股骨颈骨折延迟及不连接的股骨头病理改变与手术疗效观察

１９８２～１９９５年间收治２５９例陈旧性股骨颈骨折，手术前采用Ｘ线片、病理组织学、电镜、四环素荧光标记和ＥＣＴ观察股骨头病理改变，发现股骨头坏死在不负重状态下有其自然的修复规律，股骨头塌陷在其修复过程中与所受的应力大小有关。２５９例中１９８例采用吻合血管腓骨移植治疗，２４例采用缝匠肌肌瓣骨移植，２２例采用带旋髂深血管蒂髂骨移植，１５例行人工关节置换处理。其中１６６例吻合血管腓骨移植病例得到了３～１２年的系统Ｘ线片和功能随访观察，优良率为８４．３％。作者认为；陈旧性股骨颈骨折在良好的复位情况下采用吻合血管的腓骨与加压螺纹钉有协同固定和支撑作用。

Observation of Femoral Head Pathological Change and Therapeutic Effect in Delay and Nonunion of Femoral Neck Fracture

The pathological change of femoral head in 259 cases with old femoral neck fracture were observed by x ray film,histopathology,EM,tetracycline flurescence labeling and ECT from 1982 to 1995.The result showed that femoral head necrosis obeies natural reparative rule under non weight bearing condition.And femoral head collapse relates to stress action accepted in the active reparative procedure.Among 259 cases,there were 198 cases treated by anastomosis blood vessel fibula grafting and internal fixation with compression screws,24 cases treated by sartorius muscle flap bone grafting,22 cases treated by iliac grafting with deep circuflex iliac blood vessel,and 15 cases treated by artificial femoral head or total hip joint replacement.166 cases treated by anastomosis of blood vessel plus fibula grafting were followed up from 3 to 12 years.The rate of excellent and good was 84.8%.The fibula is not absorbed after operation,it can bring new blood supply to femoral neck and unite with femoral head and neck early after operation.It is very helpful to restore blood supply to femoral head.