Sartorius Musculoskeletal Flap Transfer for Treating Old Femoral Neck Fracture Among Young Adults
1.Department of Orthopedics，Central Hospital of Xianning，the 1st Affiliated Hospital of Hubei University of Science and Technology
2.Southern Medical University
Abstract：Objective To explore the early and medium-term effect of sartorius musculoskeletal flap transfer for treating old femoral neck fracture among young adults.Methods 11 cases (7 males and 4 females) with old femoral neck fracture were admitted to our department from July 2009 to July 2016，with a mean age of 32.8 years old (18～46 years old) and a mean time of injury of 10.3 weeks(8～18 weeks).Injury causes included traffic accident (9 cases) and high falling accident (2 cases).Garden classification was as follows：I (0 case)，Ⅱ(1 case)，Ⅲ(1 case) and Ⅳ(3 cases).All patients underwent open reduction and internal fixation with 3 hollow lag screws through Smith-Petersen approach.A bone groove of 4.0 cm ×1.5 cm×1.0 cm was made with the anterior facture line of femoral neck as the center，then a sartorius muscle iliac flap was transplanted into the groove and fixed with full thread absorbable screws.Anteroposterior and lateral X-ray films of the hip joint were observed to evaluate facture healing and Harris hip score within 3 days，1 month，3 months，6 months，12 months and 24 months after operation，respectively.Results Among the 11 patients，1 patient died in an accident and lost to follow up，while 10 patients were followed up completely，with an average follow-up period of 38.3 months (13～83 months).Femoral neck fracture was healed in these 10 patients，with a mean healing time of 11.2 months (9～15 months).Lateral-superior femoral head collapse was found in 1 patient at 12 month follow-up，with no joint space narrowing.However，due to obvious hip joint pain，the patient underwent total hip replacement.The average Harris scores of the affected hip joint three days，1 month，3 months，6 months，12 months and 24 months after operation were 73.4，76.1，75.3，86.6，89.6 and 90.7，respectively.Conclusion Sartorius muscle blood supply appears to be segmental and vessels can be reserved.It is possible to perform sartorius musculoskeletal flap transfer in order to improve the blood supply of the fracture end and promote the healing of old femoral neck fracture among young adults.
［1］Gautam VK，Anand S，Dhaon BK.Management of displaced femoral neck fractures in young adults (a group at risk)［J］.Injury，1998，29(3)：215-218.
［2］李俊明，彭高峰，宛磊，等.旋髂深血管蒂髂骨瓣在青壮年陈旧性股骨颈骨折中的应用［J］.中国骨与关节损伤杂志，2014，29 (8)：809-810.
［3］王春生，王坤正，党晓谦，等.腓骨联合髂骨移植治疗陈旧性股骨颈骨折［J］.中国修复重建外科杂志，2013，22 (3)： 318-320.
［4］赵智君，陈浩，邓玉海，等.股方肌骨瓣治疗青壮年陈旧性股骨颈骨折的临床研究［J］.中国骨与关节损伤杂志，2014，29 (2)： 171-172.
［5］Harris WH.Traumatic arthritis of the hip after dislocation and acetabular fractures：treatment by mold arthroplasty.An end-result study using a new method of result evaluation［J］.J Bone Joint Surg(Am)，1996，51(4)：737-755.
［6］张长青，王坤正，曾炳芳，等.应用吻合血管的游离腓骨移植治疗陈旧性股骨颈骨折［J］.中华创伤骨科杂志，2011，6(8)：858-860.
［7］吴水清，贾明锁，葛玉霞，等.带旋髂深血管蒂髂骨瓣植骨治疗成人股骨颈骨折［J］.中国矫形外科杂志，2013，7 (5)： 490-491.
［8］尚宏喜，刘安庆，肖德明.腓骨带血管移植联合加压螺纹钉固定治疗高危型青壮年股骨颈骨折16例［J］.实用医学杂志，2012，24 (8)：1364-1366.
［9］张建国，肖湘，张铁良.带旋髂深血管蒂髂骨瓣植骨治疗青壮年陈旧性股骨颈骨折［J］.中华骨科杂志，2015，26 (7)：468-471.
［10］孙锋，黄东，吴伟炽，等.缝匠肌穿支皮瓣的应用解剖学研究［J］.中国临床解剖学杂志，2012，30(3)： 268-270.
［11］王坤正，王春生，杨万石，等.青壮年股骨颈骨折的手术治疗［J］.中国矫形外科杂志，2015，2 (2)：77-78.
［12］李芸，杜璠.臀上动脉臀小肌大粗隆骨瓣治疗陈旧性股骨颈骨折20例分析［J］.中国骨与关节损伤杂志，2010，25 (10)：930-931.
晋公网安备 14010702070875号