植骨内固定术治疗股骨颈骨折

目的　探讨植骨内固定术治疗移位型和陈旧性股骨颈骨折的疗效。方法　本文回顾分析 34例股骨颈骨折 ,采用植骨和内固定术治疗 ,所有病例新鲜骨折平均随访 4 5年 ,陈旧性为 4 9年 ,其中新鲜骨折GardenⅣ型 1 1例 ,陈旧性 2 3例。早期采用三刃钉固定 1 5例和钉板固定 1例 ,空心松质骨螺钉固定 1 5例 ,DHS内固定 2例 ,1例单纯行植骨术。植骨方式采用髂骨松质骨植骨 2 3例 ,带肌蒂植骨 1 1例。结果　骨折愈合率 :新鲜骨折为 1 0 0 % ,陈旧性骨折为 82 6 % ;缺血坏死 1 2例。比较单纯松质骨植骨和带肌蒂骨植骨治疗结果 ,骨愈合率分别为 91 3%和 90 9% ,坏死率分为 2 6 1 %和 5 4 5 %。结论　正确认识股骨颈骨折的创伤病理特点 ,稳定的内固定和植骨术可提高骨折愈合率 ,单纯松质骨植骨发生股骨头坏死明显低于带肌蒂植骨

The Treatment of Femoral Neck Fractures with Internal Fixation and Bone Grafting

Objective To analyze the effect of displaced and old femoral neck fractures with internal fixation and bone grafting .Methods Thirty four cases of femoral neck fractures including fresh 15 cases and old 23 cases were analyzed retrospectively. All the cases were followed up for an average 4 5 years in fresh cases and 4 9 years in old cases. Fifteen cases were fixed with Smith-Peterson pin and 1 case with Smith-Peterson pin and plate,15 cases with cannulated screw and 2 cases with DHS. Eleven cases were treated with muscular pedicle bone grafting,23 cases with cancellous bone grafting respectively and 1 case without fixation.Results The rate of bone healing in fresh cases was 100% and 82 6% in old cases.Total avascular necrosis were occurred in 12 cases.Compared with the final result in 2 types bone grafting,the rate of bone healing were 91 3% and 90 9%,The rate of avascular necrosis were 26 1% and 54 5% respectively. The rate of avascular necrosis with cancellous bone grafting was significant lower than muscular pedicle bone grafting.Conclusion It is important to know traumatic pathological charecteristic of femoral neck fractures,with stable fixation and bone grafting,the rate of fracture healing is significantly improved,the rate of avascular necrosis in the cases with cancellous bone grafting is significantly lower than muscular pedicle bone grafting.