股直肌直头肌骨瓣移位治疗股骨头缺血性坏死

TRANSPOSITION OF MUSCULAR SKELETAL FLAP PEDICLED WITH STRAIGHT HEAD OF RECTUS FEMORIS FOR TREATMENT OF AVASCULAR NECROSIS OF FEMORAL HEAD

目的 观察应用带蒂股直肌直头肌骨瓣移位治疗成人股骨头缺血性坏死的疗效。方法 选择 8例股骨头缺血性坏死患者 ,按 Ficat分期 期 5例 , 期 3例。采用 Smith- Peterson切口进入关节囊。游离股直肌直头 ,其起点附着部位保持联系 ,截取包括髂骨两层骨皮质和骨膜的骨瓣 ,在 X线控制下 ,用刮匙将坏死骨组织刮除后 ,将肌蒂骨瓣紧密嵌入骨洞内。同时进行标准的髓蕊减压术。结果 术后患髋疼痛均消失 ,5例 期患者 1年后跛行完全消失 , 期患者跛行明显减轻。术后全部病例随访 1～ 3年 ,优 5例 ,良 2例 ,可 1例 ,优良率为 87.5 %。结论股直肌直头肌骨瓣移位治疗股骨头缺血性坏死具有手术操作简便的优点 ,适合于 期及 期股骨头轻度塌陷。

Objective\ To investigate the clinical results of transposition of muscular skeletal flap pedicled with straight head of rectus femoris for treatment of avascular necrosis of adult femoral head.\ Methods\ Eight patients with avascular necrosis of femoral head were adopted in this study. There were 6 males and 2 females, the ages were ranged from 24 to 56 years. According to the criteria of Ficat, there were 5 cases in stage Ⅱ and 3 cases in stage Ⅲ. The Smith Peterson incision was used to expose the capsule of the hip. After complete curettage of the necrotic bone from the femoral head, the muscular skeletal flap pedicled with straight head of rectus femoris was resected and transposited into femoral head. Finally, conventional decompression of head was performed.\ Results\ All the cases were followed up for 1 to 3 years. There were excellent results in 5 cases, good in 2 cases and moderate in 1 case. The rate of excellent and good results were 87.5%.\ Conclusion\ Comparing with other pedicled bony flaps, the muscular skeletal flap pedicled with straight head of rectus femoris is characterized by its convenience and efficacy. It is suitable for the treatment of avascular necrosis of femoral head in stage Ⅱ or Ⅲ, but the contour of the femoral head should be nearly normal.