吻合旋髂深血管的髂骨瓣移植治疗股骨骨不连、骨缺损

股骨因拥有良好的血运,骨折后骨不连少见.当发生股骨骨折骨不连时,经髂骨植骨并更换内固定,往往可以愈合.但对于骨缺损较大,或经髂骨植骨后仍不愈合者,则治疗比较困难.笔者自2001年9月～2006年9月,采用吻合旋髂深血管的髂骨瓣移植治疗股骨骨不连、骨缺损11例,疗效满意.     

硅胶膜管联合BMP/HA修复大块骨缺损机制初探

目的 探讨硅胶膜（SGM）管与骨形态发生蛋白（BMP）／羟基磷灰石（HA）复合物联合修复兔长骨缺损的机制。方法 制备兔桡骨中段1.2cm缺损,实验组缺损区外围包绕SGM，其内分别填充BMP／HA，HA材料，对照组仅填充HA；空白组骨缺损区未填充。通过X线摄片，光学显微镜和扫描电镜观察骨缺损区的影像学，组织学和超微结构变化。结果 术后1个月，SGM＋BMP／HA组骨缺损区有大量的类骨质形成。术后2个月，SGM＋BMP／HA组大量骨膜来源的分化细胞沿SGM管的内，外面及HA间隙向骨缺损区内生长，植入区可见大片的膜内成骨征象。术后3个月，GM＋BMP／HA组骨缺损区愈合。此时，SGM＋HA组与对照组骨缺损区有少量新骨形成，空白组缺损区为纤维组织充填。结论 SGM管与BMP／HA联合修复骨缺损的机制为SGM的屏障作用使骨缺损区受到引导成骨和诱导成骨的双重作用，其中诱导成骨方式为膜内骨发生。     

游离髂骨瓣移植修复胫骨骨不连、骨缺损

目的：应用游离髂骨皮瓣移植治疗因胫骨中、下段1/3粉碎性骨折而致的骨不连、骨缺损。方法：从1997-2001年，对9例胫骨中、下段1/3骨不连、骨缺损进行游离髂骨皮瓣移植治疗，术后随访6个月-3年。结果：本组9例患，6例骨皮瓣顺利成活，2例出现动静脉危象，给予及时适当处理后，骨皮瓣成活。术后随访X线显示：8例16周骨折达骨性愈合；1例远端骨折不连，再行植骨术，术后12周骨折愈合。3年随访伤肢功能活动良好。结论：游离髂骨皮瓣移植是治疗胫骨中、下1/3段因粉碎性骨折而致的骨不连、骨缺损的一种有效方法。     

块型抗感染重组合异种骨Ⅰ期植骨修复犬桡骨污染性节段性骨缺损

目的：研究和开发能够Ⅰ期植骨修复细菌污染的节段性骨缺损的植骨材料。方法：在块型重组织异种骨（MRBX）基础上，结合抗生素局部缓释技术。研制出兼具高效成骨作用和强力抗感染能力的块型抗感染重组合异种骨（MARBX）；并采用细菌污染的犬桡骨，1.5cm节段性骨缺损模型，通过解剖学、放射学、组织学及细菌学检查，对比研究MARBX和MRBXⅠ期植骨内固定修复效果。结果：术后6个月，MARBXⅠ期植骨，可有效预防感染，并基本完成骨缺损的修复；而MRBXⅠ期植骨，则导致骨髓炎，不能修复骨缺损。结论：MARBX由于既具有高效成骨活性，又有非常强的抗菌能力，能Ⅰ期植骨、有效修复污染性节段性骨缺损。     

36例长骨骨不连骨缺损的综合治疗

目的：探讨四肢长管状骨骨不连、骨缺损的治疗方法。方法：36例骨不连、骨缺损病人采用交锁髓内钉内固定，取自体髂骨植骨及术后经皮注射金葡液等综合治疗。结果：36例术后X线片显示，1个月骨折端周围出现骨痂，3个月有连续骨痂形成，6个月骨折愈合。无内固定物断裂、弯曲和松动，关节活动基本正常。结论：交锁髓内钉内固定、自体髂骨植骨及术后经皮注射金葡液综合治疗骨不连骨缺损，能提供坚强内固定，促进成骨活动，加快骨折愈合，是治疗长骨骨不连骨缺损的较好方法。     

羟基磷灰石及其复合材料在骨修复中的作用及研究进展

骨缺损的治疗仍是骨科面临的一大挑战，有许多不同的材料可用来修补骨缺损。羟基磷灰石作为充填材料为新骨的形成提供支架，发挥骨传导作用而修复骨缺损，并在一定程度上具有骨诱导性能。研究具有诱导成骨和传导成骨活性的羟基磷灰石复合材料是目前研究的一大热门课题。本从临床应用的角度，评述了近几年羟基磷灰石及其复合材料特性的研究进展。     

交锁髓内钉在治疗股骨干缺损性骨不连中的应用

目的 分析股骨干缺损性骨不连的原因，探讨交锁髓内钉植骨固定治疗股骨干缺损性骨不连短肢畸形的优缺点。方法 采用交锁髓内钉固定，自体髂骨充填骨缺损区的术式治疗股骨干骨不连短肢畸形12例，病例随访平均20个月。结果 12例全部一期愈合，平均愈合时间22个月。肢体延长平均3．2cm。无主钉、锁钉弯曲、折断等内固定失败。结论 股骨干缺损性骨不连的主要原因是骨折固定不牢固造成骨吸收所致。交锁髓内钉植骨固定合理可靠，是治疗股骨干缺损性骨不连短肢畸形的较理想方法，但骨愈合缓慢。植骨应避免遗留骨缺损，负重时间应向后推迟。     

髂骨复合皮瓣治疗骨缺损13例

严重创伤可造成骨缺损或软组织缺损,临床上较为常见。传统手术常采用Ⅰ期皮瓣修复,消灭创面。Ⅱ期植骨常诱发局部感染,植骨后吸收,多次手术,甚至引起严重感染、皮肤坏死,甚至截肢。随着显微外科技术发展及骨折固定技术提高,自2001年,我们采用髂骨复合皮瓣治疗骨缺损13例,获得良     

异体骨与自体髂骨修复粉碎性骨折的初步实验研究

目的 对比观察兔自体髂骨与同种异体骨植骨对长管骨粉碎性骨折的修复效果。将新西兰大白兔双侧肱骨人工造成粉碎骨折，一侧取自体髂骨植入，另一侧取等量同种异体骨植入，不同阶段处死后行大体，X线片及组织学观察。结果 自体髂骨植骨与异体骨植骨的骨愈合过程基本相同，均通过软骨化骨，爬行替代而愈合。植骨术后1周，纤维结缔组织包绕植骨片，无炎性反应；2周时，成骨性肉芽组织包绕植骨片，有早期软骨性骨梁形成；3周时，新生的骨梁间可见崩解的植骨片，植骨周围软骨化骨活跃；4周时，植骨片消失，出现成熟骨梁，其边缘可见骨祖细胞成排排列；5周时，骨梁变粗，致密，基本为成熟骨；6周时，呈现致密的板层结构，哈佛氏系统完整。其中第3，4周利用图像分析系统处理，结果两侧无统计学意义（P＞0．05）。结论 同种异体骨具有良好的组织相容性及骨传导作用，可以取代自体髂骨植骨修复长管骨骨折。     

外固定架及重组合异种骨植骨治疗胫骨骨缺损与骨不连

目的：探讨外固定架和重组合异种骨(RBX)植骨治疗胫骨骨缺损、伴肢体短缩的胫骨骨不连及先天性胫骨假关节的临床疗效。方法：应用外固定架共治疗胫骨骨缺损、伴肢体短缩性骨不连及先天性胫骨假关节20例。胫骨断端清理后短缩长度2—9cm，平均4．8cm。断端应用RBX植骨12例。结果：20例病人随访8个月-7年，平均4年3个月，患肢功能恢复满意。12例应用RBX植骨治疗骨不连的平均愈合时间4．8个月。结论：本手术方法治疗胫骨骨缺损、伴肢体短缩的胫骨骨不连及先天性胫骨假关节，创伤小、操作简单，肢体功能恢复满意；RBX植骨治疗骨不连，安全，对促进骨愈合疗效可靠。     

An anomalous right iliac artery presenting as iliac stenosis

An anatomical anomaly of pre-aortic inferior vena cava and retro-psoas iliac artery in a 33-year-old female is reported. This patient presented with severe right leg claudication and was successfully managed by implantation of an aortofemoral graft.     

Using bilateral iliac branch devices for endovascular iliac aneurysm repair

Introduction: The endovascular repair of bilateral iliac aneurysms using bilateral Iliac Branch Devices (IBDs) has been infrequently performed and reported. We aim to describe this technique and report on the results of our case series. Methods: Three different device designs are available. The procedural options include a totally transfemoral approach, or a combined transfemoral and brachial approach. Clinical records for patients who have had this procedure were reviewed. Results: The indications for the technique include bilateral common iliac artery aneurysm repair, with or without concomitant abdominal aortic aneurysm repair. Considerations include the timing of main body endovascular aortic aneurysm repair (EVAR) device introduction, the use of a proximal access site and the type of IIA stent‐graft that is used. Between 2007 and 2010, six patients had bilateral IBD implantation. All patients required an EVAR main body device in addition to bilateral IBDs. Eighty‐three per cent were males, mean age was 73 years. Mean follow up was 15 months. Technical success was obtained in 100% of cases. There was one branch occlusion (8.3%). There were no type I endoleaks. One patient had a type II endoleak. Conclusions: Bilateral IBDs can be used safely and with excellent rates of technical success and branch patency in appropriately selected patients.     

Isolated iliac aneurysms

Isolated iliac aneurysms are relatively infrequent, often difficult to detect and therefore rarely considered in the differential diagnosis. Because of their close anatomical relationship to the ureters, bladder, colon, pelvic veins, femoral and sciatic nerve roots one is often misled. The consequences can be grave; chronic ureteric obstruction for instance can cause damage to one or both kidneys. With the growing frequency of tube grafting for aortic aneurysms it becomes increasingly important to consider the prevalence and incidence of isolated iliac aneurysms. The aim of this study is to report the incidence, clinical course and outcome of these lesions. In a consecutive series of 678 aorto-iliac aneurysms in the years 1972-1988 there were 53 isolated iliac aneurysms (7%) ranging in size from 3.5-14 cm whereas the reported incidence in the literature lies between 1-2%; the prevalence in consecutive autopsy series is even less than 1%. CT scanning proved to be the gold standard for the evaluation of pelvic aneurysmal disease whilst angiograms were of little help. A palpable mass was present in nine cases; GI-tract signs in 12 (five patients being operated on for suspicion of appendicitis or sigmoiditis), the genito-urinary tract was involved in eight cases, sciatic or femoral root nerve compression occurred in seven, recurrent pulmonary embolism in two, lower extremity ischaemia in seven and a-v fistula in one. The male:female ratio was 51:2 and that of ruptured to non-ruptured aneurysms 15:38. The site of isolated iliac aneurysms was the common and/or the internal iliac artery uni- or bilaterally. The external iliac artery was never involved.(ABSTRACT TRUNCATED AT 250 WORDS)     

Retroperitoneal iliac fossa abscess: a complication of suppurative iliac lymphadenitis

The clinicopathologic manifestations in four patients with staphylococcal abscess localized to the retroperitoneal iliac fossa are presented. This type of abscess may represent a distinct entity and is most likely a complication of suppurative iliac lymphadenitis.Retroperitoneal abscesses localized to the iliac fossa rarely have any osseous component. Extraperitoneal drainage is curative.     

Comparing patency rates between external iliac and common iliac artery stents

PURPOSE: Placement of intraluminal stents in the common iliac artery (CIA) and external iliac artery (EIA) has become an accepted therapy for treating localized arterial stenoses. The purpose of this study was to compare anatomic patency rates of stents placed in the EIA and CIA for occlusive disease. METHODS: A radiologic computer database was used to identify 69 consecutive male patients at the Minneapolis Veterans Affairs Medical Center from February 1, 1993, through January 31, 1999, who underwent placement of 98 stents (82 Wallstents and 16 Palmaz stents) for physiologically significant iliac artery occlusive disease and varying degrees of chronic limb ischemia. Patients were followed up with surveillance duplex ultrasound scanning examinations 1 day after procedure, 3 months after procedure, and then at 6-month intervals after stent placement. Follow-up angiograms were performed for patients with duplex ultrasound scans that revealed velocities greater than 300 cm/s. Patient risk factors, iliac artery runoff, concomitant outflow procedures, and anatomic patency rates were compared between patients receiving EIA stents and those receiving CIA stents. RESULTS: The mean age for the EIA stent group was 69 +/- 1 years versus 66 +/- 1 years (P =.03) for the CIA stent group. Mean follow-up was 21.4 +/- 2.1 months (+/- SE) for all patients. Patients with EIA stents had more ischemic lower limbs when compared with patients who had CIA stents (P =.05). No differences were found between groups in risk factor analysis (P = not significant). Lesion lengths were similar between groups: EIA, 4.6 +/- 0.6 cm, and CIA, 5. 3 +/- 0.8 cm (P = not significant). The following differences were noted on primary patency rates (EIA group vs CIA group): 1 year (93% vs 88%), 2 years (91% vs 85%), and 3 years (90% vs 78%) (Cox proportional hazards; P =.13). CONCLUSIONS: Anatomic patency rates for EIA and CIA stents appear to be similar despite the fact that patients with EIA stents were older and had more ischemic limbs compared with the patients who had CIA stents.     

髂内动脉在肾移植术后髂外动脉出血中的应用

目的:探讨肾移植术后感染性外动脉移植肾动脉吻合口出血的处理。方法:采用自体髂内动脉片或段修补、串接治疗髂外动脉吻合口大出血。结果:修复后的髂外动脉血流通畅,患侧下肢血供良好。结论:感染性移植肾动脉髂外动脉吻合口出血为肾移植术后严重并发症,单纯缝扎止血常难以奏效,与其他方法比较,自体髂内动脉片或段修补、串接修补缺损的髂外动脉操作简单,效果非常满意。     

Deep circumflex iliac perforator flap with iliac crest for mandibular reconstruction.

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.