Femoral musculoskeletal bone flap and cannulated screw for the treatment of 23 cases of femoral neck fracture in young adults Liu Hua Chen Baoguang Qiu Yijun Feng Yi Chen Zhuang Youth and femoral neck fracture nonunion and avascular necrosis of the femoral head are higher, the treatment is difficult. According to reports, the incidence of nonunion of femoral neck fracture in young adults is 59, and the rate of avascular necrosis of the femoral head is 60. From the end of 94 to the end of 1999, 23 patients with femoral neck fractures were treated with blood muscles and muscle screws and cannulated screws. Good curative effect, the treatment results are reported as follows: 1. General information: 15 males, 8 females, 2548 years old, average 38.5 years old, 8 cases of neck fracture, 4 cases of head and neck, 4 cases of head and neck For the extracontinental fracture, 4 cases were accompanied by comminuted fracture of the femoral neck, and 1 case was a bone cyst at the junction of the femoral head and neck and pathological fracture. After preoperative bone traction for 25 days, the fracture of the fracture was basically restored. Under the epidural anesthesia, the posterior lateral incision was used to open the reduction and the compression of the cannulated bone and the periosteum of the femoral muscle. . After the incision is healed, the simple hip-shaped gypsum external fixation is performed, and the monthly retest is performed. After the back fold line is blurred, the plaster is removed, and the crutches are not loaded with heavy weight. The fracture line of this group is blurred about 3 months after surgery. Walking in the negative city, after 6 and 7 months, the fracture line disappeared, the bones healed, and weight-bearing walking began. At 6 months of follow-up, there was no case of aseptic necrosis of the femoral head of the cattle. The internal and external rotation of the hip flexion and extension was particularly clear, the obstacle was not painful when walking, and the effect was satisfactory. 1 The surgical method was performed after the anesthesia was effective. In the supine position, the posterior lateral approach is used to cut the gluteus maximus to protect the sciatic nerve. Discrimination, after the femoral muscle, cut 1 ligature to its external rotation muscle fracture end, cut 5, 2 between the rotor, the periosteal width of the periosteum with the femoral muscle 4, protect the reserve. Cut the switch capsule, cut the fracture end, restore under direct vision, restore the anatomical relationship of the femoral neck, fix with a hollow compression screw, open the bone groove slightly larger than the bone flap behind the femoral neck, the depth of the femoral head will be The bone of the femoral head was inserted into the bone groove and embedded in the bone groove. The bone flap was fixed with screws. The periosteum was embedded in the fracture end, and the incision was closed layer by layer. The postoperative gypsum was fixed in the abduction 20. The neutral position was healed in the incision. . Changed the hip herringbone gypsum tube shape.
Discussion of femoral pre-fracture is prone to nonunion and aseptic necrosis of the femoral head, which is harmful to young and healthy diseases. The treatment methods are diverse, and the clinical efficacy reports are quite different. For a degree of femoral neck fracture, the effect of good rape can be achieved by closing the needle. For the 01 Han degree femoral neck fracture, it is recommended to perform an open reduction and blood vessel bone graft. In this case, a hollow compression screw and a pedicled periosteum bone flap were used to treat the femoral neck fracture, and good results were obtained. The upper part of the piece of the screw is parallel, the lateral piece is chamfered, the nail body is located in the femoral neck internal trabecular bone or the pressure trabecular bone and the femur distance, the fracture end gap disappears, the fixation is reliable, and it is beneficial to the healing of the fracture stage. And prevention of nonunion occurred in 23 cases of this group, the bone fracture healed within half a year, followed up for 6 months, no previous case of aseptic necrosis of the femur, no significant obstacles in hip flexion and internal and external rotation activities, Not accompanied by hip pain during walking, the effect is satisfactory.
Avascular necrosis of the femoral head is the main cause of nonunion. The femoral and trochanter blood supply is rich in vascular anastomosis, forming a complete vascular network around the femoral muscle. The muscles of the femoral muscles are wide, no tendons, and the muscles of the blood vessels are constant, and have a certain length and caliber. The distance from the femoral neck is relatively close. Surgery, bone flap and fracture reduction are fixed in the same incision. After the bone brewing of this group, the bone and the oozing blood are active. Similarly, the cannulated nail can decompress the femoral head and prevent the formation of intramedullary hypertension. Therefore, this method is effective for the healing of the blood vessels that promote the fracture of the femoral head. Avascular necrosis of bone has a good therapeutic effect and satisfactory curative effect.
During operation, it should be noted that the width of the bone flap is cut at 2 cm and the periosteum width is about 4 cm. The pedicle periosteum bone flap is formed. When the bone flap is implanted into the bone groove, the fracture end of the fracture is embedded with the periosteum to accelerate the fracture healing speed and shorten the fracture. Healing time 2 in the free process of the femoral muscle, please reduce the damage to the ventral and superior blood vessels of the pedicle, and ensure that the bone flap is oozing and leaching; 3 hollow compression nails make the fracture end joint stable, avoiding long time outside The occurrence of fixation and osteoporosis is beneficial to the early healing and functional exercise of the fracture.
1 Wu Renxiu. Surgical anatomy of the musculoskeletal flap. Chinese Journal of Microsurgery, 1986, 2, 98.
2 Wang Shizhen, Hu Jiatun. Microanatomy and clinical application of the femoral artery. Chinese Journal of Orthopaedics, 1987, Xinjiang, Department of Surgery, The Tenth Hospital of Jiefangping
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