不断股直肌起点髋前侧入路行吻合血管游离腓骨治疗股骨头坏死的解剖学研究  

Anatomical research on free vascularized fibular grafting treatment with modified anterior approach for femoral head osteonecrosis without detaching rectus femoris

作　　者：徐佩君[1] 盛加根[1] 徐镇[1] 吴昊[1] 徐海涛[1] 徐斌[1] 张长青[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华关节外科杂志（电子版）》2014年第5期13-15,共3页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：上海市科委医学重点项目(1411950400)

摘　　要：目的：探讨在保持股直肌完整前提下，经髋关节前侧手术入路行股骨头坏死病灶清除吻合血管游离腓骨移植术治疗股骨头坏死的可行性。方法自2012年06月至2013年06月，选择本组采用常规髋关节前侧入路行股骨头坏死病灶清除吻合血管游离腓骨移植术治疗股骨头坏死病例53例共67髋。男38例（49髋），女15例（18髋）；年龄22～57岁，平均37.4岁；身高150～192 cm，平均171.9 cm；体重45～92 kg，平均70.0 kg；身高体重指数（ BMI）值为17.1～30.7，平均23.6。在显露股直肌后，观察记录支配股直肌神经的走行和入肌点位置、旋股外侧动、静脉升支的走行和距离股直肌起点距离以及股直肌与切口和髋关节的相对位置关系。结果（1）支配股直肌的神经由股神经分支发出，走行于缝匠肌深面，自内上方走向外下方，在入股直肌前分为两支神经支，外上支于股直肌内侧深面入肌，入肌点距髂前下棘下方（7.07＆#177;1.14） cm；内下支切口内未见。将股直肌向外侧牵开可见股直肌外上支张力增大，向内拉开则张力减小。（2）旋股外侧动、静脉升支发自股深动脉，经缝匠肌及股直肌深面、髂腰肌前面向外上走行至股中间肌前侧，旋股外侧动、静脉升支血管束中点距髂前下棘下方（6.16＆#177;0.52）cm。所有病例向内拉开股直肌均可很好地显露旋股外侧动、静脉其分支血管束全长。（3）股直肌直头起于髂前下棘，约1/4～1/5肌纤维位于切口线外侧，其余部分位于切口线内侧。股直肌肌腹遮挡髋关节头颈交界处内侧约1/3～1/2部分。结论（1）沿股直肌外侧间隙将股直肌向内侧牵开暴露髋关节，可保护位于内侧的血管神经束，为手术安全间隙。（2）股直肌对于髋关节遮挡较少，大部分肌纤维位于髋关节内侧，向内拉开股直肌可完全显露旋股外侧动、静脉升支及髋关节，故不�Objective To explore the feasibility of the free vascularized fibular grafting （ FVFG） by hip anterior approach for the treatment of osteonecrosis of the femoral head （ ONFH） under the premise of maintaing the intergrity of the rectus femoris（ RF） .Methods fifty three patients with total 67 hips who adopted FVFG treatment for ONFH were collected from June 2012 to June 2013, including 38 male patients （49 hips） and 15 female patients （18 hips）, with a mean age of 37.4 years （22-57）;the average height was 171.9 cm （150-192 cm）;the average weight was 70.0 kg （45-92 kg）;and the average BMI was 23.6 （17.1-30.7）.The distance between the nerve entering point of RF and the anterior inferior spine, the distance between the lateral femoral circumflex artery and the anterior inferior spine, the relative location of the RF fiber and hip joint, and the relative location of the RF fiber and the incision line were recorded and observed after the exposure of RF.Results （1） The innervations of the RF has two primary branches before entering the muscle.The upper anterior branches enter the muscle medially to RF, and the entering point is （7.07 ＆#177;1.14） cm inferior to the anterior inferior spine; the lower posterior innervation branches are not obeserved from the incision site.（2） The lateral femoral circumflex arteriovenous vessels come from the deep femoral arteriovenous vessels and go into the superficial vastus intermedius muscle.The distance from the center point of the lateral femoral circumflex artery to the anterior inferior spine is （6.16 ＆#177; 0.52） cm.The medial traction of the RF can expose full length of the lateral femoral circumflex arteriovenous vessels.（3） Only 1/4~1/5 of the RF fibers are outside the incision line.The RF fibers cover 1/3~1/2 interior part of the femoral head and the neck border.Conclusion Because RF covers only little part of the hip joint, the medial traction of the RF can both fully expose the hip joint and protect the nerve bundles

关 键 词：髋关节 前侧入路 股骨头坏死 

分 类 号：R687.3[医药卫生—骨科学] R322[医药卫生—外科学]