成人重度股骨头缺血性坏死显微手术方法选择

A STUDY ON THE SELECTIONS OF METHODS IN TREATING SEVERE ISCHEMIC NECROSIS OF FEMORAL HEAD OF ADULT

目的:探讨治疗成人重度股骨头缺血性坏死治疗的最佳方法。方法:对成人重度股骨头缺血性坏死,采用5种显微外科手术方法治疗213例,术后定期随访,对其中82例系统随访5～9年,根据手术前后疼痛、功能和 X 线片综合评定。结果:术后优良率83.6%。结论:Ficat Ⅲ期行三条血管束或带血管蒂的髂骨瓣及血管束联合植入:Ⅳ期行大块带血管蒂或肌蒂骨瓣加松质骨块及血管束植入术,再配合坏死骨彻底切除、头臼成形、滑膜切除及闭孔神经切断等能获得较好的治疗效果。

Objective:To study the best method in treating severe ischemic necrosis of the femoral head of adult.Methods:213 cases of severe ischemic necrosis of femoral head of adult had been treated by five kinds of microsurgeries.All eases were followed-up at regular intervals after opera- tion.82 cases of them were followed-up systematically from 5 to 9 years.The comprehensive evaluation done based on the preperative or postoperative pain,function and roentgenogram.Results:The postoper- ative excellent rate was 83.6%.Conclusion:A better curative effect can he obtained by three vascular bundles implantation or by combined implantation with pedicled ilium flap of vessels and vascular bun- dles in Ficat Ⅲ stage.In Ficat Ⅳ stage,we can implant large pedicled bone flap of vesseles or muscles with cancellous bone and vascular bundles supporting by complete resection of necrotic bone,plastic re- pair of the head and neck of femur,resection of synovium and obturator nerve neurotomy.