带阔筋膜张肌髂骨瓣移植治疗股骨头缺血性坏死  

The vascular pedicled iliac crest grafting with musculus tensor fasciae latae transplant to repair and treat avascular necrosis of the femoral head

作　　者：张晓文[1] 张春[1] 郭峭峰[1] 马苟平[1] 沈立锋[1] 俞华军[1] 

机构地区：[1]浙江省立同德医院,浙江杭州310012

出　　处：《中国骨伤》2007年第8期525-526,共2页China Journal of Orthopaedics and Traumatology

摘　　要：目的：探讨带阔筋膜张肌骨瓣移植结合软骨下微骨折技术在促进修复、治疗股骨头缺血性坏死的疗效。方法：股骨头缺血性坏死患者37例,男24例,女13例;年龄17-51岁,平均37岁。FicatⅠ期13例,Ⅱ期15例,Ⅲ期9例。5例为双侧发病。均经非手术治疗6-49个月后采用股骨颈开槽并去除硬化及囊性变之股骨头软骨下骨后嵌入带阔筋膜张肌骨瓣,清理坏死区域,使用2mm克氏针作锥入孔,直至有血液及脂滴自孔中溢出。术后使用CPM机康复训练,3个月内禁负重,3个月后先后经双拐、单拐、手杖辅助行走,1年后正常行走。结果：所有病例随访1-10年,平均3.4年。髋关节Harris评分,优24例,患髋无疼痛;良8例,患髋活动时疼痛明显减轻,偶服用止痛药;可3例,症状有所缓解,但仍需服用止痛药,后期行人工关节置换术后恢复正常活动。结论：应用带阔筋膜张肌骨瓣移植结合软骨下微骨折技术治疗能有效地改善股骨头的血供,促使坏死软骨面的再生修复。Objective： To investigate the clinical effects of using the vascular pedicled iliac crest graft with musculus tensot fasciae latae transplant to repair and treat avascular necrosis of the femoral head. Methods： There were 37 patients with avasular necrosis of the femoral head involving 24 male and 13 female ,the age ranged from 17 to 51 years （37 years on average）. In 13 patients the necrosis was classified as Ficat Stage Ⅰ,in 15 patients as Stage Ⅱ ,and in 9 patients as Stage Ⅲ. Five patients had necrosis lesion of both femoral head. All patients took conservative treatment for 6 to 49 months, and then removed the sclerotized and cystis degenerative bone in the femoral head after excavating a channel in the femoral neck, transplanted the vascular pedicled iliac crest strut graft to the channel ,used diameter of 2 mm Kirschner wire to burr hole at the femoral head. All patients gained rehabilitation with CPM after operation ,weight loading was forbidden in the first three months, and then patients walked with the help of double and simple walking stick and hand crutch progressively. Results： All patients were followed up for 1 to 10 years,3.4 years on average. Clinical results according to the Harris hip score were excellent in 24 patients,the trouble hip had no pain; good in 8 patients, the pain of the trouble hip relieved obviously and the patients would take pain-killer now and then; in 5 patients showing the fair results, the pain relieved partially and the patient still need pain-killer, but the problem can be solved by the total hip joint replacement at last. Conclusion ： Using iliac crest graft with musculus tensot fasciae latae transplant combining hypo-cartilage micro-fracture can improve the blood supply to femoral head and promote regenerating and repair avascular necrosis of the femoral head.

关 键 词：股骨头坏死 微骨折 阔筋膜张肌 骨移植 

分 类 号：R683.42[医药卫生—骨科学]