一种带旋髂深血管髂骨瓣的切取新方法——"逆行解剖切取法"  

A new surgical technique for dissecting iliac bone flap with deep iliac circumflex vessel—retrograde anatomical method

作　　者：吴攀峰[1] 唐举玉[1] 卿黎明[1] 曹哲明 肖禹 张兴 WU Panfeng;TANG Juyu;QING Liming;CAO Zheming;XIAO Yu;ZHANG Xing(Department of Hand and Microsurgery,Xiangya Hospital of Central South University,Changsha 410008,China;Department of Hand and Microsurgery,Zhanhe Orthopaedics and Traumatology Hospital,Pingdingshan,He’nan Province 467000,China)

机构地区：[1]中南大学湘雅医院手显微外科,长沙410008 [2]河南省平顶山市湛河骨伤科医院手显微外科,河南平顶山467000

出　　处：《中华显微外科杂志》2023年第1期82-88,共7页Chinese Journal of Microsurgery

基　　金：国家自然科学基金(81871577,81901978,82072194)。

摘　　要：目的介绍一种带旋髂深血管髂骨瓣的切取新方法——"逆行解剖切取法",报道该方法的初步应用效果。方法2018年6月至2021年5月,中南大学湘雅医院手显微外科共收治股骨头缺血性坏死患者15例,应用"逆行解剖切取法"切取带旋髂深血管髂骨瓣,术中于髂结节、髂骨内侧附近寻找合适的皮肤穿支或肌支,应用显微剪和显微蚊氏钳逆血管分支由表至里分离解剖至旋髂深血管起始部,然后骨刀凿取髂骨瓣,髂骨瓣嵌入股骨头内,吻合旋髂深血管与旋股外侧血管横支。术后通过门诊随访患者并总结该方法的初步应用效果,术前、术后Harris评分采用配对t检验,P<0.05为差异有统计学意义。结果本组髂骨瓣切取长度为3.0~5.0(4.0±0.5)cm,血管蒂长度为4.0~7.0(5.3±1.0)cm;髂骨瓣切取时间35~55(45.0±6.1)min;术中旋髂深血管髂骨瓣切取成功率为100%,所有髂骨瓣断蒂前骨面渗血活跃;术中自体血回输量为100~400(226.7±78.2)ml。术中1例出现股外侧皮神经牵拉伤,术后第1天出现大腿前外侧区域麻木,术后4个月麻木症状得到缓解,其余14例患者术后均未出现大腿前外侧区域麻木等症状。术后髂骨瓣供区引流量为50~70(62.7±7.5)ml,髂骨瓣供区切口均I期愈合。术后随访3个月~3年,髂骨瓣供区均未出现切口疝等并发症;术后9、12、18个月Harris评分分别与术前比较,差异均有统计学意义(P<0.05),18个月后基本达到较好的水平。结论"逆行解剖切取法"切取带旋髂深血管髂骨瓣能快速确定髂骨瓣的营养血管,操作相对简单,解剖安全可靠,增加了手术的成功率,减少了供区的损伤及术后的并发症,值得临床推广应用。Objective To introduce a new surgical procedure for harvesting an iliac bone flap with deep iliac circumflex vessels—"retrograde anatomical method",and report the effect of preliminary application with this procedure.Methods From June 2018 to May 2021,15 patients who admitted in the Department of Hand and Microsurgery,Xiangya Hospital of Central South University received surgeries of iliac bone flap with deep iliac circumflex artery by"retrograde anatomical method".During the surgery,appropriate cutaneous perforators or muscular branches were found near the medial side of the iliac bone of iliac tubercle.The branches were dissected from surface inwards to the starting point of deep circumflex iliac blood vessel with microsurgery and micro Schlieren forceps.The iliac bone flap was chiselled out,inserted into femoral head,and then anastomosed with the transverse branches of deep circumflex iliac blood vessel and lateral circumflex femoral blood vessel.All patients were included in the postoperative follow-up at the outpatient clinic to evaluate the preliminary effect of this procedure.Harris scores before and after surgery were assessed with paired t test.P<0.05 was considered statistically significant.Results The length of iliac bone flap was at 3.0-5.0(4.0±0.5)cm,and the length of vascular pedicle was at 4.0-7.0(5.3±1.0)cm.The time of iliac bone flap harvest was 35-55(45.0±6.1)minutes.During the operation,the success rate of harvesting iliac bone flap with deep iliac circumflex artery was 100%,and blood had oozed out of bone surface before the pedicle of all iliac bone flaps was cut-off.The volume of intraoperative autologous blood transfusion was 100-400(226.7±78.2)ml.One patient suffered from traction injury of lateral femoral cutaneous nerve in the operation.The numbness of anterolateral thigh area occurred on the 1st day after the surgery,and relieved 4 months later.Other 14 patients did not suffer from postoperative numbness in the area of anterolateral thigh.The amount of drainage from donor site for

关 键 词：旋髂深动脉 髂骨瓣 逆行解剖切取法 供区损害 移植 

分 类 号：R687.3[医药卫生—骨科学]