带血管蒂髂骨瓣移植的临床应用

Clinical Application of Vascular Pedicled Iliac Flap Graft

目的 总结带血管蒂髂骨瓣治疗股骨颈骨折及小儿股骨头缺血坏死的临床疗效。 方法 本组股骨颈头下型骨折 12 3例 ,采用带旋髂深血管支髂骨瓣治疗 4 3例 (股骨颈陈旧性骨折、股骨头早期坏死 15例 ,股骨颈头下型骨折 2 8例 ) ;带旋股外侧动脉升支血管髂骨瓣治疗 80例 (股骨颈骨折并股骨头早期坏死 9例 ,股骨颈头下型骨折 71例 ) ,其中小儿股骨头缺血坏死 10例。切取的骨瓣最小为 2cm× 2cm× 1.5cm ,最大为 5cm× 1.5cm× 8cm。 结果 术后 2个月出现骨痂 ,3～ 5个月后骨折基本愈合 ,股骨头缺血坏死一般在 3个月以后恢复正常。 12 3例股骨颈骨折 119例治愈 ,股骨头坏死 4例 ;小儿股骨头缺血坏死 10例均获成功。 结论 两种带血管的髂骨瓣血运都极其丰富。带旋股外侧动脉升支血管髂骨瓣由于解剖上的特点则更适合用于股骨颈。

Objective To sumarize the effect of vascular pedicled iliac flap graft for transcervical fracture and pediatric ischemic necrosis of femoral head. Methods Vascular pedicled iliac flaps were grafted in 123 cases of femoral neck fracture and 10 cases of pediatric ischemic necrosis of femoral head. The iliac flaps with deep iliac circumflex vessel were used in 43 femoral neck fracture. The iliac flaps with ascending branch of lateral circumflex femur artery were used in 80 femoral neck fracture and all the femural head necrosis children. The size of iliac bone flap ranged from 2 cm×2 cm×1.5 cm to 5 cm×1.5 cm×8 cm. Results 4 cases underwent iliac bone flaps with ascending branch of lateral circumflex femur artery occurred femoral head necrosis. The others got cured with osteotylus formation within 2 months, union of fracture within 3 to 5 months, and recovery of femoral head necrosis in 3 months after operation. Conclusions There are sufficient blood supplies in these two kinds of vascular iliac flaps. Iliac bone flaps with ascending branch of lateral circumflex femur artery is more suitable for those diseases of femoral neck, trochanter and upper femoral bone.