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股骨颈骨折是一种老年人的常见骨折。随着交通、建筑业的高速发展,青壮年股骨颈骨折日趋增多。由于暴力方式及解剖学特点等因素,常发生骨折不愈合及股骨头坏死。我科1990年5月-2005年1月应用缝匠肌髂骨瓣、阔筋膜张肌髂骨瓣及股方肌肌骨瓣植入治疗50岁以下青壮年股骨颈骨折87例,以预防骨折不愈及股骨头坏死。现报告如下。 相似文献
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腓骨钉联合带旋髂深血管蒂髂骨瓣治疗青壮年股骨颈骨折不愈合 总被引:3,自引:0,他引:3
目的 评价腓骨钉联合带旋髂深血管蒂髂骨瓣对青壮年股骨颈骨折不愈合的治疗效果。方法采用腓骨钉联合带旋髂深血管蒂髂骨瓣治疗6例青壮年股骨颈骨折不愈合,病程6月~1.5年。结果术后随访7月~2.5年,5例术后6~9月骨折愈合,股骨头无缺血坏死,现负重行走,髋关节活动基本正常。1例移植腓骨从股骨头滑出,后观察4月,因骨折未愈合改用全髋关节置换术治疗。结论腓骨钉联合带旋髂深血管蒂髂骨瓣治疗青壮年股骨颈骨折不愈合,符合生理和生物力学要求,可作为青壮年股骨颈骨折不愈合的治疗方法之一。 相似文献
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目的:探讨青壮年股骨颈骨折特点,提高诊治水平。方法:15例22~50岁青壮年股骨颈骨折患者。经选用带血管蒂髂骨瓣移位加股骨头减压术。结果:术后15例经3~5年的随诊,14例股骨颈骨折愈合好,无股骨头坏死情况,效果满意。结论:青壮年股骨颈骨折股骨头血供的改善和重建是治疗的关键。采用带血管蒂髂骨瓣移位加股骨头髓腔减压术不失为治疗该种疾病的有效方法之一。 相似文献
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股方肌蒂骨膜骨瓣移植治疗青壮年股骨颈骨折江振华,刘仁寿,姚忠军青壮年股骨颈骨折不愈合及股骨头缺血坏死率较高,在治疗方法上困难较多。Protzman曾报道老人股骨颈骨折术后不愈合发生率为10%~50%,青壮年为59%;老人股骨头缺血性坏死率平均为25%... 相似文献
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带旋髂深血管蒂髂骨瓣转移治疗青壮年陈旧性股骨颈骨折 总被引:1,自引:0,他引:1
目的:探讨用带旋髂深血管蒂髂骨瓣转移治疗青壮年陈旧性股骨颈骨折的疗效。方法:采用经前路切开复位带旋髂深血管蒂髂骨瓣转移及多螺钉内固定治疗青壮年陈旧性股骨颈骨折36例,结果:经1.5-5年随访,优良率为89.2%,股骨头无菌性坏死率为3%,疗效满意,结论:带旋髂深血管蒂髂骨瓣具有充足血供,能明显提高股骨颈骨折的治愈率,减少股骨头无菌性坏死的发生,对治疗青壮年陈旧性股骨颈骨折有重要价值。 相似文献
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青壮年股骨颈骨折多由高能量创伤引起,股骨头缺血性坏死及骨不连接的发生率较高。随着带血管蒂、肌蒂骨瓣的应用,此并发症有所下降。笔者自2001年6月-2006年4月应用旋髂深动脉蒂髂骨瓣移植治疗青壮年股骨颈骨折18例,功能恢复良好。报告如下。 相似文献
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股骨颈骨折多发生于老年人,是高能量的损伤,也可造成青壮年骨折。该类型骨折存在不愈合、股骨头缺血性坏死两大潜在因素,影响其治疗效果。我院从2000年1月~2003年12月,采用中空加压螺钉治疗股骨颈骨折15例,疗效满意,总结如下。 相似文献
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Y Kimata K Uchiyama M Sakuraba S Ebihara R Hayashi T Asakage T Nakatsuka K Harii 《British journal of plastic surgery》2001,54(6):487-490
The deep circumflex iliac myocutaneous perforator (DCIP) flap with iliac crest was used to reconstruct oromandibular defects in 10 patients. In seven of the patients a dominant perforator was found preoperatively using a Doppler flowmeter; in five of these seven patients a DCIP flap was successfully transferred. In two of the seven patients the dominant perforators were too narrow: one patient underwent a standard osteocutaneous flap transfer and one patient underwent a second flap transfer. In three patients no dominant perforator was found before or during surgery. The freedom of the DCIP flap from the harvested iliac crest facilitates correct positioning. However, to ensure that the DCIP flap can be safely elevated, the presence of perforators must be confirmed preoperatively. Even when a perforator has been identified, complicated dissection may be necessary. We stress the importance of a thorough knowledge of the anatomy of second flaps and of obtaining informed consent to use them. 相似文献
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股骨颈骨折是常见病、多发病,并发症多,治疗较困难。尤以青壮年头下型及颈中型骨折,常易发生骨不愈合及缺血性坏死,造成残疾。笔者于1998年至2002年8月,对17例股骨颈头下型及颈中型骨折,采用带旋髂深血管蒂髂骨瓣植骨,取得良好的疗效。现报告如下。1临床资料1.1一般资料:本组17例中,头下型12例,颈中型5例;男14例,女3例;年龄21~56岁,平均38.5岁;左侧7例,右侧10例;均为新鲜骨折。致伤原因交通事故伤15例,坠落伤2例。1.2治疗方法:入院后先股骨髁上牵引3~5天,X片复查。骨折位置基本达到解剖复位后,在硬膜外麻醉下,取平卧位,患侧臀部垫高,作髂… 相似文献
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Treating flush iliac artery occlusion by endovascular means can be very challenging and is a cause of technical failure requiring open surgical intervention. We describe a simple endovascular technique that can be valuable in increasing technical success and avoiding the use of a re-entry device. The technique involves placing an occlusive contralateral iliac artery balloon to assist in recanalizing a flush iliac artery occlusion. 相似文献
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髂骨短钉骨水泥强化与长钉的固定强度比较 总被引:2,自引:0,他引:2
目的 评价两种髂骨钉在承受周期性载荷后的固定强度,探讨聚甲基丙烯酸甲酯(poly-met hylmethacrylate,PMMA)强化髂骨短钉固定的生物力学作用.方法 对11具成人尸体标本(男7具、女4具;年龄41~78岁,平均60.7岁)骨盆标本,行双能X线吸收法(DEXA)扫描以确定骨矿物质密度(bone mineral density,BMD),平均值为(0.68±0.17) g/cm2.实验采用配对设计,随机选择一侧髂骨置入直径为7.0 mm、长度为(138±4) mm的髂骨长钉,另一侧置入PMMA强化的直径为7.0 mm、长度为(70±2) mm的髂骨短钉(短钉定义为60~80 mm,长钉定义为100~140 mm), PMMA的注入量为2~5 ml(平均3.6 ml).随后对螺钉施加30~300 N的垂直周期性载荷,载荷频率为2 Hz,加载次数为2000次,最后以5 mm/min的速度进行两种螺钉拔出试验,获得螺钉的最大拔出力.结果 髂骨长钉和髂骨短钉PMMA强化后的初始刚度分别为(249±101) N/mm和(253±122) N/mm.加载周期载荷后,两者的终末刚度分别为(214±92) N/mm和(229±120) N/mm.加载周期载荷后,短钉强化和长钉的最大拔出力分别为(2529±1055)N和(2436±915)N,两者之间差异无统计学意义.两种固定方式的最大拔出力与骨密度呈线性关系.结论 PMMA强化髂骨短钉应用于腰骶骨盆重建是可行的,对于骨质疏松的患者应尽量采用此方法固定. 相似文献
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Molmenti EP Varkarakis IM Pinto P Tiburi MF Bluebond-Langner R Komotar R Montgomery RA Jarrett T Kavoussi LR Ratner LE 《Transplantation proceedings》2004,36(9):2643-2645
We evaluated a technique for implantation of right kidneys with short renal veins without the need for venous reconstruction. METHOD: The technique of iliac vein transposition was performed in six recipients who received right kidneys with short renal veins. Two cases were living related donors, two were living unrelated, one was an autotransplant, and one was a cadaver kidney recipient. The common and external iliac veins and arteries of the recipient were thoroughly mobilized, allowing for the lateral transposition of the external iliac vein with respect to the external iliac artery. The renal vessels were subsequently implanted in an end to side fashion onto the corresponding transposed external iliac vessels. After implantation, the iliac vein remained lateral with respect to the iliac artery. CONCLUSIONS: The technique described allows for the implantation of right kidneys without the need for venous reconstruction. Such an approach is especially useful in cases of grafts with short veins. 相似文献
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Ziegler P Avgerinos ED Umscheid T Perdikides T Erz K Stelter WJ 《Journal of vascular surgery》2007,46(2):204-210
OBJECTIVE: The objective of the current study was to share a 6-year experience with the iliac bifurcation device (IBD) and determine its safety and effectiveness in patients with common iliac artery aneurysms. METHODS: Between 2001 and 2006, 46 patients were prospectively enrolled in a single institution study on the IBD. Indications included unilateral or bilateral common iliac artery aneurysms (CIAA) (combined or not with abdominal aortic aneurysm endovascular repair). The first 26 patients were intended to receive a first generation unibody IBD and the following 20 patients the second generation, modular, IBD. RESULTS: In 33 patients out of 46 attempted (technical success per patient 72%), 35 iliac bifurcated devices (2 patients received bilateral IBD) out of 51 attempted (technical success per vessel 69%), were successfully implanted. The technical success rate (per vessel) was 58% for the first generation device and 85% for the second generation device. Inability to introduce the side branch into the IIA and intraoperative occlusions were the main reasons for technical failure. Among these failures, only two patients required open conversions. The mean +/- SD follow-up (radiological and clinical) of the 33 patients with a total of 35 successful IBD implantations was 26 +/- 17 months (median 24, range 3 to 60). During the follow-up period out of 35 successfully-implanted iliac bifurcation devices, four (11%) hypogastric side branch occlusions occurred, all within the first 12 months. Cumulative IBD side branch patency was 87% at 60 months. Comparing the first with the second generation IBD outcomes, cumulative patency rates at 2 years revealed no statistical difference (P = .774). No endoleak, and particularly no IBD, modular side branch disconnection, no late rupture, or deaths have yet been encountered. CONCLUSIONS: Preservation of pelvic circulation in high risk patients treated for bilateral or unilateral common iliac aneurysms combined or without AAA is feasible and secure exclusively by endovascular repair. New generation iliac bifurcated devices show a favourable intraoperative performance and long-term outcomes. 相似文献
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正患者女,45岁,因慢性肾功能不全接受右侧髂窝肾移植术,术后4h血压进行性下降,给予多种大剂量血管活性药物后血压波动于30~50/20~40mmHg,心率130~150次/分,失血性休克,伴右下肢肿胀逐渐加重。急诊床旁超声:右侧髂窝移植肾大小正常,各级动脉血流树稀疏,可见三级动脉,频谱呈"针状"高速高阻型(图1A),移植肾静脉内未见明确血流信号(图1B),肾周血肿;右股动脉纤细,远端流速减低;右下肢深、浅静脉内径增宽,其内未见血流信号,未见明确血栓。 相似文献
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我科自1991年以来采用旋髂深血管髂骨骨膜瓣移植治疗股骨颈骨折27例,疗效满意,现总结如下. 相似文献
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骨不连、骨缺损的治疗是骨科医生常面临的一个问题。自体骨因兼有骨诱导活性和骨传导作用,且具有成骨作用的骨髓细胞,成骨效果最好,故目前仍是植骨的“金标准”。虽然植骨材料目前有同种异体骨、异种骨、人工骨等多种选择,但在已严重骨缺损、骨萎缩的骨不连端,仍需要取含丰富松质骨的大块髂骨进行植骨。临床上常可见到患者术后供骨区不同程度的慢性疼痛、局部组织塌陷、髂嵴部变形等并发症. 相似文献