阔筋膜张肌臀中肌间隙入路带血管蒂大转子骨瓣治疗股骨头坏死

Treatment of avascular necrosis of femoral head by greater trochanter bone flap vascular pedicle vessel through the interspace between tensor fasciae latae and gluteus medius

目的：探讨经阔筋膜张肌臀中肌间隙入路带旋股外侧动脉横支大转子骨瓣修复股骨头坏死的解剖学基础，总结用该术式治疗股骨头坏死的临床经验。方法：在尸体解剖和模拟手术的基础上，对28例股骨头坏死患者施行阔筋膜张肌臀中肌间隙入路带血管蒂大转子骨瓣手术。结果：28例成功完成股骨头坏死病灶清除带旋股外侧动脉横支大转子骨瓣移植＋钽棒内固定术。平均切口长度9．3cm，平均手术时间60min；平均术中出血量260ml，术中输血3例，均为200ml。结论：阔筋膜张肌臀中肌间隙入路行股骨头坏死修复术切口小，组织损伤轻，出血少，显露良好、操作方便。

Objective： To discuss the anatomical basis and summarize the clinical experience of repairing femoral head necrosis by vascularized greater trochanter bone grafts via the interspace between gluteus medius and tensor fasciae latae. Methods： On the basis of autopsy and simulation operation in the specimens, the surgery with vascularized greater trochanter bone grafts necrosis via the interspace between gluteus medius and tensor fasciae latae was performed on 28 patients. Results： 28 patients of avascular necrosis of femoral head were performed with focal cleaning, vascularized bone flap graft and tantalum rod insertation via the approach, the mean incision length, operation time, blood loss was 9.3 cm, 60 minutes, 260 ml, respec- tively. Only 3 patients had 200 ml blood transfusion during operation. Conclusion： Treatment of avascular necrosis of femoral head by vaseularized greater trochanter bone grafts via the interspace between gluteus medius and tensor fasciae latae has many advantages, such as mini-incision,less tissue trauma, less bleeding and better exposure, and is facilitated to perform operation.