多条血管束植入治疗成人股骨头坏死的远期疗效观察（附190例 …

目的 分析多条血管束植入术对于治疗成人股骨头缺血性坏死的远期疗效,总结多条血管束植入手术的技术要求与成败经验,探讨多条血管束植入在股骨头坏死治疗过程中的作用。方法 自１９８２年２月至 １９９３年２月应用旋股外侧动静脉的升支、横支组成多条血管束,经“Ｖ”形骨隧首植入股骨头治疗各种病因导致的成人股骨头缺血性坏死３００余例,对其中获得长期随访的１９０例２０３髋刊物了分析和总结,最长随访时间为１３．７年,     

成人重度股骨头缺血性坏死显微手术方法选择

目的:探讨治疗成人重度股骨头缺血性坏死治疗的最佳方法。方法:对成人重度股骨头缺血性坏死,采用5种显微外科手术方法治疗213例,术后定期随访,对其中82例系统随访5～9年,根据手术前后疼痛、功能和 X 线片综合评定。结果:术后优良率83.6%。结论:Ficat Ⅲ期行三条血管束或带血管蒂的髂骨瓣及血管束联合植入:Ⅳ期行大块带血管蒂或肌蒂骨瓣加松质骨块及血管束植入术,再配合坏死骨彻底切除、头臼成形、滑膜切除及闭孔神经切断等能获得较好的治疗效果。     

血管束植入软骨面开窗植骨治疗成人股骨头坏死

目的:评价多束血管束植入软骨面开窗植骨治疗成人股骨头坏死的疗效,探讨其手术适应证及术中术后注意事项。方法:各种病因所致Ⅱ～Ⅲ期成人股骨头坏死患者30例,男28例,女2例;年龄28～45岁,平均37.8岁。采用经股骨头前外侧软骨面开窗病灶清除植骨,利用旋股外侧动静脉的升支、横支等组成多条血管束,经骨隧道植入股骨头治疗。术后牵引6～8周,患肢半年内不负重活动。结果:30例患者平均随访5.4年,根据成人股骨头坏死疗效评价法,评定手术前后髋关节疼痛、功能、关节活动度及X线表现,总分比较差异有显著性(P<0.01)。结论:股骨头软骨面开窗病灶清除植骨并多束血管植入治疗Ⅱ～Ⅲ期成人股骨头坏死疗效满意,开窗软骨瓣术后都能得到修复,手术操作简单,股骨头内病灶可直观彻底清除,利于新骨形成。     

多条血管束加带血管蒂骨瓣植入术治疗成人股骨头缺血性坏死的手术配合

1996年10月以来,我院对318例60岁以下Ⅱb～Ⅳ期(Ficat分期法)的成人股骨头缺血性坏死患者,采用多条血管束加带血管蒂骨瓣植入术治疗.     

血运重建加内固定治疗股骨颈骨折

目的研究血运重建方法对股骨颈骨折的治疗作用.方法1991年1月至2000年1月,对36例股骨颈骨折手术内固定同时采取血管束植入,带血管蒂、肌蒂骨膜(骨)瓣移位或移植,并对部分植入血管或移植骨瓣血管进行对接吻合连通血液循环.结果36例1～9年随访,其中35例在2～5个月骨折愈合,单纯血管束植入术中,1例年长者发生骨不愈合,2例出现股骨头缺血性坏死.结论股骨颈骨折手术治疗中,为防止骨不愈合及股骨头缺血性坏死,可常规进行血运重建手术.在骨折端进行植入血管的对接吻合连接血运是一个提高疗效的重要方法.     

血运重建加内固定治疗股骨颈骨折

目的：研究血运重建方法对股骨颈骨折的治疗作用。方法：1991年1月至2000年1月,对36例股骨颈骨折手术内同时采取血管束植入,带血管蒂、肌蒂骨膜（骨）瓣移位或移植,并对部分植入血管或移植骨瓣血管进行对接吻合连通血液循环。结果：36例1－9年随访,其中35例在2－5个月骨折愈合,单纯血管束植入术中,1例年长发生骨不愈合,2例出现股骨头缺血性坏死。结论：股骨颈骨折手术治疗中,为防止骨不愈合及股骨头缺血性坏死,可常规进行血运重建手术。在骨折端进行植入血管的对接吻合连接血运是一个提高疗效的重要方法。     

以血管束植入为主的复合手术治疗股骨头缺血性坏死

以血管束植入为主的复合手术治疗股骨头缺血性坏死孙捷＊汤志刚＊毛权＊徐守宇＊孙晓＊陈高新＊１９９０年７月以来，我们采用多条血管束植入，髋关节松解与成形，滑膜切除，股骨头钻孔减压及髋臼加盖与内收肌切断的综合手术治疗股骨头缺血性坏死３５例３８个髋，经术后平...     

臀中肌支大转子骨瓣治疗早期股骨头坏死疗效观察

目的:探讨转移旋股外侧动脉升支束中臀中肌支大转子骨瓣治疗早期股骨头坏死的临床疗效。方法:通过转移旋股外侧动脉升支束中臀中肌支大转子骨瓣治疗股骨头坏死患者36例(36髋),男22例,女14例;FicatⅠ期21例,Ⅱ期12例,Ⅲ期3例。采用成人股骨头缺血性坏死疗效评价法进行临床疗效评价。结果:所有患者术后均获得随访,随访时间10~24个月,平均13.4个月。8例患者术后经数字减影血管造影(DSA)检查,提示术后股骨头血供恢复,微循环开始重新建立。所有患者术前与随访后根据成人股骨头缺血性坏死疗效评价法,从疼痛、功能、关节活动度、X线评价、总分等方面比较,差异有统计学意义(P0.01);总体疗效分级比较,差异亦有统计学意义(P0.05或P0.01)。结论:旋股外侧动脉升支中臀中肌支大转子骨瓣具有良好的机械支撑力,同时为股骨头提供丰富的血运及诱导成骨因素,是一种治疗股骨头坏死的有效方法。     

内外减压血管束植入治疗小儿股骨头缺血性坏死

目的　探讨小儿股骨头缺血性坏死的治疗方法。方法　从解剖学角度设计,采用内外减压血管束植入法治疗３７ 例患者。结果　随访３～１１ 年,优良率９４－６ ％ 。结论　内外减压血管束植入法治疗小儿股骨头缺血性坏死,能阻断其发病的中间环节,改善股骨头的包容,增加股骨头血供并有利于股骨头复原。     

一例人体坏死股骨头血管束植入后的形态学观察

1例陈旧性股骨颈骨折不连接并股骨头坏死患者,在植入血管束14个月后因再次股骨颈骨折行股骨头置换术.作者对取出的人体股骨头标本进行形态学研究,结果见原植入的血管束在坏死的股骨头内向四周放射新生出丰富的血管;血管束植入术后坏死股骨头有新骨形成,但修复缓慢,是软骨成骨过程.认为血管束植入坏死股骨头后可大大改善股骨头的血运;软骨成骨在坏死股骨头的修复中起着重要作用.     

髓芯减压＋自体外周血干细胞移植治疗早期股骨头缺血性坏死

目的探讨应用髓芯减压＋自体外周血干细胞移植治疗股骨头缺血性坏死（ANFH）的疗效。方法对61例Ⅰ、Ⅱ期的ANFH患者采用髋关节髓芯减压入路＋自体外周血干细胞移植方法治疗。结果所有患者随访6～32个月,疼痛均消失,行走正常,髋关节活动范围正常或接近正常,CT或MRI片示股骨头轮廓清晰,囊性变消失,骨密度均匀,关节间隙正常。结论髋关节髓芯减压＋自体外周血干细胞移植手术治疗早期ANFH具有损伤小、简便、准确、有效的优点。     

多组血管束植入股骨头修整与再造治疗中晚期股骨头缺血性坏死

目的 探讨中晚期股骨头缺血性坏死临床保髋治疗的应用价值。方法 对39例中晚期股骨头坏死行旋股外侧动静脉主干及分支血管束植入,股骨头清创、减压及植骨修复术。结果 随访2～5年,31例获得临床骨性愈合;5例出现股骨头塌陷、颈缩短,关节炎加重;2例术后伤口感染;1例内固定不可靠。结论 选择适当的病例,通过多组血管束植入股骨头修整与再造术,79.5％的患者可获得较满意疗效。     

干细胞移植改善股骨头坏死缺血状态122例临床观察

目的探讨经动脉自体骨髓干细胞（BMSC）和外周血干细胞（PBSC）移植改善股骨头坏死缺血状态的临床疗效。方法2004年7月至2006年12月对122例（211髋）成人缺血性股骨头坏死（ANFH）患者施行自体BMSC或PBSC移植治疗,按国际分期标准（ARCO）分期,设自身前后对照方法进行疗效观察。BMSC组90例和PBSC组32例在DSA下行股骨头供血动脉干细胞移植术,移植后第3、6、12、24个月进行髋关节Harris评分做疗效评价,6个月复查股骨头供血动脉造影观察血管新生情况。每间隔6个月复查影像学变化。结果122例患者随访3～24个月（平均10．2个月）,髋关节疼痛缓解104例（85．1％）,关节功能改善76例（62．0％）,90例（73．9％）行走间距延长。干细胞移植术后6个月,15例患者股骨头供血动脉造影检查见供血动脉较移植前明显增多、增粗,血流速度增快;12～24个月20例股骨头区可见骨质病变获得改善。结论经动脉自体BMSC和PBSC移植方法简便,安全有效,对缺血性股骨头无再次损伤,患者依从性好,是治疗缺血性股骨头坏死的一种新途径。     

股骨头缺血坏死介入治疗及近期疗效

目的：探讨介入性治疗股骨头缺血坏死的近期疗效。方法：自2006年至2008年,对28例（男19例,女9例,年龄14～70岁,平均38岁）股骨头缺血坏死患者采用介入插管的方法,超选择进入到股骨头营养血管旋股内外侧动脉和闭孔动脉,造影观察其血液供给情况后,注入溶栓药物、扩血管药物及改善微循环药物,术后再次造影观察对比股骨头供血改变情况;治疗后12～36个月摄X线片观察股骨头骨密度改变情况;并分析其临床症状（疼痛及关节活动度）的改变情况。结果：28例患者治疗前后血管造影对照显示治疗后血管增多,股骨头染色增强,12～36个月后X线片显示病骨密度和形态逐渐恢复或接近正常者占97.2%（35/36）,患髋疼痛程度及关节活动度临床症状明显改善。结论：介入方法治疗股骨头缺血坏死是一种简便、无痛苦、安全、疗效可靠的治疗方法,能在临床上广泛应用。     

Bipolar prosthetic replacement for the treatment of avascular necrosis of the femoral head.

Eighty-three hips in 66 patients with nontraumatic avascular necrosis of the femoral head (ANFH) showing evidence of severe collapse or secondary osteoarthritic changes were treated with surgical implantation of bipolar hip prostheses either with or without cement fixation of femoral stems. The cases were observed for more than three years (range, three to ten years seven months; average, five years seven months) and assessed in terms of functional and roentgenographic results. These data were compared with the results of classic hemiarthroplasties using fixed head prostheses (Austin-Moore-type with curved or straight stem) that were performed at the authors' institutions before 1980. The results confirm that the clinical outcome is improved with use of the bipolar prosthesis. Satisfactory results (a score of 80 or greater on a hip function scoring system proposed by the Japanese Orthopaedic Association) were maintained throughout the follow-up period in most cases (71 of 83 hips) with the bipolar prosthetic replacements. In a group of patients with unsatisfactory results (12 hips), proximal migration of prosthetic head was seen in two cases. The incidence of proximal migration of bipolar heads, including those exhibiting minimal movement, was significantly lower when compared with that observed in an Austin-Moore-type head-fixed prosthesis group (7/83 versus 12/19) during a comparable postoperative follow-up period. It is noteworthy that the proximal migration of the bipolar head was not progressive, and, in most cases observed more than five years, the cartilaginous spaces of acetabulum were preserved, whereas in the Austin-Moore-replaced group, the migration was evident and progression occurred within three years of surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Observation of prosthesis movement after implantation of the bipolar artificial femoral head]

The follow-up results of the movement of two components of hip prosthesis in 30 cases at different times after implantation of bipolar artificial femoral head were reported in this paper. It was demonstrated that the motion at both bearing surfaces in all cases was present 3 months-3 years after operation, and the motion range was not reduced with time. Therefore, the movement of bipolar artificial femoral head could be maintained within at least 3 years after implantation.     

Revision knee joint alloplasties]

In the presented paper the authors evaluate the results of treatment in patients following revision knee joint alloplasties due to aseptic loosening of the tibia element in the endoprosthesis. The clinical material from the years 2000-2003 consists of 12 patients aged from 68 to 73; namely, 10 women (83.5%) and 2 men (16.5%). The longest time between the original implantation of endoprosthesis into the knee joint and the diagnosis of the aseptic loosening of its tibia element was 6 years and the shortest 2 years. The longest time of follow-up in patients who had had the revision operation was 2 years and the shortest was 6 months. The authors evaluated achieved results in the period between 20th and 24th month since the revision operation in 10 patients on the basis of the time criteria referring to the time of healing the-bone implants and on the basis of the HSS knee rating scale in their own modification. We achieved 9 very well and 1 sufficient results based on time criteria and 5 very well, 1 well, 3 sufficient, 1 insufficient results based on HSS knee rating scale criteria.     

髓芯减压游离腓骨移植治疗ARCOⅢ期股骨头缺血性坏死的保髋疗效分析

目的探讨髓芯减压、游离腓骨移植保髋手术治疗中青年ARCOⅢ期股骨头缺血性坏死的临床疗效。方法回顾性分析自2011-01-2019-12诊治的20例(23髋)中青年ARCOⅢ期股骨头缺血性坏死,作股骨粗隆下切口,经股骨颈钻孔到达坏死区进行髓腔减压及死骨清除,于同侧小腿切取带血管蒂腓骨段经隧道植入股骨头;于大腿前外侧另作切口,游离旋股外侧血管降支,将移植腓骨的血管蒂引至该切口并与旋股外侧降支动静脉吻合。结果 19例(22髋)获得随访,随访时间平均5.2(1.5~8.5)年。1例术后切口裂开,1例术后出现第1~3趾僵硬,3例术后出现拇趾僵硬。术后1例疼痛未减轻,1例(双髋)疼痛减轻幅度较小,1例疼痛缓解4年后再次疼痛。末次随访时疼痛VAS评分为(2.1±1.5)分,较术前明显降低;末次随访时髋关节功能Harris评分为(86.6±7.2)分,较术前明显提高,差异均有统计学意义(P<0.05)。末次随访时X线片评估结果:2髋改善,16髋稳定,4髋加重;股骨头坏死加重患者的疼痛没有加重,髋关节功能尚好。结论髓芯减压、吻合旋股外侧血管降支、经股骨颈游离腓骨移植联合松质骨植骨是中青年ARCOⅢ期股骨头缺血性坏死的有效保髋手术治疗方法,而且技术路线与手术操作相对简单。     

Avascular necrosis of the femoral head in pertrochanteric fractures: a report of 8 cases and a review of the literature

OBJECTIVE: To evaluate patients with pertrochanteric fractures (Type 31A1 + 2 ASIF/OTA classification) treated surgically and who subsequently developed avascular necrosis of the femoral head (ANFH). SETTING: University hospital. DESIGN: Retrospective clinical study and analysis of the literature. PATIENTS: From 1995 to 2003 the authors operated on 1,373 patients with pertrochanteric fractures. Eight patients with a mean age of 69 years (range, 52-78 years) subsequently developed ANFH. INTERVENTION: Five patients were treated with a dynamic hip screw (DHS), and 3 were treated with an intramedullary hip nail (IMHN). RESULTS: All fractures in these 8 patients healed without complications in 3 to 4 months. Avascular necrosis of the femoral head developed 4 months to 4 years after the operation. Detailed analysis of these cases did not reveal any risk factors or errors in surgical technique to account for the ANFH. Results of a literature review of 41 cases in addition to our 8 cases give us reason to believe the etiology of postoperative AFNH following surgical treatment of pertrochanteric fractures is probable injury to the deep branch of the medial circumflex artery at time of fracture. Other possible risk factors include high-energy trauma, comminution, displacement of the fragments, and atypical fracture line. CONCLUSIONS: ANFH develops in approximately 0.5-1% of all pertrochanteric fractures, mostly within 4 years after the injury and predominantly in patients older than 50 years of age. The diagnosis should be considered in patients who have undergone an operation previously and have symptoms that are unclear. Prevention of ANFH in these fractures includes an early reduction, stable fixation, and correct surgical technique.     

Natural history of nontraumatic avascular necrosis of the femoral head

We studied the natural history of nontraumatic avascular necrosis of the femoral head (ANFH) in 115 hips in 87 patients, 69 steroid-induced, 21 related to misuse of alcohol and 25 idiopathic. The average length of follow-up was over five years. Collapse occurred most often when the focus of bone necrosis occupied the weight-bearing surface of the femoral head. Flatness of the head due to subchondral fracture was an early manifestation of collapse. Classification into six types based upon the radiographic findings provided an accurate prognosis for individual cases of ANFH which is useful in planning treatment and in assessing its outcome.