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带旋髂深血管束髂骨骨膜移植治疗中青年股骨颈骨折

OBSERVATION OF FEMORAL HEAD ACTIVITY IN OLD FRACTURE OF FEMORAL NECK

Abstract To understand the femoral head activity in old fracture of femoral neck, 159 cases from 1982 to 1994 were observed through X-ray film, pathological sections, transparent electronic microscope, tetracycline label technique and ECT examination. The results showed that under a status without stress, the avascular femoral head tended to be repaired in its natural way. The collapse of femoral head was caused by stress to some extent duringthe active repair process. Great attention should be paid in treating fracture of femoral neck that load should never be put on the femoral head during the process of fracture healing.

Short- and medium-term effectiveness of percutaneous compression plate internal fixation in the treatment of femoral neck fractures in the elderly

ObjectiveTo investigate the short- and medium-term effectiveness of percutaneous compression plate (PCCP) internal fixation for femoral neck fractures in the elderly.MethodsThe clinical data of 32 elderly patients with femoral neck fracture treated with PCCP internal fixation between January 2012 and January 2019 were retrospectively analyzed. All of them were traumatic fractures. The causes of injury were falling in 20 cases, traffic accident in 7 cases, and falling from height in 5 cases. According to Garden classification, there were 7 cases of type Ⅱ, 15 cases of type Ⅲ, and 10 cases of type Ⅳ; there were 12 cases with Singh index level Ⅳ, 14 cases with level Ⅴ, and 6 cases with level Ⅵ; the bone mineral density of femoral neck was 0.610-0.860 g/cm2 (mean, 0.713 g/cm2). The time from injury to operation was 3-14 days, with an average of 5.8 days. Patients began to weight-bear gradually within 3 days postoperatively. The operation time, intraoperative blood loss, hospitalization stay, fracture reduction (Garden alignment index), fracture healing, failure of internal fixation, femoral neck shortening, and osteonecrosis of the femoral head were observed; hip function recovery was evaluated by Harris score.ResultsThe operation time was 35-135 minutes (mean, 73.4 minutes), the intraoperative blood loss was 75-385 mL (mean, 116.4 mL), the hospitalization stay was 3-15 days (mean, 8.3 days). At 1 week after operation, the Garden alignment index of fracture reduction was grade Ⅰ in 25 cases, grade Ⅱ in 6 cases, and grade Ⅲ in 1 case. One case of superficial infection of the incision occurred after operation, and no early complications such as deep vein thrombosis in the lower extremities, pulmonary embolism, or bedsores occurred. All the patients were followed up 2.1-4.0 years, with an average of 2.7 years. Except for 2 cases of delayed union (displaced trans-neck and subhead fractures), no nonunion of fracture and failure of internal fixation occurred, the fracture healing time was 4-8 months, with an average of 4.9 months. Femoral neck shortening occurred in 12 cases (37.5%); osteonecrosis of the femoral head occurred in 3 cases (9.4%), all of which were displaced trans-neck and subhead fractures, of which 2 cases received total hip arthroplasty and the other received conservative treatment. The Harris scores of the hip joint at 3 months, 2 years after operation and at last follow-up were significantly improved when compared with those before operation (P<0.05); there was no significant difference between each time point after operation (P>0.05). At last follow-up, the hip joint function was evaluated according to Harris score, the results were excellent in 15 cases, good in 12 cases, and fair in 5 cases, with an excellent and good rate of 84.4%. There was no significant difference in postoperative hip function composition among patients with different ages, Garden classification, Singh index, and Garden alignment index (P>0.05).ConclusionFor elderly patients with femoral neck fractures without severe osteoporosis and with relatively good physical conditions, PCCP internal fixation can achieve satisfactory short- and medium-term effectiveness, but there is a certain risk of osteonecrosis of the femoral head.

BIOMECHANICAL RESEARCH OF DYNAMIC SLEEVE THREE-WING SCREW IN FIXING FEMORAL NECK FRACTURE OF DIFFERENT ANGLES

Objective To explore the biomechanical stabil ity of dynamic sleeve three-wing screw for treatment of femoral neck fracture and to provide theoretical basis for choosing dynamic sleeve three-wing screw in cl inical appl ication. Methods Nine human cadaveric femurs were selected and divided randomly into 3 groups (n=3), excluding deformities, fractures, and other lesions. The central neck of the specimens were sawn with hand saw respectively at Pauwels angles of 30, 50, and 70°. All cut ends were fixed with dynamic sleeve three-wing screw. Instron-8874 servohydraul ic mechanical testing machine was used to fixed the specimens which simulated uni ped standing, at the rate of 10 mm/minute and l inear load 0-1 200 N at 11 key points. The strain values of princi pal pressure side and princi pal tension side under different loads were measured. Results There was a peak at 6th point in the 1 200 N load. The strain values at Pauwels angles of 30, 50, and 70° were (—1 657 ± 171), (—1 879 ± 146), and (—2 147 ± 136) με; showing significant differences (P lt; 0.01). The strain values of princi pal pressure side and princi pal tension side of the femoral neck became higher with the increasing Pauwels angle under the same load, showing significant differences (P lt; 0.01). The strain values became higher with the increasing load under the same Pauwels angle (P lt; 0.01). Conclusion Dynamic sleeve three-wing screw has good biomechanical stabil ity for treatment of femoral neck fracture. It explains theoretically that the fracture is more unstable with the increasing Pauwels angle．

90 岁以上老龄股骨颈骨折患者死亡相关危险因素分析

目的 对 90 岁以上老龄股骨颈骨折患者治疗后死亡的相关危险因素进行分析。 方法 回顾分析 2011 年 3 月—2016 年 3 月收治的 64 例 90 岁以上老龄股骨颈骨折患者资料，男 29 例，女 35 例；年龄 90～99 岁，平均 92.3 岁。骨折 Garden 分型：Ⅱ型 15 例，Ⅲ型 32 例，Ⅳ型 17 例。合并 3 种以上合并症者 37 例（57.8%）。受伤至入院时间 2 h～8 d，平均 65 h。入院后检测血红蛋白 86～152 g/L，平均 117 g/L；白蛋白 31.3～42.0 g/L，平均 36.2 g/L。术前美国麻醉医师协会（ASA）分级：Ⅱ级 28 例，Ⅲ级 23 例，Ⅳ级 13 例。谵妄患者 18 例（28.1%）。其中 40 例采用人工股骨头置换术治疗，24 例采用非手术治疗。所有患者随访至出院后 1 年，若患者死亡则以死亡为终点，观察记录患者出院后死亡率，单因素分析初步筛选死亡相关影响因素；进一步采用 logistics 回归行多因素分析，筛选死亡相关独立危险因素。 结果 患者住院时间 2～49 d，平均 19.4 d。所有患者均获随访，随访时间 1～12 个月，平均 10.1 个月。30 d 死亡率 10.9%（7/64），1 年死亡率 23.4%（15/64）。其中死于心力衰竭 5 例，呼吸衰竭 9 例，深静脉血栓形成 1 例。单因素分析显示，ASA 分级、合并症、入院后白蛋白及血红蛋白水平是老龄股骨颈骨折患者 1 年内死亡的影响因素（P<0.05）；进一步多因素分析显示，ASA 分级Ⅲ、Ⅳ级、合并症≥3 种、血红蛋白<120 g/L 是老龄患者 1 年内死亡的独立危险因素（P<0.05）。 结论 积极治疗老龄股骨颈骨折患者合并症，纠正营养状况，加强多学科协作，可降低死亡率。

人工全髋关节置换术治疗坏疽性脓皮病一例

Femoral Neck Fracture Treated with Close Reduction plus Cannulated Screw Fixation with Quadratus Femoris Muscle Pedicle Bone Grafting

目的 目前对青壮年有移位新鲜股骨颈骨折患者的治疗仍存在许多争议，被认为尚未完全解决难题之一，股骨颈骨折内固定术后常导致骨折不愈合股骨头缺血性坏死。 方法 2003年1月-2008年6月，收治青壮年新鲜移位股骨颈骨折患者12例，年龄17~55岁，平均36.3 岁。所有患者在受伤后1周内采用牵引下闭合复位空心钉内固定加股方肌骨瓣移植术治疗。术后随访1~5年，平均3.5年。 结果 12例患者均达骨性愈合，随访期内未出现股骨头缺血性坏死；术后采用Harris 髋关节评分标准进行评估，获优良10例，一般1例，差1例。 结论 青壮年新鲜有移位股骨颈骨折患者，采用牵引下闭合复位空心钉内固定加股方肌骨瓣转移术治疗效果良好，均能达到骨折愈合，且无股骨头缺血性坏死发生。

TREATMENT OF FRACTURE OF FEMORAL NECK IN THE AGED WITH ARTIFICIAL HIP JOINT REPLACEMENT

OBJECTIVE To evaluate the clinical effect of total hip joint replacement and hemiarthroplasty in treatment of fracture of femoral neck in old patients. METHODS One hundred and ten cases with femoral neck fracture in the aged, 70 to 106 years old, from Aug 1990 to Aug 1999 were reviewed, 96 cases were followed up, among which 52 cases received total hip joints replacement and the other 44 cases received hemiarthroplasty. All of the 96 cases were followed up for 15 to 112 months, averaged 51 months, and were evaluated in operation procedures, post-operative recovery and joint function according to Harris Scoring. RESULTS The operation time of total hip joints replacement was 20 minutes longer, bleeding volume was 120 ml larger, and post-operative drainage was 140 ml more, in average, than those in hemiarthroplasty. There was no obvious difference between the two types of operation in bed-resting time, length of stay and hospitalizing costs. According to Harris Scoring, there were 38 cases of excellent in hemiarthroplasty (86.4%) and 48 cases of excellent in total hip joints replacement (92.3%). CONCLUSION Both of the artificial joint replacements are reasonable choices for treatment of fracture of femoral neck in old patients, but total hip joints replacement is recommendable for those comparatively younger patients with good systematic status, and hemiarthroplasty is a good option for those elderly with some systematic diseases.

REPAIR OF FEMORAL NECK FRACTURE WITH VASCULAR PEDICLED PERIOSTEUM FLAP TRANSFER IN YOUNG AND MIDDLE-AGED

Objective To estimate clinical effect ofspin iliac deep vascular pedicled periosteum flap in repairing traumatic femoral neck of theca inside fracture in young and middleaged. Methods From April 1993 to September 2001, 12 cases of traumatic femoral neck fracture were given diaplastic operation with fixation of 3 centre hollow pressed bolt and were conducted under os traction bed and "C" arm X-ray machine. Spin iliac deep vascular pedicled periosteum flap wasstripped off, and transferred to the front of femoral neck fundus，then transplanted to the narrow inside of fracture through outer open door of articular capsule.Results All patients were followed up for 17 years. All fracture healedwithout femoral head necrosis, but mild arthritis appeared in 7 cases.Conclusion Vascular pedicled periosteum flap transfer of young and middle-aged femoral neck fracture, by decompression of femoral neck and reconstruction of blood circulation, can promote the fracture healing and decrease the wound and blood circulation destroy.

空心钉内固定加股直肌骨瓣移植治疗青壮年股骨颈骨折23 例

探讨一种治疗青壮年股骨颈骨折的方法。 方法 2000 年5 月－ 2005 年10 月，采用空心钉内固定加股直肌骨瓣治疗青壮年股骨颈骨折23 例。男16 例，女7 例；年龄21 ～ 45 岁，平均31.3 岁。车祸伤18 例，高处坠落伤5 例。左侧10 例，右侧13 例。骨折部位：头下型10 例，头下经颈型13 例。Garden 分型：Ⅲ型15 例，Ⅳ型8 例。 结 果 23 例患者术后获随访16 ～ 52 个月，平均26 个月。术后无感染、退钉、骨瓣松动等发生。22 例术后4 ～ 6 个月X 线片示骨折愈合；1 例术后8 个月X 线片示骨折未愈合，术后16 个月CT 及ECT 示股骨头坏死。髋关节功能按Harris 评分标准：优13 例，良8 例，差2 例，优良率91%。 结论 空心钉内固定加股直肌骨瓣移植能有效减少青壮年股骨颈骨折的骨折不愈合和股骨头坏死的几率。