pathological and anatomical characteristicsThe function of the hip joint is not weaken as the time goes on when the fracture is healedIt is the best methods to treat the femoral neck fracture now,the arthroplasty has many complication,so the indication must be confined