Augmented osteosynthesis with tensor fascia latae muscle pedicle bone grafting in neglected femoral neck fracture.
Augmented osteosynthesis with tensor fascia latae muscle pedicle bone grafting in neglected femoral neck fracture.
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DOI：
10.4103/0019-5413.97263
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发表时间：
2012-07
影响因子：
1
通讯作者：
Bhuyan BK
中科院分区：
文献类型：
--
作者：
Bhuyan BK
年轻患者的股骨颈囊内骨折可能由于骨折部位的剪切应变过大而无法愈合，这对任何骨科医生来说都是一个手术挑战。问题是由股骨颈的吸收和股骨头的无血管坏死（AVN）。在股骨颈骨折的治疗中，就骨折愈合和股骨头AVN而言，目前还没有令人满意的解决方法。肌蒂骨移植被提倡为股骨头提供额外的血液供应。我们报告48例被忽视的股骨颈骨折经内固定和阔筋膜张肌蒂骨移植治疗的回顾性分析。48例股骨颈骨折患者，年龄20 ~ 53岁，平均年龄32.9岁，男女比例2:1。所有骨折均大于3周，平均延迟86天（22-150天）。所有病例均行切开复位内固定及阔筋膜张肌蒂植骨术。辅以多次钻孔和皮质松质骨移植。骨折固定采用三枚平行的6.5 mm AO空心松质螺钉，植骨用一枚4 mm松质螺钉固定以提供安全固定。随访2-6.8年（平均4.4年），采用改良Harris髋部评分系统进行临床评估，影像学检查骨折愈合迹象。41/48例（85.41%）患者愈合，平均随访4.4年（2-6.8年），功能恢复良好，可蹲坐。根据改良的Harris髋关节评分系统对结果进行评估，19例为优，22例为良，5例为一般，2例为差。并发症为骨不连（n=3）、无血管坏死（n=2）和髋内翻畸形（n=2）。肌蒂植骨内固定是一种适合的选择，以确保愈合被忽视的股骨颈骨折患者的生理活动晚出现。
Neglected intracapsular femoral neck fracture in young patients may fail to unite because of the excessive shearing strain at the fracture site and it is a surgical challenge to any orthopedic surgeon. The problem is compounded by resorption of the femoral neck and avascular necrosis (AVN) of femoral head. There is no satisfactory solution available in the management of femoral neck fracture as far as the union of the fracture and AVN of femoral head are concerned. Muscle pedicle bone grafting has been advocated to provide additional blood supply to the femoral head. We report a retrospective analysis of 48 cases of neglected femoral neck fracture treated by internal fixation and tensor fascia latae based muscle pedicle bone grafting. 48 patients with femoral neck fractures with age varied from 20 to 53 years (average age 32.9 years) with male to female ratio of 2:1 were enrolled. All fractures were more than 3 weeks old with mean delay being 86 days (22–150 days). Open reduction and internal fixation along with tensor fascia latae muscle pedicle bone grafting was done in all cases. It was supplemented by multiple drilling and cortico-cancellous bone grafting. Fracture fixation was done with three parallel 6.5-mm AO cannulated cancellous lag screws and the graft fixed with a 4-mm cancellous screw to provide a secure fixation. During the followup period of 2-6.8 years (average 4.4 years) the results were assessed clinically by modified Harris hip scoring system and radiologically by the evidence of signs of fracture union. Union was achieved in 41/48 (85.41%) cases which were followed for an average period of 4.4 years (2–6.8 years) with good functional results and ability to squat and sit cross-legged. Results were assessed according to modified Harris Hip Scoring system and found to be excellent in 19, good in 22, fair in 5, and poor in 2 patients. Complications were nonunion, (n=3) avascular necrosis (n=2), and coxa vara deformity (n=2). Internal fixation with muscle pedicle bone grafting is a suitable option to secure union in neglected femoral neck fractures in physiologically active patients with late presentation.
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DOI：
10.1302/0301-620x.68b3.3733802
发表时间：
1986-01-01
影响因子：
--
作者：
NAGI, ON;GAUTAM, VK;MARYA, SKS
通讯作者：
MARYA, SKS
DOI：
10.2106/00004623-197355020-00002
发表时间：
1973-01-01
影响因子：
5.3
作者：
MEYERS, MH;HARVEY, JP;MOORE, TM
通讯作者：
MOORE, TM
影响因子：
2.3
作者：
Nagi, O N;Dhillon, M S;Gill, S S
通讯作者：
Gill, S S
DOI：
10.1302/0301-620x.78b2.0780253
发表时间：
1996-03-01
影响因子：
--
作者：
Sugano, N;Masuhara, K;Hayami, Y
通讯作者：
Hayami, Y
DOI：
10.1302/0301-620x.68b2.3958010
发表时间：
1986-01-01
影响因子：
--
作者：
BAKSI, DP
通讯作者：
BAKSI, DP