阔筋膜张肌骨瓣在髋关节融合中的应用

Application of bone graft with tensor fasciae latae in the hip fusion

目的:介绍阔筋膜张肌带蒂髂骨瓣移植行髋关节融合的方法,并探讨其疗效。方法:采用阔筋膜张肌带蒂髂骨瓣移植行髋关节融合9例,男7例,女2例;年龄26～49岁(平均34岁);右侧3例,左侧6例。其中,髋臼骨折后发生创伤性骨性关节炎4例,股骨头骨折后发生创伤性骨性关节炎1例,先天性髋关节脱位1例,髋关节结核2例,股骨头无菌性坏死1例。用骨刀从髂骨上切取阔筋膜张肌带蒂髂骨瓣,修去股骨头与髋臼软骨面,在髂骨和股骨头与颈上做一骨槽,将带蒂髂骨瓣用松质骨螺钉固定至骨槽中。结果:术中无并发症发生,经临床观察和2～5.4年随访(平均3.4年),所有患者关节融合牢固(术后12～14周),术后5～6个月逐渐恢复轻工作,部分患者8～10个月恢复了有一定强度的工作。取得较满意的治疗效果。结论:阔筋膜张肌带蒂髂骨瓣移植行髋关节融合的方法具有促进骨愈合,避免骨延迟与不愈合,提高治疗效果的优点。

Objective：To introduce the method of hip fusion with pedicled iliac bone flap of tensor fasciae latae and explore its therapeutic effect. Methods：The hip joint of 9 patients （7 male,2 female） were fused with pedicled iliac bone graft of tensor fasciae latae. Their age was from 26 to 49 years with the mean of 34 years, 3 cases in right and 6 in left, There are 4 eases of traumatic osteoarthritis after acetabulum fracture and 1 case traumatic osteoarthritis after femoral head fracture, congenital hip dislocation in 1, coxalgia in 2, aseptic necrosis of femoral head in 1, The pedicled iliac bone graft of tensor fasciae latae was resected with osteotome from ilium denuded femoral head and cartilago acetabularis. A trough was made with osteotome in ilium and femoral head and neck. Pedicled iliac graft was fixed to ilium and femoral neck with cancellous screws. Results ：There was no complication during operation. Clinical observation and follow-up were from 2 to 5.4 years with the mean of 3.4 years. Fusion of joint was firm （ 12 - 14 weeks after operation） in the group. The patients returned light work progressively at 5 -6 months after operation and some patients returned to partial intensive work at 8 - 10 months. Conclusion：Hip fusion with pedicled iliac bone graft of tensor fasciae latae can accelerate bone healing, decrease the rate of delayed union or monunion and improve curative effect.