带旋髂深动脉髂骨瓣治疗股骨头缺血性坏死54例疗效观察

EFFECT OF ILIAC BONE GRAFT WITH DEEP ILIAC CIRCUMFLEX VESSELS ON ISCHEMIC NECROSIS OF FEMORAL HEAD:A REPORT OF 54 CASES

目的用带旋髂深血管蒂髂骨瓣移植改善股骨头血液循环,治疗股骨头缺血性坏死。方法在股骨头颈部作长约4cm×1.5cm×1.5cm骨槽,彻底减压,去除死骨至股骨头软骨下,再将带旋髂深血管蒂髂骨瓣植入股骨头颈槽内并固定。结果术后经2～11年随访,按照范启申等评定方法,优31例、36髋(Ⅱ期28髋、Ⅲ期8髋)。良12例、15髋(Ⅱ期3髋、Ⅲ期12髋)。中4例、5髋(Ⅲ期5髋)。差2例、3髋(Ⅳ2例、3髋)。优良率达86.4%。结论带旋髂深血管蒂髂骨瓣治疗股骨头缺血性坏死,具有清除坏死骨组织,髓腔减压,改善股骨头血液循环,利用骨瓣生长能力,促进骨生长,防止股骨头进一步坏死等优点,尤其适用于中青年患者。

Objective To investigate the therapy of ischemic necrosis in the femoral head by the transplantation of pedicled bone flap with deep iliac circumflex vessel in adult and to assess its curative effect. Methods A bonegroove about 1.5cm × 1.5cm × 5cm was made in the femoral head, necrotic bone was removed and decompressed to the core cartilage, then the pedicled bone flap with deep liac circumflex vessel was transplanted, last the transplantation was fixed. Results All patients were followed up from 2 years to 11 years after operation. According to the assessment of Fan Qishen, the result was excellent in 31 cases of 36 coxas, good in 12 cases of 15 coxas, fair in 4 cases of 5 coxas and poor in 2 cases of 3 coxas. The postoperative excellent and good rate was 86.40%. Conclusion Operative treatment of ischemic necrosis of the femoral head in adult by transplantation of bone flap pedicled with deep iliac circumflex vessel has the characteristics of restoration of blood supply of the femoral head, decompression of marrow cavity, elimination of necrotic bone and support of the femoral head. The method for treatment of ischemic necrosis of the femoral head is effective especially in adult.