旋髂浅动脉联合缝匠肌蒂髂骨瓣治疗青壮年股骨颈骨折  

The use of iliac flap pedicled with superficial circumflex iliac artery and sartorius in treatment of femoral neck fracture of young adults

作　　者：左荣跃[1] 陈一勇[2] 史增元[1] 毛海蛟[1] 尹维刚[2] 林荣[2] 丁杰[2] 刘振新[1] Zuo Rongyue;Chen Yiyong;Shi Zengyuan;Mao Haijiao;Yin Weigang;Lin Rong;Ding Jie(Department of Orthopaedic Surgery,Affiliated Hospital of Medical School of Ningbo University,Ningbo,ZhejiangProvince 315020,China;Department of A natomy of Medical School,Ningbo University,Ningbo,Zhejiang Produce315211,China)

机构地区：[1]宁波大学医学院附属医院骨科,315020 [2]宁波大学医学院解剖学系,315211

出　　处：《中华显微外科杂志》2019年第3期254-257,共4页Chinese Journal of Microsurgery

摘　　要：目的探讨旋髂浅动脉联合缝匠肌蒂髂骨瓣移植治疗青壮年股骨颈骨折的解剖与临床疗效.方法从2012年4月至2017年3月,对50侧经动脉灌注红色乳胶的成人尸体下肢标本,解剖观测旋髂浅动脉、缝匠肌的动脉来源、外径、走行与分布.设计旋髂浅动脉联合缝匠肌蒂髂骨瓣移植治疗青壮年股骨颈骨折11例,其中男9例,女2例,年龄16~54岁,平均34.5岁.GardenⅢ型骨折4例,Ⅳ型7例.门诊定期随访.结果旋髂浅动脉起源于股动脉,起始处外径(1.2±0.3)mm,起点至髂前上棘(8.8±1.3)cm,其走行至髂前上棘区并发出1~3条分支入髂嵴.缝匠肌起于髂前上棘,近段动脉来源于旋髂浅动脉和股动脉,动脉呈节段性进入缝匠肌并在肌内形成链型吻合营养髂骨瓣.临床应用旋髂浅动脉联合缝匠肌蒂髂骨瓣移植治疗青壮年股骨颈骨折11例,术后切口全部一期愈合.术后随访16~42个月,平均32.3个月,骨折全部愈合,愈合时间3~7个月,平均4.6个月.末次随访时髋关节Harris评分为(93.02±5.33)分:优7例、良4例.所有患者均无骨折不愈合、股骨头坏死等并发症发生.结论旋髂浅动脉联合缝匠肌蒂髂骨瓣移植治疗青壮年股骨颈骨折手术简便,骨瓣血供丰富,有利于促进骨折愈合、减少股骨头坏死的发生,是治疗青壮年股骨颈骨折的一种有效方法.Objective To investigate the effect of iliac flap pedicled with superficial circumflex iliac artery and sartorius in the treatment of femoral neck fracture of the young adults.Methods From April,2012 to March,2017,50 cadaveric lower limbs were injected with red latex,and the origin,diameter,course and distribution of the superficial circumflex iliac artery and arteries of the sartorius were observed.The iliac flap pedicled with superficial circumflex iliac artery and sartorius was used to treat the femoral neck fracture in young adults in 11 cases.There were 9 males and 2 females with an average age of 34.5(ranged from 16 to 54) years.The fractures were classified ac cording to Garden:4 cases of type Ⅲ and 7 cases of type Ⅳ.Regular outpatient follow-up was made.Results The superficial circumflex iliac artery originated from the femoral artery and the initial diameter was (1.2±0.3) mm.The length of the superficial circumflex iliac artery to the anterior superior iliac spine was (8.8±1.3) cm.The superficial circumflex iliac artery run to the anterior superior iliac spine and sent 1-3 periosteal branches into the iliac crest.The sartorius originates from the anterior superior iliac spine,and its proximal artery arises from the superficial circumflex iliac artery and the femoral artery.Link-pattern arterial anastomosises were formed in sartorius by branches of adja cent vascular pedicles,which nourished the ilium flap.All incisions healed by first intention.All cases were followedup from 16 to 42 months,with an average of 32.3 months.All fractures healed for 3-7 months,with an average of 4.6 months.No fracture nonunion,femoral head necrosis and other complications occurred.Harris hip scores was 93.02± 5.33.Seven cases were excellent and 4 cases were good.Conclusion The iliac flap pedicled with superficial cir cumflex iliac artery and sartorius has rich blood supply,easily performed conducive to promoting fracture healing,and reducing the occurrence of femoral head necrosis.It is an effective method for the tre

关 键 词：旋髂浅动脉 缝匠肌 髂骨瓣 股骨颈骨折 移植 

分 类 号：R687.3[医药卫生—骨科学]