带血管蒂髂骨瓣移植治疗中青年股骨头坏死

应用带血管蒂骨瓣移植治疗中青年股骨头坏死 2 1例 ,经 3年以上随访 ,效果满意。我们认为 :其治疗主要解决两方面的问题 ;降低股骨头内压 ,提供良好的血供。此手术采用头颈部开槽即降低了股骨头内高压 ,采用带旋髂深血管骨瓣移植不需吻合血管 ,通畅率高 ,能提供可靠的动脉血供。带血管蒂髂骨瓣移植治疗中青年股骨头坏死$河北省秦皇岛市第二医院骨科@俞汝霞     

带旋髂深血管蒂髂骨瓣移植治疗成人股骨头缺血性坏死

带旋髂深血管蒂髂骨瓣移植治疗成人股骨头缺血性坏死徐恩常李铭李平波我院自１９８６年至１９９２年采用带同侧旋髂深血管蒂髂骨瓣移植治疗成人股骨头缺血性坏死１２０例１４０髋，获得较满意效果，报道如下。临床资料本组１２０例１４０髋，男７６例９２髋，女４４例４８...     

血管束与血管蒂髂骨瓣联合移植治疗股骨头缺血性坏死

我院自 1992～ 1998年采用旋髂深血管蒂髂骨瓣和旋股外侧血管升降支血管束联合移植治疗股骨头缺血坏死 2 8例 ,效果满意。1　临床资料本组 2 8例 ,男 19例 ,女 9例。年龄 2 3～ 5 0岁。左侧 15髋 ,右侧 13髋。其中 6例与激素治疗有关 ,3例有长期酗酒史 ,外伤性 17例 ,特发性 1例 ,原因不明 1例。术前根据Ｘ线改变进行评定 ,以Ｍａｒｃｕｓ[1] 分期法Ⅱ期 4例 ,Ⅲ期 2 0例 ,Ⅳ期4例。2　治疗方法仰卧位 ,患侧垫高 30°。切口近似倒Ｙ形 ,主切口以Ｓｍｉｔｈ Ｐｅｔｅｒｓｅｎ切口 ,副切口始于腹股沟韧带上方 1 5ｃｍ处 ,平行腹股沟韧带 ,在髂…     

带血管蒂髂骨瓣移植在髋部疾患的应用

带血管蒂髂骨瓣移植在髋部疾患的应用蒲兴海田文生许多髋部疾患，以传统治法，成功率尚低。如“报道老年人股骨颈骨折经内固定治疗后，骨不连的发生率为１０％～５０％；而青壮年股骨颈骨折不连接的发生率可高达５９％。股骨头缺血坏死率老年人平均２５％；而青壮年则为...     

自体松质骨及带血管蒂髂骨瓣移植治疗青壮年股骨头坏死的疗效观察

目的 观察自体松质骨及带血管蒂髂骨瓣移植治疗青壮年股骨头坏死的疗效.方法 对56例(58髋)股骨头坏死采用自体松质骨及带血管蒂髂骨瓣移植治疗.结果 经1～6年随访,所有患者均获骨性愈合.术后疗效优28例,良26例,差2例,优良率96.4％.结论 自体松质骨及带血管蒂髂骨瓣移植治疗青壮年股骨头坏死,能有效改善股骨头血运...     

带血管蒂髂骨瓣移植治疗股骨头缺血性坏死填充位置的有限元分析

背景:带血管蒂髂骨瓣移植治疗股骨头缺血性坏死过程中如何正确地将移植骨(膜)瓣嵌入坏死区域是目前需要解决的问题.目的:应用有限元分析法评价带血管蒂髂骨瓣修复股骨头坏死放置位置的最佳力学效果.方法:将股骨头坏死患者的薄层CT数据导入医学建模软件Mimics建立股骨模型.在模型上确定股骨头坏死的区域,坏死区域赋予骨瓣的材质特...     

带血管蒂髂骨膜瓣移位治疗股骨头缺血性坏死

目的 探讨带血管蒂的髂骨膜瓣移位治疗股骨头缺血性坏死的疗效。方法 １９８３年６月～１９９７年８月,应用带旋股外血管升支或旋髂深血管蒂的髂骨膜瓣移位治疗股骨头缺血性坏死１０６例,其中Ⅱ期６４例,Ⅲ期３９例,Ⅳ期３例。结果 １０６例经２年４个月～１６例随访,根据赵德伟制定的成人股骨头缺血性坏死修复与再造疗效评价方法,成５４例,良３８例,可９例,优良率为８６．８％。结论 带血管蒂髂骨膜瓣移位治疗股骨头缺     

带血管蒂髂骨瓣移位治疗股骨颈骨折术后股骨头缺血性坏死

目的 探讨应用带血管蒂髂骨瓣移位治疗股骨颈骨折术后股骨头缺血性坏死(avascular necrosis of femoral head,ANFH)的疗效.方法 2002年6月-2006年12月,采用带血管蒂髂骨瓣移位治疗股骨颈骨折内固定术后ANFH 22例22髋.男18例,女4例;年龄28～48岁,平均37.5岁.左...     

带血管蒂髂骨瓣移位治疗青少年镰状细胞病股骨头缺血性坏死

目的探讨带血管蒂髂骨瓣移位治疗青少年镰状细胞病股骨头缺血性坏死的临床疗效。方法1998年～2001年在尼日尔的马腊迪省医院，治疗患者12例14髋，其中男5例，女7例；单侧10例10髋，双侧2例4髋；年龄11～22岁。均为FicatⅢ、Ⅳ期患者。Harris评分平均75分。采用带血管蒂髂骨瓣移位12例12髋，有2例双髋患者，仅作一侧手术。结果术后患者均获随访24～30个月，平均27．4个月。髋部疼痛消失，无感染等并发症，Harris评分平均90分，X线片示病变无进展，无重复手术，近期疗效满意。结论对于青少年FicatⅢ、Ⅳ期的镰状细胞病股骨头缺血性坏死患者，采用带血管蒂髂骨瓣移位术治疗，能解除疼痛，恢复髋关节功能，延缓人工全髋关节置换的时间。     

带血管蒂髂骨膜瓣移植术治疗股骨头缺血性坏死

带血管蒂髂骨膜瓣移植术治疗股骨头缺血性坏死王成琪，范启申，王剑利，王增涛，张树明股骨头缺血性坏死发病原因尚不太清楚，但是不论是成人还是小儿，造成股骨头坏死的原因是血供不良，因此在病程的各个时期如何改善股骨头血供是治疗该病的主要措施。￣［１，４］我们自...     

Use of vascularized pedicle iliac bone graft in the treatment of avascular necrosis of the femoral head

A vascularized pedicle iliac bone graft was performed in patients with extensive necrosis in whom the necrotic area occupied more than two-thirds of the femoral head. The purpose of this procedure is to supply vascularity and mechanical strength to the avascular femoral head. Our series consisted of 18 hips. The patients’ age at surgery ranged from 21 to 55 years. Fourteen hips were identified as stage II and 4 hips as stage III. Iliac bone graft alone was performed in 4 stage II joints. Transtrochanteric anterior rotational osteotomy of the femoral head was done additionally in 10 stage II joints and 4 stage III joints. In the group who underwent iliac bone graft alone, the mean Japanese Orthopedic Association (JOA) score improved from 58.5 to 63.8 (mean follow-up 52 months). In the group who underwent combination procedure with osteotomy, the mean JOA score improved from 71.7 to 85.0 (mean follow-up 43 months). Stage progression was noted in 3 of 4 joints in the group who underwent iliac bone graft alone. In the group who underwent the combined procedure, stage progression was noted in 2 of 10 joints at more than 1 year after operation. A vascularized pedicle iliac bone graft to treat avascular necrosis of the femoral head is considered promising for joint preservation. Received: 19 October 2000     

Use of vascularized pedicle iliac bone graft combined with transtrochanteric rotational osteotomy in the treatment of avascular necrosis of the femoral head

Introduction A vascularized pedicle iliac bone graft combined with transtrochanteric anterior rotational osteotomy was performed in patients with extensive necrosis in whom the necrotic area occupied more than two-thirds of the weight-bearing zone of the femoral head. The purpose of this procedure is to supply vascularity and mechanical strength to the avascular femoral head.Materials and methods Seventeen hips in 14 patients (8 male, 6 female) whose average age at surgery was 37.9 (range 21–51) years underwent this procedure between June 1992 and December 2002. These hips (stage 2 in 3 hips, stage 3A in 13 hips, and stage 3B in 1 hip) were examined for changes according to the Japanese Orthopedic Association (JOA ) score and the presence or absence of progression of the clinical stage at least 1 year after surgery.Results The mean JOA score improved from 67.8 points preoperatively to 78.1 points by 18–133 (mean 50.7) months postoperatively. There was no disease progression to a more advanced stage in 12 of 17 hips (71%) postoperatively.Conclusion A vascularized pedicle iliac bone graft combined with transtrochanteric anterior rotational osteotomy to treat avascular necrosis of the femoral head is considered promising for joint preservation.     

Predictive factors for vascularized iliac bone graft for nontraumatic osteonecrosis of the femoral head

We reviewed the results of 35 operations performed on 29 patients with osteonecrosis of the femoral head in which a pedicle iliac bone was utilized. The average age was 35 years (17–62). There were 28 patients of stage 2 and 7 of stage 3; there were 17 type C-1 hips and 18 type C-2 hips. The pedicle bone was inserted in the anterolateral direction of the femoral head. The average follow-up period was 8 years and 7 months. Collapse of the femoral head occurred in 19 hip joints. Although 16 of 28 stage 2 hips showed collapse, all 7 stage 3 hips resulted in collapse. Thirteen of 17 hips did not show collapse in patients with type C-1 necrosis, whereas 15 of 18 hips developed collapse in patients with type C-2 necrosis. When the bone graft was inserted in the anterolateral direction of the femoral head, incidence of collapse was reduced. These results indicate that deep circumflex iliac pedicle bone graft may be indicated for stage 2 type C-1 necrosis, and that the penetration of the graft into the anterolateral aspect of the lesion is essential for the procedure to succeed.     

牛骨形态发生蛋白加自体髂骨植入治疗儿童股骨头缺血性坏死

目的 探讨牛骨形态发生蛋白（ｂＢＭＰ）＋自体髂骨植入治疗儿童股骨头缺血性坏死的疗效。方法 自体髂骨植入１０２髋,ｂＢＭＰ植入３７髋,ｂＢＭＰ＋自体髂骨植入６９髋。比较３种手术方法疗效。结果 随访６个月～１５年,３种手术方法中以ｂＢＭＰ＋自体髂骨植入组疗效为最优。结论 ｂＢＭＰ＋自体髂骨植入治疗儿童股骨头缺血性坏死疗效显著。     

带旋髂深血管蒂髂骨瓣治疗股骨头缺血性坏死

目的探讨股骨头缺血性坏死治疗的方法。方法 应用带旋髂深血管蒂髂骨植入治疗８８例股骨头缺血性坏死。结果 ８８例随访２－９年，根据成人股骨头缺血性坏死疗效评价法，优良率９０．９％。结论该手术可以增加股骨头血运，骨瓣可以起支撑作用。对于Ｆｉｃａｔ分期Ⅰ－Ⅲ期的患者是一种较好的治疗方法。     

Non-traumatic osteonecrosis of the femoral head treated with transtrochanteric anterior rotational osteotomy combined with vascularized iliac bone grafting

A 49-year-old Japanese man who had non-traumatic osteonecrosis of the femoral head with a wide necrotic lesion received transtrochanteric anterior rotational osteotomy combined with vascularized iliac bone grafting. After the bone graft (6 × 1.5 cm) was collected, the femoral head was anteriorly rotated by 90°. A bone tunnel of 1.2 cm in diameter was prepared on the necrotic lesion adjacent to the intact area from the anterior part of the femoral neck to inside the femoral head. The bone graft was trimmed to the size of this bone tunnel, and inserted up to immediately below the articular surface. In the monitoring using T1-weighted magnetic resonance imaging (MRI), the low signal-intensity area between the bone graft and intact area had disappeared, and a high signal-intensity area on the weight-bearing portion of the femoral head had extended. With modifications on the insertion point of the bone graft, transtrochanteric anterior rotational osteotomy combined with vascularized iliac bone graft would be a useful means to preserve the femoral head in large non-traumatic osteonecrosis of the femoral head. Received: December 24, 1999 / Accepted: May 23, 2000     

全髋关节置换治疗创伤性股骨头坏死

目的评价人工全髋关节置换术治疗创伤性股骨头坏死的疗效。方法对30例创伤性股骨头坏死患者行全髋关节置换术,术后摄片评估假体位置,比较术前和末次随访时Harris评分及VAS评分,采用欧洲生活质量评分体系(EQ-5D)评定患者的健康生活量。结果 30例均获随访,时间8~86(32±4.3)个月。患者术后切口均一期愈合。未发生深静脉血栓、感染、脱位及坐骨神经损伤等手术并发症。末次随访X线片:5例骨水泥假体按Harris标准1例可能有松动(为髋臼骨折病例),其余均无松动;25例生物型假体按Engh标准均为骨长入稳定,1例发生异位骨化(根据Brooker分级为Ⅰ级)。末次随访时Harris评分为82~99(92.00±4.26)分,VAS评分改善到0~4(0.98±1.21)分,EQ-5D评分为0.76~0.97(0.82±0.12)分,3项评分与术前比较差异均有统计学意义(P0.01)。结论全髋关节置换治疗创伤性股骨头坏死经过术前周密的安排、术中精细的操作可以取得满意的临床疗效。     

扩大髓芯减压带血管蒂髂骨瓣移植治疗成人股骨头缺血坏死

目的评价扩大髓芯减压、并带旋髂深血管蒂髂骨瓣植骨治疗成人股骨头缺血坏死的临床应用价值。方法回顾性分析29例成人股骨头缺血坏死患者行扩大髓芯减压、并带旋髂深血管蒂髂骨瓣植骨治疗前后的影像学表现、功能评分。结果所有患者的疼痛症状都得到一定程度的缓解,Harris评分都有显著提高,术后优良率达93%。结论扩大髓芯减压、并带旋髂深血管蒂髂骨瓣植骨术是治疗2、3期成人股骨头缺血坏死的有效方法。     

股骨头髓芯减压带旋髂深血管蒂髂骨骨瓣植骨治疗股骨头缺血性坏死

目的　探讨股骨头髓心减压带旋髂深血管蒂髂骨骨瓣植骨术治疗股骨头缺血坏死的疗效及手术适应证。　方法　 1995年 10月～ 2 0 0 0年 8月共进行 18例 (2 6髋 )股骨头髓心减压带旋髂深血管蒂髂骨骨瓣植骨术。根据Harris髋关节评分系统进行关节功能评价 ,根据ARCO分期分型系统进行影像学评价。　结果　随访 16例 2 3髋 ,平均 3 1 5个月。Harris评分由术前平均 61 7改善为随访时 76 0分。 13髋 (5 6% )随访时Harris评分 >80 0分 (内侧型 8髋 ,中央型 3髋 ,外侧型 2髋 ) ,根据ARCO分期分型系统进行分类随访时优良率 ,内侧型 80 % ,中央型 60 % ,外侧型 2 5 %。 8髋分期发生进展。塌陷及失败率内侧型 2 0 % ,中央型 40 % ,外侧型 75 %。　结论　股骨头髓芯减压带旋髂深血管蒂髂骨骨瓣植骨术适用于ARCO分期分型系统中ⅠA中央型、ⅠB内侧型、ⅡA中央型、ⅡB内侧型股骨头缺血性坏死 ,并具有良好的近、中期疗效。对坏死范围较大的股骨头不能防止病程的进展 ,但可缓解症状 ,延缓全髋关节置换的时间