带双血管蒂大转子骨瓣转移治疗股骨头缺血性坏死

Treatment of osteonecrosis of the femoral head by using greater trochanteric bone flap pedicled with double blood vessels

目的探讨应用旋股外侧血管横支及升支、臀中肌支双血管蒂大转子骨瓣转移的方法治疗股骨头缺血性坏死的临床效果。方法应用带旋股外侧血管横支及升支、臀中肌支双血管蒂大转子骨瓣转移术治疗股骨头缺血性坏死32例(32髋),其中男18例,女14例；FicatⅡ期15侧,Ⅲ期17例。术后平均随访25个月(15～38个月),根据Harris髋关节功能评分标准进行临床评价,根据手术前后Ficat分期改变进行影像学评价,对其中的9例进行手术前后数字减影血管造影(DSA)检查以明确坏死股骨头血运重建状况。结果术后两髋改行人工全髋关节置换。股骨头得到重建的病例,术后Harris髋关节功能评分明显提高(术前平均55分,术后88．6分),本组临床成功率为90．6%,影像学成功率为87．5%。9例重建股骨头手术前后DSA评估提示血管蒂充盈好,骨瓣血运丰富。结论旋股外侧血管横支及升支、臀中肌支双血管蒂大转子骨瓣转移的方法治疗股骨头缺血性坏死骨瓣血供确切,股骨头血运重建良好,早期疗效满意。

Objective To evaluated the clinical results of treatment of osteonecrosis of the femoral head （ONFH） by using bone flap pedicled with gluteal muscle branch of ascending branch of the lateral femoral circumflex artery and transversal branch of the lateral femoral circumflex artery. Methods Bone flap pedicled with double blood vessels was applied in 32 hips with stage Ⅱ and Ⅲ ONFH according to the Ficat staging system. Fifteen hips were instage Ⅱ and 17 were in stage Ⅲ. All patients were followed up for a mean of 25 months （range, 15-38 months） and were assessed clinically and radiologically according to Harris scoring. Selective digital subtraction angiography was performed in 9 cases to confirm the blood reconstruction of femoral head. Results Two cases underwent total hip replacement postoperatively. Preoperative and postoperative Harris score were 55 and 88. 6. Clinical success rate was 90. 6% and radiological success rate was 87.5%. DSA demonstrated blood supply was found reconstruction in the necrotic femoral head. Condusion Transplantation of bone flap pedicled with gluteal muscle branch of ascending branch of the lateral femoral circumflex artery and transversal branch of the lateral femoral circumflex artery appears to be a effective treatment for osteonecrosis of the femoral head, blood supply of bone flap and blood reconstruction of femoral head was confirmed. Early clinical results were satisfied.