髓芯减压缝匠肌髂骨瓣移植治疗青壮年股骨头缺血性坏死  

TREATING AVASCULAR NECROSIS OF FEMORAL HEAD IN YOUNG ADULT BY GRAFTING SARTORIUS MUSCLE ILIAC BONE FLAP

作　　者：周林军[1] 谭均[1] 李永奎[1] 许冰[1] 胡勇[1] 

机构地区：[1]成都市第五人民医院骨科,成都611130

出　　处：《中国修复重建外科杂志》2007年第8期814-816,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨和总结青壮年股骨头缺血性坏死的有效治疗方法。方法1994年9月～2003年8月,对68例75侧青壮年股骨头缺血性坏死患者行髓芯减压的同时清除股骨头内纤维组织及坏死骨,取缝匠肌髂骨瓣植入股骨头内。其中男57例63侧,女11例12侧;年龄16～58岁,平均42.5岁。左侧31例,右侧37例,双侧7例。致病原因:长期饮酒52例,长期服用激素6例,髋部外伤6例,不明原因4例。病程8个月～4年。Ficat分期:期10例11侧,期27例31侧,期31例33侧。结果术后68例获2年6个月～11年随访,平均5.2年。按Harris髋关节评分,优23例,良33例,可10例,差2例,术后无1例复发,优良率82.3%。结论股骨头髓芯减压法具有清除病灶彻底、减压充分、重建股骨头的血循环等特点,缝匠肌髂骨瓣植骨为股骨头带入成骨成分、血液供应,可加速骨的重建,适用于青壮年股骨头缺血坏死Ficat分期、、期患者,是一种较为有效的治疗方法。Objective To explore an improved method of treating avascular necrosis of the femoral head in young adults by grafting the sartorius muscle iliac bone flap. Methods From September 1994 to August 2003, 68 patients （57 males, 11 females ; age, 16-58 years） underwent of the transplant the sartorius muscle oliac bone flap into the femoral head after decompression of the femoral head medullary core and removal of the dead bone and the fibrous tissue in the femoral head. The transplantation was performed on 31 patients left-unilaterally, on 37 patients rightunilaterally, and on 7 patients bilaterally. The pathological causes were as follows ： alcoholism in 52 patients, prolonged use of hormones in 6, trauma in the hip in 6, and undetermined cause in 4. Their illness course ranged from 8 months to 4 years. According the Ficat staging, 10 patients belonged to Stage Ⅰ （11 sides）, 27 patients to Stage Ⅱ （31 sides）, and 31 patients to Stage Ⅲ （33 sides）. Results The follow-up of the 68 patients for 2. 5-11 years averaged 5.2 years revealed that based on the Harris evaluation for the hip function, 23 patients had an excellent result, 33 had a good result, 10 had a fair result, and 2 had a poor result. The excellent and good results accounted for 82.3%. There was no recurrence after operation. Conclusion This method has the following advantages： the lesion focus can be eradicated; enough decompression can be achieved, and the blood circulation for the femoral head can be rebuilt. The grafting of the sartorius muscle iliac bone flap can bring the osteogenesis components to the femoral head, promoting the reconstruction of the bones. This method is suitable and effective for the patients with avascular necrosis of the femoral head （Ficat Grades Ⅰ,Ⅱ and Ⅲ ） in young adults.

关 键 词：股骨头缺血性坏死 髓芯减压 缝匠肌髂骨瓣 青壮年 

分 类 号：R687.3[医药卫生—骨科学]