双支撑骨柱移植术治疗成人晚期股骨头缺血性坏死（附22例报告）  

The Use of Double Strut Bone Garft for the Treatment of Advanced Osteoncerosis of the FemoralHead in Adults:A Report of 22 Cases

作　　者：王义生[1] 张春霖[1] 王利民[1] 皮国富[1] 左铁臣[1] 张毓洲[1] 翟福英[1] 许振华[1] 

机构地区：[1]河南医科大学第一附属医院骨科

出　　处：《中华骨科杂志》1995年第9期584-587,共4页Chinese Journal of Orthopaedics

基　　金：河南省医药卫生重点科研课题

摘　　要：临床上股骨头缺血性坏死日渐增多，治疗方法很多，但由于未能去除坏死骨或去除坏死骨不彻底，或植入骨瓣较小，对晚期病例的效果不令人满意。作者设计一种新术式“双支撑骨柱移植术”：骨髓团＋火柴棒状髋骨条＋髂骨骨柱＋带股方肌蒂骨柱。自１９８８年３月～１９９５年６月治疗成人晚期（ＩＩＩ～Ｖ期）患者３８例４５髋。随访２年以上者２２例２７髋，男１６例，女６例；平均年龄３６．５（１８～５９）岁，平均病史２．６（０．５～１０）年。其中，ＩＩＩ期１１髋，ＩＶ期８髋，Ｖ期８髋。术后平均随访３．２（２～７）年，优良率为９６．３％。此新术式的优点为：（１）彻底清除坏死骨；（２）双骨柱粗大长，支撑力量强大，恢复正常生物力学性能；（３）带股方肌蒂骨柱血运充足，利于新骨形成；（４）植入新骨丰富；（５）开窗减压，加之股方肌蒂骨柱的血运，恢复股骨头的骨内外血流动力学平衡；（６）股骨头内再骨化（新生）加速。AbstractDespite the increasing incidence of avascularosteonecrosis of the femoral head,the results oftreatment have been disappointing,because of theinadequacy of bone removal and the small size of thebone graft.A new technique has been developed bythe authors,using the double bone graft, marrowballs, iliac bone chips,iliac strut and pedicle strutgraft of quatratus femoris muscle。From March l988to June l995,a total of 45 hips in 38 adult patient withadvanced stage(3～5)were so treated.27 hips in 22patients were followed-up for more than 2 years。There were l6 males and 6 females with a mean age of36.5 years(18～59)and a history of 2.8 years inaverage(0.5～10).11 hips were in stage 3,8 hips instage 4 and 8 hips in stage 5.The period ofpostoperative follow-up studies varied from 2～7 yearswith an average of 3.2 years. The rate of excellentand good results was 96.3%。The advantage of thismethod were:(1)complete removal of the necroticbone;(2)the long big,wide double strut bone graftsare strong enough to sustain loading and to recover thenormal biomechanics of the hip;(3)the quadratusfemoris muscle pedicled bone graft with its sufficientblood supply is beneficial for new bone formation inthe femoral head;(4)the intraosseous pressure isdecreased by the fenestration and the balance ofhemodynamics both inside and outside of the femoralhead were recovered.(5)the reossification within thefemoral head was enhanced。

关 键 词：双支撑骨柱 移植术 股骨头坏死 缺血性坏死 

分 类 号：R681.805[医药卫生—骨科学]