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帶旋髂深血管蒂髂骨及髂骨膜瓣移位治療中青年股骨頸骨折

目的 總結帶旋髂深血管蒂髂骨及髂骨膜瓣移位治療中青年股骨頸骨折的手術方法及臨床療效。 方法 2003 年4 月－ 2007 年3 月，收治22 例中青年股骨頸骨折患者。男12 例，女10 例；年齡25 ～ 53 歲，平均42 歲。均為閉合性骨折。致傷原因：交通事故傷18 例，高處墜落傷4 例。受傷至手術時間5 h ～ 43 d。新鮮骨折20 例，陳舊性骨折2 例。骨折部位分型：頭下型10 例，經頸型12 例。骨折Garden 分型：Ⅲ型6 例，Ⅳ型16 例。術前Harris 髖關節功能評分（22.80 ± 8.75）分。采用帶旋髂深血管蒂髂骨及髂骨膜瓣移位加空心加壓螺釘治療。 結果 術后1 例供區傷口伴液化滲出，經換藥治愈；其余切口均Ⅰ期愈合。術后患者均獲隨訪，隨訪時間20 ～ 60 個月，平均42 個月。21 例股骨頸骨折愈合，愈合時間3 ～ 6 個月，平均3.5 個月；1 例骨折不愈合并股骨頭缺血性壞死，于術后6 個月行人工全髖關節置換術。術后14 個月Harris 評分為（86.40 ± 7.95）分，與術前比較差異有統計學意義（P lt; 0.05）。 結論 帶旋髂深血管蒂髂骨及髂骨膜瓣治療中青年股骨頸骨折可改善骨折端血運，促進骨折愈合，減少股骨頭壞死的發生。

帶旋股外側升支蒂髂骨治療中青年股骨頭缺血壞死

帶旋髂深血管蒂髂骨瓣聯合空心加壓螺釘內固定治療青壯年股骨頸骨折的療效分析

目的 總結帶旋髂深血管蒂髂骨瓣聯合松質骨空心加壓螺釘內固定治療青壯年股骨頸骨折的療效。 方法 2006 年1 月－ 2008 年12 月，采用帶旋髂深血管蒂髂骨瓣聯合松質骨空心加壓螺釘內固定治療23 例外傷致股骨頸骨折患者。其中男17 例，女6 例；年齡19 ～ 47 歲，平均31.4 歲。骨折按Garden 分型：Ⅱ型3 例，Ⅲ型14 例，Ⅳ型6 例。受傷至手術時間1 ～ 9 d，平均5 d。 結果 術后患者切口均Ⅰ期愈合。23 例均獲隨訪，隨訪時間13 ～ 36個月，平均15.3 個月。骨折愈合時間9 ～ 15 個月。術后15 個月Harris 評分為73 ～ 92 分，其中優5 例，良16 例，中2 例，優良率91.3%。1 例術后33 個月發現股骨頭缺血性壞死（avascular necrosis of femoral head，ANFH），其余患者無ANFH及股骨頭晚期塌陷等并發癥發生。所有患者無神經損害并發癥，無術區感染；1 例術后伴供骨區疼痛，12 個月后疼痛自行消失。 結論 帶旋髂深血管蒂髂骨瓣聯合松質骨空心加壓螺釘內固定治療青壯年股骨頸骨折手術操作簡便、安全，可獲得較好療效。

Clinical study of a new biodegradable magnesium internal fixation screw in treatment of osteonecrosis of the femoral head

Objective To investigate the safety and efficacy of a new biodegradable magnesium internal fixation screw for vascularized iliac bone flap grafting in treatment of osteonecrosis of the femoral head (ONFH). Methods Patients with ONFH admitted between July 2020 and February 2021 were selected as the research objects, and 20 patients (20 hips) met the selection criteria and were included in the study. The patients were divided into two groups (n=10) by central random method. The iliac bone flap was fixed with a new biodegradable magnesium internal fixation screw in the trial group, and the iliac bone flap was wedged directly in the control group. There was no significant difference (P>0.05) in gender, age, and side, type, Association Research Circulation Osseous (ARCO) stage, and disease duration of ONFH between the two groups. The operation time and intraoperative blood loss of the two groups were recorded. Laboratory tests were performed at each time point before and after operation, including white blood cell (WBC), electrolytes (K, Ca, P, Mg), blood urea nitrogen (BUN), serum creatinine (Scr), glomerular filtration rate (eGFR), lymphocyte ratio (CD4/CD8), immunoglobulin G (IgG), IgM, alanine transaminase (ALT), aspartate aminotransferase (AST). After operation, Harris score was used to evaluate the hip joint function. CT of the hip joint and X-ray films in anteroposterior and frog positions of the pelvis were used to review the iliac bone flap position, fusion, and screw biodegradation in the trial group. Results The vital signs of the two groups were stable, the incisions healed by first intention, and no adverse events occurred after operation. One patient in the control group refused to return to the hospital for follow-up at 3 months after operation, and 1 patient in the trial group refused to return to the hospital for follow-up at 1 year after operation. The rest of the patients completed the follow-up at 2 weeks, 3 months, 6 months, and 1 year after operation. Laboratory tests showed that there was no significant difference in WBC, electrolytes (K, Ca, P, Mg), BUN, Scr, eGFR, CD4/CD8, IgG, IgM, ALT, and AST between the two groups at each time point before and after operation (P>0.05). The operation time and intraoperative blood loss of the trial group were significantly less than those of the control group (P<0.05). The Harris scores of the two groups at 1 year significantly increased when compared with the values before operation and at 6 months after operation (P<0.05). There was no significant difference in Harris score between the two groups at each time point (P>0.05). Postoperative CT of hip joint and X-ray films of pelvis showed that the iliac bone flap reached osseous fusion with the fenestration of the head and neck junction of femoral head in the two groups at 1 year after operation, and no loosening or shedding of iliac bone flap was observed during follow-up. In the trial group, there were signs of dissolution and absorption of the new biodegradable magnesium internal fixation screws after operation, and the diameter of the screws gradually decreased (P<0.05); no screw breakage or detachment occurred during follow-up. Conclusion In the treatment of ONFH with vascularized iliac bone flap grafting, the new biodegradable magnesium internal fixation screws can fix the iliac bone flap firmly. Compared with the traditional iliac bone flap wedging directly, it has a shorter operation time, less intraoperative blood loss, and can obtain similar joint function.

TREATMENT OF AVASCULAR NECROSIS OF FEMORAL HEAD AFTER FEMORAL NECK FRACTURE WITH PEDICLED ILIAC BONE GRAFT

Objective To explore the effectiveness of pedicled il iac bone graft transposition for treatment of avascular necrosis of femoral head (ANFH) after femoral neck fracture. Methods Between June 2002 and December 2006, 22 cases (22 hips, 16 left hips and 6 right hips) of ANFH after femoral neck fracture were treated with il iac bone graft pedicled with ascending branch of the lateral femoral circumflex vessels. There were 18 males and 4 females with an age range from 28 to 48 years (mean, 37.5 years). The time from injury to internal fixation was 2-31 days, and all fractures healed within 12 months after internal fixation. The ANFH was diagnosed at 15-40 months (mean, 22 months) after internal fixation. The ANFH duration was 3-11 months (mean, 8 months). According to Association Research Circulation Osseous (ARCO) staging system, 2 hips were classified as stage IIa, 3 hips as stage IIb, 3 hips as stage IIc, 3 hips as stage IIIa, 7 hips as stage IIIb, and 4 hips as stage IIIc. The preoperative Harris hip score (HHS) was 64.10 ± 5.95. Results All incisions healed by first intention and the patients had no compl ication of lung embol ism, sciatic nerve injury, lower l imb deep venous thrombosis, and numbness and pain of donor site. All patients were followed up 2.5 to 6.3 years (mean, 4.8 years). The fracture heal ing time was 8-12 months, and no femoral neck fracture recurred. The HHS was 90.20 ± 5.35 at last follow-up, showing significant difference when compared with the preoperative value (t= —18.447, P=0.000). The hi p function were excellent in 11 hi ps, good in 10 hips, fair in 1 hip, and the excellent and good rate was 95.5%. Four hips were radiographically progressed in ARCO staging, 18 hips remained stable with a stable rate of 81.8%. Conclusion Pedicled il iac bone graft transposition is an ideal option for treatment of ANFH after internal fixation of femoral neck fracture for the advantages of femoral head revascularization, sufficient cancellous bone supply, and relatively simple procedure.

Treatment Ischemic Necrosis of the Femoral Head with Vacularized Iliac Graft in Young Patients with Sickle-Call Disease

Objective To investigate the therapeutic effects of the vacularized iliac graft for ischemic necrosis of the femoral head in Niger young patients with sickle cell disease. Methods From November 1998 to Apirl 2001, 12 patients (5 males and 7 females, aging 11-22 years) with sickle cell disease suffered from ischemic necrosis of the femora! head in 14 hips. The lesion was on one hip in 10 patients and on bilateral hip in 2 patients. Necrosis was classified as Ficat Stage Ⅲ-Ⅳ in all patients. Twelve hips in 12...

TREATMENT OF ADULT AVASCULAR NECROSIS OF FEMORAL HEAD BY TRANSPLANTING ILIAC BONE FLAP WITH DEEP ILIAC CIRCUMFLEX VESSELS AND CANCELLOUS BONE

Objective To investigate the effectiveness of transplanting iliac bone flap with deep iliac circumflex vessels and cancellous bone for the treatment of adult avascular necrosis of the femoral head (ANFH). Methods A retrospective analysis was made on the clinical data of 685 patients (803 hips) with ANFH, who underwent iliac bone flap transplantation with deep iliac circumflex vessels and cancellous bone between March 2002 and January 2010. There were 489 males (580 hips) and 196 females (223 hips) with a mean age of 40.4 years (range, 18-63 years), including 567 unilateral cases (303 left hips and 264 right hips) and 118 bilateral cases. The causes of ANFH included alcohol-induced in 223 cases, steroid-induced in 179 cases, alcohol + steroid-induced in 21 cases, traumatic in 136 cases, acetabular dysplasia in 8 cases, bone cyst in 5 cases, septic arthritis in 2 cases, joint tuberculosis in 3 cases, rheumatoid arthritis in 5 cases, and idiopathic in 103 cases. According to Steinberg staging, 211 hips were rated as stage II, 513 hips as stage III, and 79 hips as stage IV. The preoperative Harris hip score was 60.30 ± 7.02. Results Fat necrosis occurred in 2 cases after operation, primary healing of incision was obtained in the other cases; delayed infection, lower extremity deep vein thrombosis, and pulmonary embolism occurred in 2 cases, respectively. All patients were followed up 36-60 months (mean, 49 months). Harris hip score at last follow-up (83.50 ± 7.31) was significantly higher than that at preoperation (t= — 2 266.980, P=0.000), and the scores were significantly higher than those at preoperation in different stages (P lt; 0.05). The results were excellent in 523 hips, good in 185 hips, fair in 65 hips, and poor in 30 hips, and the excellent and good rate was 88.2%. X-ray examination showed bone fusion of transplanted bone flap and bone graft with an average of 4.2 months (range, 3-6 months); according to Steinberg staging, imaging stable rate was 78.3% (629/803) at last follow-up. Conclusion Iliac bone flap transplantion with deep iliac circumflex vessels and cancellous bone has the advantages of complete decompression of the femoral head, exact flap blood supply, improved blood supply of the femoral head, new support for the femoral head, and participation of osteoinductive effect for the treatment of adult ANFH, so it is an effective treatment for the retention of the femoral head.

空心加壓螺釘聯合帶旋髂深血管骨瓣治療青壯年股骨頸骨折

目的總結空心加壓螺釘聯合帶旋髂深血管骨瓣治療青壯年股骨頸骨折的療效。 方法2005年8 月－2011年2月，收治13例青壯年股骨頸骨折患者。男8例，女5例；年齡18～46歲，平均34.5歲。致傷原因：交通事故傷9例，高處墜落傷3例，跌傷1例。受傷至手術時間1～10 d，平均3.5 d。根據Garden分型標準分型，Ⅲ型5例，Ⅳ型8 例。采用空心加壓螺釘固定聯合帶旋髂深血管骨瓣移植治療。 結果除1例患者術中發現血管變異改用縫匠肌肌骨瓣移植外，其余患者均順利完成手術。術后切口均Ⅰ期愈合，無相關并發癥發生。13例均獲隨訪，隨訪時間18～52個月，平均33.5個月。12例聯合帶旋髂深血管骨瓣移植者均達骨性愈合，愈合時間3.0～4.5個月，平均3.5個月；無股骨頭缺血性壞死發生；術后18個月Harris 評分89～100分，平均96分。1例聯合縫匠肌肌骨瓣移植者術后9個月復查示股骨頭缺血性壞死并進行性加重。 結論對于青壯年股骨頸骨折，應用空心加壓螺釘固定聯合帶旋髂深血管骨瓣移植重建血運，能促進骨折愈合，減少股骨頸缺血性壞死幾率，是一種有效的治療方法。