保留股骨头后上支持动脉的股方肌骨瓣治疗股骨头坏死的解剖学研究与初中期临床疗效观察  

Anatomic study and early clinical effect of modified quadratus femoris bone flap for femoral head necrosis with superior artery preservation

作　　者：徐永清 浦路桥 李川 蔡兴博 王腾 浦绍全 李霞 XU Yong-qing;PU Lu-qiao;LI Chuan;CAI Xing-bo;WANG Teng;PU Shao-quan;LI Xia(Department of Orthopaedics,920th Hospital of Joint Logistics Support Force,Kunming,Yunnan,650032,China)

机构地区：[1]中国人民解放军联勤保障部队第九二〇医院骨科,昆明650032

出　　处：《中国骨与关节杂志》2024年第10期774-779,共6页Chinese Journal of Bone and Joint

基　　金：云南省创伤骨科临床医学中心(ZX20191001);云南省骨科与运动康复临床医学研究中心(202102AA310068)。

摘　　要：目的设计保留股骨头后上支持动脉的股方肌骨瓣并使用冰鲜标本进行解剖学研究,观察此方法在股骨头坏死治疗中的临床疗效。方法采用10具冰鲜标本设计保留后上支持带动脉的股方肌骨瓣并进行解剖学研究,观察此方法的临床疗效。2019年1月至2022年8月因股骨头坏死收住我科,术前数字减影血管造影(digital subtraction angiography,DSA)检查后上支持带动脉显影并接受此种方法进行保髋治疗的88例患者,其中男69例,女19例;年龄20~55岁,平均38.6岁;国际骨循环研究会(Association Research Circulation Osseous,ARCO)分期:Ⅱ期45髋,Ⅲ期43髋。接受保留股骨头后上支持动脉的股方肌骨瓣移植术治疗,术后行股骨头DSA检查评价后上支持带动脉保留情况,术后12个月使用Harris髋关节功能评分,国际髋关节评分(international hip outcome tool,iHOT-12),疼痛视觉模拟评分(visual analogue scale,VAS)评估髋关节功能,影像学检查评价股骨头坏死的进展情况。结果10具冰鲜标本均成功完成手术设计并完整保留了后上支持带动脉,7具尸体(70%)股骨头后上支持带动脉来源于旋股内侧动脉。3具尸体(30%)来源于臀下动脉,骨瓣切取长度平均为4 cm。88例患者均顺利完成手术并获12~55个月随访,平均30.2个月。患者髋关节的Harris评分由术前(55.98±4.34)分提高至术后(90.55±4.27)分,差异有统计学意义(P<0.05),优良率为95.5%,iHOT-12评分由术前的(55.30±3.14)分提高至术后(88.05±1.47)分,差异有统计学意义(P<0.05),VAS评分由术前(6.35±0.78)分降低至术后(1.98±0.73)分,差异有统计学意义(P<0.05)。96.5%患者后上支持带动脉完整显影,随访期间股骨头未进一步塌陷,无关节置换病例。结论保留股骨头后上支持动脉的股方肌骨瓣移植术可有效保留股骨头主要动脉血供,为保留关节手术提供了新方法,但需要长期随访病例进一步评价其治疗效果。Objective The modified femoral quadratus bone flap with posterior superior supporting artery was designed and anatomized with chilled specimens to observe the clinical efficacy of this method in the treatment of femoral head necrosis.Methods An anatomical study was conducted on 10 chilled specimens to design and observe the clinical efficacy of the modified quadratus femoris bone flap with posterior superior sertorius artery.Additionally,a retrospective analysis was performed on 88 male patients(aged 20-55 years)who underwent hip preservation treatment for femoral head necrosis from January 2019 to August 2023.These patients also underwent preoperative DSA examination for upper support band development of the femoral head.Modified quadratus femoris bone flap with preserved superior supporting artery was used to treat 45 hips in stageⅡand 43 hips in stageⅢ.At 12 months postoperatively,hip function was assessed using Harris score,international hip outcome tool score and visual analogue scale.Results The surgical design of 10 chilled specimens was successfully completed.The posterior superior retinacular artery was completely retained.Among these specimens,the posterior superior retinacular artery of the femoral head was derived from the medial femoral elector artery in 7 cadavers(70%),from the inferior gluteal artery in 3 cadaver(30%)and the average length of bone flap was 4 cm.Follow-up data showed that all 88 patients were followed up for 30.2 months(ranging 12-55 months).The Harris score of hip joint increased from(55.98±4.34)points before surgery to(90.55±4.27)points after surgery,and the differences were statistically significant(P<0.05)with the excellent rate of 95.5%.International hip outcome tool score increased from(55.30±3.14)points before surgery to(88.05±1.47)points after surgery,and the differences were statistically significant(P<0.05).Visual analogue scale decreased from(6.35±0.78)points before surgery to(1.98±0.73)points after surgery,and the differences were statistically significant(P<0.

关 键 词：股骨头坏死 解剖 动脉 血管造影术 

分 类 号：R684[医药卫生—骨科学]