部分臀中肌髂骨瓣重建青壮年股骨头颈部血供的临床研究

Reconstruction of blood supply to the femoral head and neck with a partial gluteus medius-ilium flap in young and middle-aged patients

目的探讨部分臀中肌髂骨瓣重建股骨头颈部血供的疗效。方法2004年6月至2009年12月共收治20例股骨颈骨折或股骨头缺血性坏死患者，男15例，女5例；年龄25～56岁，平均38．6岁。股骨颈骨折组10例，男7例，女3例；骨折按Garden分型：Ⅱ型2例，Ⅲ型5例，Ⅳ型3例。受伤至手术时间为11～23d，平均14．3d。股骨头缺血性坏死组10例，男8例，女2例；股骨头缺血性坏死按Ficat分期：Ⅱ期6例，Ⅲ期4例。股骨颈骨折患者采用内固定治疗，股骨头缺血性坏死患者采用清除坏死骨、植骨治疗，两组患者均应用部分臀中肌髂骨瓣移植于股骨头颈部，以修复重建股骨头颈部血供。结果20例患者术后获1～5年（平均3．1年）随访。股骨颈骨折组患者骨折均获愈合，术后3个月髋关节Harris评分为81～97分，平均92分；其中优5例，良4例，差1例，优良率为90％。1例出现股骨头坏死。股骨头缺血性坏死组患者症状明显改善，术后3个月髋关节Harris评分为73～95分，平均84分；其中优4例，良3例，可1例，差2例，优良率为70％。3例出现股骨头坏死加重，其中2例行关节置换术治疗。结论部分臀中肌髂骨瓣血供丰富、操作简单、安全可靠且术后不影响臀中肌功能，是一种重建股骨头颈部血供的有效方法。

Objective To study the therapeutic effect of partial gluteus medius-ilium flap in reconstruction of the blood supply to the femoral head and neck to treat femoral neck fracture and femoral head necrosis in young and middle-aged adults. Methods From June 2004 to December 2009, we treated 20 patients with femoral neck fracture and femoral head necrosis. They were 15 men and 5 women, aged from 25 to 56 years （mean, 38.6 years）. In the 10 cases of femoral neck fracture （group A）, there were 7 men and 3 women, and 2 Garden type 11, 5 type mand 3 type IWfractures. The duration from injury to surgery averaged 14.3 days （from 11 to 23 days）. In the 10 cases of femoral head necrosis （group B）, there were 8 men and 2 women, and 6 ones of Ficat phase 1I and 4 ones of phase III. Group A were treated with reduction and hollow nail fixation. Group B were treated with removal of the necrotic bone and graft of iliac spongy bone. Partial gluteus medius-ilium flaps were used in both groups to reconstruct the blood supply to the femoral head and neck. Results The 20 patients were followed up for one to 5 years （mean, 3.1 years）. In group A, all fractures healed and the average Harris hip score 3 months postoperation was 92 （range, 81 to 97） . Femoral head necrosis occurred in one case. In group B, the symptoms were greatly improved and the average Harris hip score 3 months postoperation was 84 （range, 73 to 95）. Deterioration was found in 3 cases, 2 of which had to sustain hip replacement. Conclusion The partial gluteus medius-ilimn flap is effective in reconstruction of the blood supply to the femoral head and neck, because it keeps abundant blood supply, and is simple, safe and reliable to handle without sacrificing function of the gluteus medius.