数字剪影血管造影辅助肌骨瓣移植治疗股骨头坏死的疗效观察  

Digital subtraction angiography assisted musculoskeletal flap transplantation for the treatment of osteonecrosis of the femoral head

作　　者：浦路桥 崔轶 施荣茂 贺斌 孙寒 王波 徐永清 PU Luqiao;CUI Yi;SHI Rongmao;HE Bin;SUN Han;WANG Bo;XU Yongqing(Department of Orthopedics,the 920th Hospital of Joint Logistics Support Force,Kunming Yunnan,650032,P.R.China)

机构地区：[1]联勤保障部队第九二〇医院骨科,昆明650032

出　　处：《中国修复重建外科杂志》2021年第6期673-677,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：联勤保障部队第九二〇医院院内基金(2019YGD01)。

摘　　要：目的观察数字剪影血管造影(digital subtraction angiography,DSA)技术辅助肌骨瓣移植治疗股骨头坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。方法回顾分析2016年1月—2019年12月收治的15例15髋ONFH患者临床资料。患者均为男性,年龄20~45岁,平均31.6岁。病因:激素型9例,酒精型6例。病程15 d~3年,平均8个月。国际骨循环协会(ARCO)分期:Ⅱ期4髋,Ⅲ期11髋。术前疼痛视觉模拟评分(VAS)为(6.2±0.2)分,髋关节Harris评分为(57.3±1.3)分。术前行股骨头DSA检查确定股骨头血管病变部位,根据造影结果指导肌骨瓣移植术式的选择。对于股骨头上、下支持带血管均显影者行单纯髓芯减压术,对上支持带血管显影而下支持带血管未显影者采用前外侧入路的阔筋膜张肌骨瓣移植,对上支持带血管不显影而下支持带血管显影者采用经后外侧入路的股方肌骨瓣移植,对上、下支持带血管均未显影者行吻合血管的腓骨瓣移植。结果 15例15髋均获随访,随访时间6~24个月,平均14个月。随访期间患者ONFH未进一步加重,股骨头无塌陷,关节间隙正常,髋关节屈伸功能可。末次随访时,VAS评分为(1.9±0.2)分,髋关节Harris评分为(92.1±0.8)分,均较术前显著改善,差异有统计学意义(t=14.85,P=0.00;t=23.22,P=0.00)。结论对于需行肌骨瓣移植的ONFH患者,术前行股骨头DSA可明确股骨头血管病变部位,以此指导肌骨瓣移植术式的选择,对保髋手术具有重要意义。Objective To observe the effectiveness of digital subtraction angiography(DSA) assisted musculoskeletal flap transplantation in the treatment of osteonecrosis of the femoral head(ONFH). Methods The clinical data of 15 patients with 15 hips of ONFH admitted between January 2016 and December 2019 were retrospectively analyzed. All patients were male, aged 20-45 years, with an average age of 31.6 years. There were hormone type in 9 cases and alcohol type in 6 cases. The disease duration ranged from 15 days to 3 years, with an average of 8 months. The Association Research Circulation Osseous(ARCO) staging: 4 hips in stage Ⅱ, 11 hips in stage Ⅲ. The preoperative visual analogue scale(VAS) score was 6.2±0.2, and the Harris score of the hip joint was 57.3±1.3. Preoperative DSA examination of the femoral head was performed to determine the location of vascular lesions of the femoral head. According to the results of the angiography, the surgical selection of the musculoskeletal flap was guided. For the patients with both superior and inferior retinaculum vessels developed, simple core decompression was performed. For the patients with superior retinaculum vessels developed but inferior retinaculum vessels not developed, anterolateral tensor fasciae flap was used. For the patients whose superior retinaculum did not develop and the inferior retinaculum developed, posterolateral quadratus femoris flap was used. The fibular flap with anastomotic vessels was used in the patients whose superior and inferior retinaculum vessels were not developed. Results All 15 cases of 15 hips were followed up 6-24 months, with an average of 14 months. During the follow-up, the patient’s ONFH did not worsen, the femoral head did not collapse, the joint space was normal, and the hip joint fextion and extension function was acceptable. At last follow-up, the VAS score was 1.9±0.2, and the hip Harris score was 92.1±0.8, both of which were significantly improved when compared with preoperative ones(t=14.85, P=0.00;t=23.22, P=0.00). Conc

关 键 词：股骨头坏死 数字剪影血管造影 肌骨瓣移植 

分 类 号：R687.3[医药卫生—骨科学]