股外侧肌上端肌支股骨骨(膜)瓣的解剖与临床应用

THE ANATOMIC STUDY AND CLINICAL APPLICATION OF THE BONE (PERIOSTEUM) FLAP PEDICLED WITH UPPER MUSCULAR BRANCHES OF LATERAL FEMORAL MUSCLE

目的 报道股外侧肌上端肌支股骨骨 (膜 )瓣的应用解剖及临床应用。方法 在 40侧成人下肢标本上解剖观测股外侧肌上端血管肌支的分支分布情况 ,设计以股外侧肌支为蒂的股骨骨 (膜 )瓣移位术 ,并进行了摹拟手术。 1989年 2月～ 1999年 2月 ,以股外侧肌支为蒂切取股骨骨 (膜 )瓣移位修复股骨上段骨不连、骨缺损 7例。结果 股外侧肌上端肌支来自旋股外侧动脉横支 ,肌支在大转子尖下 (16 .8± 3.0 ) cm发出肌骨膜支和骨膜支 ,肌骨膜支外径 1.4～ 1.7mm,长度 2 .7～ 5 .6 cm,骨膜支外径 0 .4～ 0 .6 mm,长度 1.2～ 1.5 cm。骨膜血管向下或水平走行 ,达骨膜后发出吻合支 ,参与形成股骨血管网 ,分布于股骨上段。临床应用的 7例 ,术后经 18～ 42个月的随访 ,骨折于术后 10～ 18周获得骨性愈合。髋关节活动度在 180°者 4例 ,12 0°者 2例 ,6 5°者 1例。供区愈合良好 ,无不适。结论 以股外侧肌上端肌支为蒂的股骨骨 (膜 )瓣 ,可用于修复股骨中上段的骨不连。

Objective To explore the anatomic feature and clinical application of the bone (periosteum) flap pedicled with upper muscular branches of lateral femoral muscle. Methods The anatomic features and distribution of upper muscular branches of lateral femoral muscle were observed in the lower extremities of 40 adult cadavers. From February 1989 to February 1999, 7 cases with bone defect or nonunion of upper part of femur were treated with transfer of bone (periosteum) flap pedicled with upper muscular branches of lateral femoral muscle. Results The upper muscular branches of lateral femoral muscle originated from the transversal branch of lateral circumflex femoral artery. The musculoperiosteal branch and periosteal branch were originated at 16.8±3.0 cm below the greater trochanter. The diameter and length of musculoperiosteal branch were 1.4 to 1.7 mm and 2.7 to 5.6 cm, those of the periosteal branch were 0.4 to 0.6 mm and 1.2 to 1.5 cm respectively. Bone union achieved in 10 to 18 weeks after operation in all 7 cases after 18 to 42 months follow up. The motion of hip joint reached 180° in 4 cases, 120° in 2 cases and 65° in 1 case. The donor area recovered well. Conclusion The bone (periosteum) flap pedicled with upper muscular branches of lateral femoral muscle is an effective alternative for repairing the bone defect or nonunion of the upper or middle part of femur.