OCM前外侧入路在微创全髋关节置换中的应用

[目的]探讨慕尼黑骨科医院（OCM）前外侧入路在微创全髋关节置换术中的初步应用。[方法]于2005年2月-2006年12月开展OCM入路微创全髋关节置换术18例，应用小切口技术，从臀中肌与阔筋膜张肌间隙进入，保留后方关节囊与肌肉完整性，两步法进行股骨颈截骨，合理使用特殊器械安置髋臼及股骨假体。[结果]18例患者随访时间平均12．5个月，手术切口平均长度9．2cm；术中平均出血量230ml，术后平均引流量90ml；术中1例发生股骨假体周围骨折，1例发现髋臼前倾角过大。下地活动时间平均6．5d，术后6个月Harris评分平均值从术前46．2提高为87．1分。[结论]OCM入路应用于微创全髋关节置换术，可获得满意的临床疗效，具有明确的学习曲线并要求特殊手术器械。     

双切口微创全髋关节置换的临床报告

目的介绍双切口微创全髋关节置换的手术方法。方法2004年以来,应用双切口微创全髋关节置换10例。前切口平行股骨颈的体表投影,长4.5cm,从缝匠肌和股外侧肌间隙进入,“工”字形切开关节囊后完成股骨颈截骨,使用特殊的髋臼锉和带偏心距的髋臼打入器安放髋臼,缝合关节囊。髋后切口3.0cm,劈开臀中肌纤维通过套筒股骨扩髓,在X线机透视下安放股骨假体。结果本组患者术中出血量平均为184mL,术后3d下地活动,住院时间平均为7.4d。患者术后随访平均为4.5个月,8例已完全脱拐,行走正常,2例出院不足1个月,仍需扶拐行走。结论双切口全髋关节置换不切断臀中肌,损伤小,保留关节囊,患者功能恢复快,住院时间短。手术适应证为股骨颈骨折或病变较轻、且不过于肥胖的初次置换者,并发症包括髋臼或股骨柄位置不佳和股骨近端骨折。双切口髋关节置换需要一个独立的学习过程,并且需要C型臂X线监视仪和特殊的髋臼锉、打入器等。     

OCM入路的解剖学基础及在双侧MIS-THA中的临床应用

目的通过对慕尼黑骨外科(orthopdische chirurgie münchen,OCM)入路的解剖学基础的研究,为需要进行双侧全髋关节置换术的患者提供一种便捷且微创的手术方式。方法解剖3具成年尸体标本(6髋),观察OCM入路解剖结构,选择4例患者进行单次手术双侧OCM入路微创(minimally invasive surgery,MIS)-全髋关节置换术(total hip arthroplasty,THA),总结临床结果和手术操作技术。结果 OCM入路为臀中肌、阔筋膜张肌和股外侧肌围成的长三角形间隙,其上内角处即臀中肌和阔筋膜张肌纤维连接处,是臀上神经下支由臀中肌进入阔筋膜张肌的关键部位,手术切口的选择不能超过此水平。将OCM入路应用于4例患者行双侧MIS-THA,共8髋,手术切口长度(8.1±1.4)cm,术中出血(451±10.3)m L。随访时间12~30个月,平均20个月。术后X线片有1例前倾角偏大,无并发症和功能障碍。Harris评分术前(32.7±3.2)分,术后6个月(95.1±1.9)分。结论 OCM入路为肌肉间隙入路,不会损伤外展肌群,为真正的微创入路,患者可以采取仰卧位,这样可以在单次手术中进行双侧微创手术,节约了医疗资源同时易于被患者接受,并且手术创伤小,术后康复快,疗效好。     

非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形

[目的]介绍非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形的手术技术和初步临床效果。[方法]对19例股骨头颈短缩畸形患者采用非股骨短缩截骨全髋置换治疗。手术采用后外侧入路，先切开并松解粘连挛缩的髋关节囊，充分显露髋臼，确定真性髋臼位置并行髋臼成形或再造，安放髋臼假体；适配型号的股骨柄试模置入后安放递增长度的股骨头进行髋关节复位，在保持髋关节张力的情况下触摸髋关节周围挛缩的软组织并依次松解，随后置入适配的股骨柄及股骨头假体，复位髋关节。[结果]19例患者均顺利完成手术。术后均实现髋臼及股骨柄生物性压配与初始稳定，无严重并发症。术后随访6～36个月。术后6个月随访时患者Harris评分为（94.5±4.7）分，临床效果评定：优15例、良4例，优良率100%。术后影像显示所有患者均保持解剖位旋转中心，假体位置良好，术后3个月X线片均示广泛性骨长入，随访期间均未发生脱位、假体柄移位及断裂。[结论]全髋关节置换术不行股骨缩短截骨治疗终末期关节合并股骨头、颈缩短畸形技术可行，短期疗效满意。     

非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形

[目的]介绍非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形的手术技术和初步临床效果。[方法]对19例股骨头颈短缩畸形患者采用非股骨短缩截骨全髋置换治疗。手术采用后外侧入路，先切开并松解粘连挛缩的髋关节囊，充分显露髋臼，确定真性髋臼位置并行髋臼成形或再造，安放髋臼假体；适配型号的股骨柄试模置入后安放递增长度的股骨头进行髋关节复位，在保持髋关节张力的情况下触摸髋关节周围挛缩的软组织并依次松解，随后置入适配的股骨柄及股骨头假体，复位髋关节。[结果]19例患者均顺利完成手术。术后均实现髋臼及股骨柄生物性压配与初始稳定，无严重并发症。术后随访6～36个月。术后6个月随访时患者Harris评分为（94.5±4.7）分，临床效果评定：优15例、良4例，优良率100%。术后影像显示所有患者均保持解剖位旋转中心，假体位置良好，术后3个月X线片均示广泛性骨长入，随访期间均未发生脱位、假体柄移位及断裂。[结论]全髋关节置换术不行股骨缩短截骨治疗终末期关节合并股骨头、颈缩短畸形技术可行，短期疗效满意。     

非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形

[目的]介绍非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形的手术技术和初步临床效果。[方法]对19例股骨头颈短缩畸形患者采用非股骨短缩截骨全髋置换治疗。手术采用后外侧入路，先切开并松解粘连挛缩的髋关节囊，充分显露髋臼，确定真性髋臼位置并行髋臼成形或再造，安放髋臼假体；适配型号的股骨柄试模置入后安放递增长度的股骨头进行髋关节复位，在保持髋关节张力的情况下触摸髋关节周围挛缩的软组织并依次松解，随后置入适配的股骨柄及股骨头假体，复位髋关节。[结果]19例患者均顺利完成手术。术后均实现髋臼及股骨柄生物性压配与初始稳定，无严重并发症。术后随访6～36个月。术后6个月随访时患者Harris评分为（94.5±4.7）分，临床效果评定：优15例、良4例，优良率100%。术后影像显示所有患者均保持解剖位旋转中心，假体位置良好，术后3个月X线片均示广泛性骨长入，随访期间均未发生脱位、假体柄移位及断裂。[结论]全髋关节置换术不行股骨缩短截骨治疗终末期关节合并股骨头、颈缩短畸形技术可行，短期疗效满意。     

非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形

[目的]介绍非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形的手术技术和初步临床效果。[方法]对19例股骨头颈短缩畸形患者采用非股骨短缩截骨全髋置换治疗。手术采用后外侧入路，先切开并松解粘连挛缩的髋关节囊，充分显露髋臼，确定真性髋臼位置并行髋臼成形或再造，安放髋臼假体；适配型号的股骨柄试模置入后安放递增长度的股骨头进行髋关节复位，在保持髋关节张力的情况下触摸髋关节周围挛缩的软组织并依次松解，随后置入适配的股骨柄及股骨头假体，复位髋关节。[结果]19例患者均顺利完成手术。术后均实现髋臼及股骨柄生物性压配与初始稳定，无严重并发症。术后随访6～36个月。术后6个月随访时患者Harris评分为（94.5±4.7）分，临床效果评定：优15例、良4例，优良率100%。术后影像显示所有患者均保持解剖位旋转中心，假体位置良好，术后3个月X线片均示广泛性骨长入，随访期间均未发生脱位、假体柄移位及断裂。[结论]全髋关节置换术不行股骨缩短截骨治疗终末期关节合并股骨头、颈缩短畸形技术可行，短期疗效满意。     

后方关节囊修补预防全髋关节置换术后早期脱位

[目的]探讨加强修补后方软组织预防行后外侧切口首次人工全髋关节置换术后早期脱位的临床疗效和机理。[方法]回顾分析212例首次THA术中缝合后方关节囊与外旋短肌至臀中肌腱性部分的病例术中假体旋转活动度及术后早期脱位率，并与前期行关节囊完全切除的486例作对照分析。[结果]随访6个月～5a（平均3．7a），修补关节囊组仅2髋（0．9％）发生术后早期脱位；对照组发生脱位27髋（5．6％）。两组差异有显著意义（x^2=8．51，P〈0．005）。术中观察显示修补关节囊能够限制髋关节过度内旋20％～50％，阻止股骨头假体在髋臼内衬内的初始滑动。[结论]在假体安放正确基础上，加强修补后方关节囊能够有效预防行后外侧切口首次THA术后早期脱位，机理为关节囊修补后能限制髋关节过度内旋、阻止股骨头假体在髋臼内衬内的初始滑动，并提供了形成致密的假关节囊的生物学基础。     

金属对金属大头径微创全髋关节置换术治疗青中年股骨头坏死的临床研究

目的探讨金属对金属（金对金）大头径假体微创全髋关节置换术（THA）治疗青中年股骨头坏死Ⅲ、Ⅳ期的临床疗效。方法本组32例（35髋）青中年股骨头缺血性坏死Ⅲ、Ⅳ期患者,年龄24～59岁,平均45岁,术前髋关节Harris评分平均（37．9±7．5）分;以改良后外侧小切口、肌间隙人路、充分保留关节动力性组织结构为特征的金对金大头径微创THA治疗。术中严格采取正确的假体植入技术,术中保留完整的软骨下骨和髋臼横韧带,击入臼杯时一次性安装成功,正确运用万古霉素预防感染。术后口服利伐沙班片抗凝,术后12h开放负压引流及卧床行功能锻炼,术后第2天拔除引流管后扶拐下地部分负重行走,术后2—3周患者即可弃拐完全负重行走。结果本组32例35髋患者均获随访,随访时间为12个月～6年,平均为4年。所有患者切口均一期愈合,无深静脉血栓形成、关节脱位、坐骨神经损伤、髋臼及股骨疲劳骨折、关节疼痛等严重并发症,X线片示髋关节假体位置均良好,无松动、移位、股骨柄下沉、假体周围骨折等表现。末次随访Harris评分由术前平均（37．9±7．5）分,提高至术后平均（92．2±4．6）分,前后比较有统计学意义（t=44．341,P〈0．05）。所有患者末次随访时髋关节功能明显优于术前,均对治疗效果满意,完全恢复正常生活及工作。结论采用金对金大头径微创THA治疗青中年股骨头坏死Ⅲ、Ⅳ期患者,能够明显降低手术风险,缩短卧床时问,迅速恢复髋关节功能,减少手术并发症,取得了满意的近期临床疗效。随着基础和临床研究的不断深入,金对金大头径髋关节假体的长期疗效还需要进一步探讨。     

金属对金属髋关节表面置换术两种不同手术入路中假体位置的X线测量比较

[目的]了解外侧入路和后外侧入路两种不同入路中髋关节表面置换中假体位置的差异。[方法]72个关节中,分为两组:A组21例病人,共26个髋关节,采用Hardinge的外侧入路。B组44例,共46个髋关节,采用改良的Gibson入路,股骨头由关节后方脱出。测量的指标包括:(1)术前颈干角和术后股骨假体柄干角;(2)髋臼假体的外展角;(3)股骨假体的中心偏移距;(4)术前髋臼前倾角和术后髋臼假体前倾角;(5)股骨假体侧方中心偏移距;(6)股骨假体的侧方偏移角。[结果]股骨假体的柄干角A组为139.5°,B组为140.5°,2种入路间的柄干角无显著性差异;髋臼假体的外展角A组为37.7°,B组为44.4°;前倾角A组为21.6°,B组为15.2°。[结论]髋关节表面置换可以采用外侧入路和后外侧入路,股骨假体安放位置在两种入路中差别不大,但在髋臼假体安放时,相差显著。与后外侧入路比较,外侧入路中,髋臼假体的外展角较小,但前倾角较大。     

New two-incision minimally invasive total hip arthroplasty: comparison with the one-incision method

Background  There has been increasing interest in performing total hip arthroplasty (THA) with minimally invasive surgery (MIS). This study was conducted to examine the effectiveness of MIS-THA using the new two-incision technique versus the one-incision technique. Methods  A consecutive series of 113 patients who underwent MIS-THAs (63 one-incision cases, 50 two-incision cases) were studied. One-incision THA was performed with a posterolateral approach. For the two-incision, the first incision for cup insertion was made over the anterolateral side of the hip. Intermuscular dissection was performed between the gluteus medius and the tensor fascia lata. The second incision, for stem insertion, was made on the posterolateral side of the hip along the fiber of the gluteus maximus. Intermuscular dissection was made between the gluteus medius and the piriformis. Results  Postoperative rehabilitation was significantly more rapid in the new two-incision group compared to the group with one incision. Postoperatively, the Harris Hip Score and the Western Ontario and the McMaster Universities Osteoarthritis Index score were significantly different between the two groups, especially the functional sections. Conclusions  The findings of this study show that our new two-incision MIS-THA is an excellent surgical modality that allows early rehabilitation.     

OCM入路微创小切口全髋关节置换术后的深静脉血栓发生率

背景：OCM入路微创小切口全髋关节置换术（THA）创伤小、恢复快,理论上可降低DVT的发生率,但目前尚缺乏术后早期影像学检查判定DVT发生率的确切报道。目的：对行OCM入路微创小切口的全髋关节置换患者进行术后常规深静脉造影检查,以明确其深静脉血栓发生率并指导临床血栓预防。方法：行单侧OCM入路微创小切口THA患者27例,男13例,女14例;年龄28-90岁,平均（63.4±16.4）岁;BMI为21.2-29.8 kg/m2,平均（24.9±2.42）kg/m2;其中股骨头坏死9例,股骨颈骨折7例,发育性髋关节发育不良（DDH）6例,髋关节骨关节炎3例,强直性脊柱炎2例。术后行利伐沙班及气压泵治疗。评估手术时间、手术切口长度、肢体长度差异、术后下地行走时间、术后VAS评分（术后1、3 d）、术中和术后出血情况、术中和术后输血情况。股骨颈骨折患者术前及所有患者术后3-5d行双下肢深静脉造影,以明确DVT发生情况。结果：手术切口长8-10 cm,平均（8.5±0.6）cm;手术时间为65-125 min,平均（82±13）min;术中出血量为100-350 ml,平均（225±72）ml;术后引流量为120-905 ml,平均（457±218）ml,共4例患者输血。所有患者术后当天即可进行主动屈髋锻炼,双下肢长度差异均〈1 cm,术后1、3 d的VAS评分分别为0-6分,平均（2.5±1.4）分和0-4分,平均（1.9±1.2）分,所有患者术后2-3 d即可站立或行走。术前7例股骨颈骨折患者中2例发现患侧下肢DVT,术后深静脉造影检查仍提示同侧DVT,其余25例患者术后仅1例股骨颈骨折患者提示健侧腓肠肌静脉丛血栓形成。结论：采用OCM微创小切口手术入路THA可明显降低DVT的发生率。     

Comparative study of anterolateral approach versus posterior approach for total hip replacement in the treatment of femoral neck fractures in elderly patients

Objective： To compare the clinical outcome of anterolateral minimally invasive approach versus conventional posterior approach for total hip replacement against femoral neck fractures in elderly patients.
Methods： The retrospective study was carried out on 42 patients who suffered from displaced femoral neck fractures （19 cases of Garden type Ⅲ, 23 cases of Garden type Ⅳ） treated by total hip replacement via anterolateral minimally invasive approach or conventional posterior approach by the same experienced surgeon. The average age of the patients was 78.1 years （range： 65-89 years）. They were divided into anterolateral mini-invasive group （22 cases） and posterior group （20 cases）. The mean time of follow-up was 13 months （range： 6-36 months）. The anterolateral approach described by Hardinge goes through between anterior 1/3 and posterior 2/3 of the gluteus medius muscle, reaching the femoral neck from anterior capsule. The traditional posterior approach described by Moore （Southern incision） goes through the insertions of short external rotation muscles, reaching the femoral neck from posterior capsule. The related variables under observation were length of incision, operation time, postoperative limp, length of hospital stay and bed stay and dislolcation rate.
Results： The length of the skin incision varied between 7 cm and 12 cm with the anterolateral minimally invasive technique, compared to 15-22 cm in the conventional procedure. It took less time （average 15 minutes） to complete the anterolateral minimally invasive approach （72 15 min）, compared with the conventional approach （87 min ±10 min）. The average Harris hip score was 91.23±10.20 in anterolateral approach, 90.03±11.05 in the posterior approach. The average length of hospital stay for patients with the anterolateral approach was （6.4±2.2） days （range： 4-9 days）, while that in posterior approach was （9.2 ±3.1） days （range： 6-13 days）. The average length of bed stay was （3.4±1.1） days （range： 2-5 days） in anterolateral group and （6.2±2.8） days （range： 3-10 days） in posterior group. No patients in anterolateral group experienced dislocation. One （5%） hip in posterior approach had dislocation. Conclusions： Anterolateral mini-invasive approach can decrease trauma, operation time, length of hospital stay and bed stay and rehabilitation time. The stability and minimal muscular damage permit the acceleration of postoperative rehabilitation, which can subsequently reduce the perioperative risk in the treatment of femoral neck fractures in the elderly undergoing total hip replacement.     

Total Hip Arthroplasty: Is Small Incision Better?

Outcome data are eagerly awaited at present time to evaluate the role of minimally invasive surgery in orthopedic surgery. This matched-pair study reports the outcome of total hip arthroplasty (THA) performed through regular or small incision technique by a single surgeon. There were 120 patients in this cohort with a mean age of 66.8 years (range, 39-90 years). There was no detectable difference in outcome between the two groups with regard to blood loss, analgesia requirement, functional recovery, length of hospital stay, or disposition at discharge. One patient in the small incision group with undersized femoral component required revision of the femoral stem 8 months later. The recent extensive interest for minimally invasive THA has been attributed to market-driven and patient-driven demand for this procedure. We were not able to detect any difference in outcome parameters for THA performed through small incision compared with the conventional techniques.     

Distal femoral shortening osteotomy for treatment of sciatic nerve palsy after total hip arthroplasty — a report of 3 cases

Background and purpose Minimally invasive surgery (MIS) for hip replacement is thought to minimize soft tissue damage. We determined the damage caused by 4 different MIS approaches as compared to a conventional lateral transgluteal approach.

Methods 5 surgeons each performed a total hip arthroplasty on 5 fresh frozen cadaver hips, using either a MIS anterior, MIS anterolateral, MIS 2-incision, MIS posterior, or lateral transgluteal approach. Postoperatively, the hips were dissected and muscle damage color-stained. We measured proportional muscle damage relative to the midsubstance cross-sectional surface area (MCSA) using computerized color detection. The integrity of external rotator muscles, nerves, and ligaments was assessed by direct observation.

Results None of the other MIS approaches resulted in less gluteus medius muscle damage than the lateral transgluteal approach. However, the MIS anterior approach completely preserved the gluteus medius muscle in 4 cases while partial damage occurred in 1 case. Furthermore, the superior gluteal nerve was transected in 4 cases after a MIS anterolateral approach and in 1 after the lateral transgluteal approach. The lateral femoral cutaneous nerve was transected once after both the MIS anterior approach and the MIS 2-incision approach.

Interpretation The MIS anterior approach may preserve the gluteus medius muscle during total hip arthroplasty, but with a risk of damaging the lateral femoral cutaneous nerve.     

仰卧位常规器械OCM入路与后外侧入路全髋关节置换术的疗效对照

目的:比较仰卧位常规器械OCM入路与后外侧入路全髋关节置换术的临床疗效。方法 :2017年2月至2019年1月因髋关节疾病行髋关节置换患者67例,其中微创组21例采用OCM入路,男12例,女9例;股骨颈骨折10例,股骨头无菌性坏死5例,髋关节骨性关节炎6例。传统组46例采用传统后外侧入路,男28例,女18例;股骨颈骨折24例,股骨头无菌性坏死12例,髋关节骨性关节炎10例。所有患者使用生物型陶-陶人工关节假体。观察比较两组患者手术时间、术中出血量、切口长度、手术前后肌酸激酶(CK-NAC)、下地活动时间、住院时间、术后假体的外展角及前倾角。比较两组术前及术后12个月Harris评分。结果:所有病例获得随访,时间14～26(18.4±3.6)个月。两组患者术中出血、术后前倾角及外展角比较,差异均无统计学意义(P0.05)。两组病例手术时间、切口长度、术后肌酸激酶、下地时间、住院时间差异均有统计学意义(P0.05)。两组术前及术后12个月Harris功能评分差异均无统计学意义(P0.05)。结论:两种入路人工全髋关节置换术均可获得满意的疗效,OCM入路损伤小,术后康复快,是可靠的手术入路。     

人工髋关节置换术中的小切口运用

目的 报告小切口进行髋关节置换手术的可行性和优越性。方法 自2001年9月～2004年5月，运用小切口对74例患者进行人工髋关节置换手术。结果 切口长6．5～8．5cm。全髋置换平均手术时间80min，平均术中失血280mL，12h平均引流150mL；股骨头置换术平均手术时间40min，平均术中失血150mL，术后平均引流100mL。术后平均8d出院，平均住院14d。术后未发现并发症。随访1-32个月，复查X线片未见人工关节松脱，患者可负重行走。结论 小切口具有创伤小、出血量少、损伤组织少、感染机会低、医源性损伤少、人工关节稳定性强、患者恢复时间短等优势。     

Risk of superior gluteal nerve and gluteus medius muscle injury during femoral nail insertion

BACKGROUND: Abduction weakness and limping is a well-recognized complication of closed antegrade insertion of femoral nails. Iatrogenic injuries to the superior gluteal nerve and the gluteus medius muscle are the most likely contributing factors. The purpose of this study of cadavers was to assess the risk of nerve and muscle injury with various lower-limb positions used during nail insertion. METHODS: We studied thirteen hips of ten formalin-fixed adult cadavers. With the cadaver in the full lateral position, a 9-mm reamer was introduced in a retrograde fashion from the intercondylar notch and passed through the gluteus medius muscle. The distance between the point of entry of the reamer into the undersurface of this muscle and the inferior main branch of the superior gluteal nerve (the nerve-reamer distance) and the distance between the entry and exit points of the reamer in the gluteus medius muscle (the intramuscle distance) were measured in three different hip positions: 15 degrees of flexion and 15 degrees of adduction (Position 1), 30 degrees of flexion and 30 degrees of adduction (Position 2), and 60 degrees of flexion and 30 degrees of adduction (Position 3). RESULTS: In Position 1, the average nerve-reamer distance was 7 mm and the average intramuscle distance was 24 mm. In three hips the reamer injured the nerve directly, and in two other hips the distance was 相似文献   

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

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11～23 d,平均14.3 d.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扶愈合,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.股骨头缺血性坏死绀患者症状明显改善,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.

Abstract：

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 Ⅱ, 5 type Ⅲ and 3 type Ⅳ fractures. 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 Ⅱ 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-ilium 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.     

关节囊修补对老年初次全髋关节置换术后早期脱位的影响

目的探讨后路老年初次全髋关节置换术中关节囊修补及其对术后早期脱位的影响。方法分析1996年11月至2007年5月行K—L入路治疗老年初次全髋关节置换的股骨颈骨折患者120例,均为单髋病例。根据术中是否进行关节囊的修补及外旋肌群的修复分为两组：A组术中切除后关节囊,行外旋肌群的修补;B组术中“T”形切开关节囊进行修补,并将关节囊与外旋肌群共同缝合于大转子及臀中肌止点。结果A组80例,16例失随访,术后早期脱位2例2髋（2．5％）。B组40例,1例失随访,无一例出现术后早期脱位。结论后路关节囊及软组织袖修补方法简单,不增加手术创伤,可以有效发挥阻挡作用,降低术后早期脱位率。