骨盆肿瘤切除后带血管蒂股骨上段翻转重建髋关节的解剖学研究

Reconstruction of the acetabulum with free vascularized ipsilateral femoral autograft overturned after the resection of pelvis tumor:anatomic study

目的探讨骨盆肿瘤切除后带血管蒂股骨上段翻转重建髋关节的可行性。方法 1)选取10具骨盆标本,测量骨盆重建所需股骨截骨长度,并测量50例股骨干标本滋养孔位置,将截骨长度与滋养孔位置进行比较,确定股骨干滋养动脉在截骨长度内能否得到保留。2)对34具尸体标本髂内动脉和股深动脉主要分支的分布、外径、长度以及臀上、下动脉起始处至耻骨联合下缘距离进行解剖学观测,比较供、受区血管长度和外径,确定合适的吻合血管。结果 1)股骨近端第1滋养孔和第2滋养孔均在截骨范围外,不能作为移植骨的供血管。2)臀上动脉出孔处分别与旋股内、外动脉起始端吻合后总长度比臀上动脉起始处到耻骨联合下缘分别长出1.74～2.23 cm和2.39～2.57 cm;臀下动脉出孔处分别与旋股内、外动脉起始端吻合后总长度比臀下动脉起始处到耻骨联合下缘分别长5.87～6.44 cm和6.51～6.83 cm,能够满足吻合需要,且血管吻合后张力不大。臀上、下动脉出梨状肌孔处、旋股内、外动脉起始处外径相仿,P<0.05,差异没有显著性。结论骨盆肿瘤尤其是髋臼部位肿瘤切除后利用带血管蒂自体股骨上段翻转移位重建骨盆环、再造髋臼在解剖学上是可行的。

Objective To determine the possibility of pelvis reconstruction with free vascularized ipsilateral femoral autograft after resecting pelvis tumor.Methods The distance from the superior edge of the auricular plane of sacral bone to the inferior edge of the pubic symphysis（IEPS） on 10 pelvis was measured as the theoretical length for reconstructing,the location of the nutrient foramen of femur was measured on 50 femurs and compared with the theoretical length to determine if the nutrient artery of the femur could be preserved or not.After that,the external diameter and the length of pelvic and proximal femur blood vessels with their main branches were observed and measured on 34 cadavers perfused with red latex.Data were analyzed to determine the proper blood vessel for revascularization.Results The distance from the proximal nutrient foramen of femur to the superior edge of the femoral head was（18.8±3.4） cm in male and（17.4±2.6） cm in female,and the distance from distant nutrient foramen of femur to the superior edge of the femoral head was（26.5±2.1） cm in male and（23.5±2.7） cm in female.These data,compared with the theoretical length which was（16.7±1.9） cm,showed that none of the proximal and the distant nutrient foramen of femur could be preserved for bone graft.The lengths of superior gluteal artery（SGA） in pelvis and the medial femoral circumflex artery（MFCA） were 17.36～22.25 mm,which was longer than the distance from the origin point of SGA to the IEPS,and the lengths of SGA and the lateral femoral circumflex artery（LFCA） were 23.86～25.74 mm,which was longer than the distance from the origin point of SGA to the IEPS.Similarly,the lengths of inferior gluteal artery（IGA） and the MFCA were 58.70～64.38 mm,longer than the distance from the origin point of SGA to the IEPS,and the lengths of IGA and LFCA were 65.13～68.29 mm,which was longer than the distance from the origin point of SGA to IEPS.These data showed that both of SGA and IGA could be anastomosed to the MFCA or LFCA,and there were no tension after the anastomosis.The external diameters of the SGA at the point of suprapiriformis foramen,IGA at the point of infrapiriformis foramen,MFCA and LFCA at the origin point were close to each other without significant difference（P0.05）.Conclusions It is feasible to use the vascularized ipsilateral femoral autograft to reconstruct the acetabulum and keep the integrity of the pelvic ring after the resection of pelvis tumor.