带肌蒂双血供大转子骨瓣移植治疗股骨头缺血性坏死  

Treatment of avascular necrosis of the femoral head with greater trochanter bone flap with pedicled muscle and double blood vessels

作　　者：吕晓龙[1] 侯明亮[2] 

机构地区：[1]河南省商丘市第一人民医院骨科,河南商丘476100 [2]商丘医学高等专科学校,河南商丘476100

出　　处：《中国医药导报》2008年第31期5-6,25,共3页China Medical Herald

摘　　要：目的:探讨带肌蒂双血供大转子骨瓣移植治疗股骨头缺血性坏死(ANFH)的临床效果。方法:采用带肌蒂双血供(旋股外侧血管横支和升支臀中肌支血管)大转子骨瓣移植的方法治疗ANFH患者55例,术后随访3年,采用数字减影血管造影(DSA)检查术后股骨头血运和微循环重建情况,参照百分法进行疗效评价。结果:55例患者中有11例术前和术后随访做了数字减影血管造影(DSA)检查,患者术后股骨头血供恢复,微循环开始重新建立。术前与术后随访3年比较,患髋临床评价、X线评价、总分差异有统计学意义(P<0.01);总体比较期别间的疗效分级,差异亦有统计学意义(χ2=21.14,P<0.01)。结论:带肌蒂双血供大转子骨瓣移植术植入的骨瓣承担起良好的机械支撑力,并促进骨修复,重塑股骨头高度及其外形。此治疗方法预后与ANFH的世界骨循环研究学会(ARCO)期别有关。因此,此手术尤适用于Ⅱ期和Ⅲ期的早期ANFH。Objective：To study the clinical effects of greater trochanter bone flap with pedicled muscle and double blood vessels for the treatment of avascular necrosis of the femoral head （ANFH）. Methods： 55 patients with ANFH were treated by surgery with greater trochanter bone flap with pedicled muscle and double blood vessels, and all patients were followed up for 3 years. Digital subtraction angiography （DSA） was used to evaluate the microcirculation and blood supply of femoral head, and percentage method was employed to judge the clinical effects. Results： 11 cases in 55 took DSA examination, results showed that their femoral head blood supply recovered well, and microcirculation had been reconstructed. Clinical evaluation, X-ray evaluation and total scores of patients 3 years after the follow-up were significantly increased compared with those before the operation（P〈0.01）. The effect among the stages showed a marked difference（X^2=21.14, P〈0.01）. Conclusion： The transplantation of greater troehanter bone flap with pedicled muscle and double blood vessels is an effective treatment for ANFH, blood supply and microcireulation reconstruction of femoral head are confirmed. The progno- sis is related to the Association Research Circulation Osseous（ARCO）stage. Therefore, this operation is suitable for the early ANFH of stage Ⅱ and Ⅲ.

关 键 词：股骨头缺血性坏死 骨瓣移植 大转子 肌蒂 

分 类 号：R681.3[医药卫生—骨科学]