跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

Objective To study the clinical effect of iliac flap straddled donor area to primary repair large defect of bone and soft tissue. Methods Through the anatomical study about iliac flap, the new oper-ation method about iliac flap was designed, which straddled donor area and used one blood vessel stem (deep iliae circumflex artery) and two branch blood vessel(deep iliac circumflex artery and superficial iliac circum-flex artery compounding in series) for blood supply. Blood supply area of the analogical operation was stud-ied by irrigating fresh cadaver with Indian ink. Thirty-two patients with large defect of bone and soft tissue (20 males, 12 females, 17-68 years old, average 36 years old) were repaired by this method, and the hemo-dynamics was studied by laser Doppler flowmetry. Results It was feasible to connect superficial iliac cir-cumflex artery with the branch of deep iliac circumflex artery. Indian ink irrigating fresh cadaver simulate operation showed that area scope dyed by Indian ink: in ilium, Indian ink was found in the bone which was (15.8±3.2) cm away from anterior superior iliac spine. In skin flap, Indian ink was found (8.6±2.4) cm superi-or, (5.4±2.6) cm inferior, (5.8±2.6) cm internal and (24.6±5.8) cm external from the anterior superior iliac spine. Laser Doppler flowmetry showed that the peripheral blood flow of skin flap increased as time passed, the increase speed began to tardy at the third day, then ingress the platform stage. Thirty-two cases were all succeed with functional rehabilitation and perfect shape. Thirty-one cases got completely bone healing; bone healing time ranged from 9 to 19 months, with an average of 12 months. One case turned to chronic os-teomyelitis, and had to suffer operation again, the bone healing time was 22 months. Conclusion As the ili-ae flap straddled donor area has sufficient blood supply, it can repair large defect of bone and soft tissue in one stage.     

前路病灶清除髂骨植骨内固定治疗下颈结核25例

<正>颈椎结核在脊柱结核中发生率较低,但其造成的危害较严重,患者常因病灶压迫颈脊髓而瘫痪,甚至死亡,由于颈椎活动度大、颈脊髓周围空间小,颈椎结核常伴随颈脊髓受压和颈椎后凸畸形,需要手术进行病灶清除、神经减压和颈椎稳定性重建^[1]。颈椎结核主要临床表现为椎体前中柱破坏,手术方式以前路清除病灶、重建脊柱稳定性为主。2017年1月至2020年6月,浙江省中西医结合医院骨科应用前路病灶清除髂骨植骨融合钛板内固定治疗下颈椎结核25例,临床疗效满意,现报道如下。     

旋股外侧动脉升支阔筋膜张肌支髂骨瓣的解剖学研究及临床意义

目的 :探讨带旋股外侧动脉升支阔筋膜张肌支髂骨瓣的解剖及应用要点。方法 :在 2 5侧经动脉灌注红色乳胶的成人下肢标本上 ,重点观测旋股外侧动脉升支阔筋膜张肌支的走行、分支、发出点和外径等。结果 :旋股外侧动脉升支的阔筋膜张肌支上行支发出点距髂前上棘平面 7.1± 2 .3cm ,外径 1.2± 0 .8mm ,该支又分出 2～ 3支外径在 0 .3mm～ 0 .5mm的小分支从阔筋膜张肌后份进入肌质 ,上行至肌起始处达髂骨 ;其下行支发出点距髂前上棘平面 7.9± 1.8cm ,外径 1.3± 0 .8mm。结论 :旋股外侧动脉升支阔筋膜张肌支髂骨瓣具有手术可行性和实际应用价值     

左髂骨恶性血管外皮细胞瘤1例

恶性血管外皮细胞瘤是一种罕见的软组织肿瘤,发生于骨内者仅有少数病例报告１。本文１例发生于髂骨,且较早出现膀胱及肝脏转移。现报告如下。１临床资料患者男,５６岁,工人。因无明显诱因出现左髋部疼痛２个月,于１９９６年１１月８日入院。检查：左髋部肿胀,以髂骨翼处为著,髂嵴明显压痛,局部皮肤无明显异常,皮温正常,无波动感,腹股沟淋巴结肿大,有轻压痛,全身检查无其他阳性体征。Ｘ线片（图１）显示：左髂骨翼一约８ｃｍ×６ｃｍ密度减低图１左髂骨翼一约８ｃｍ×６ｃｍ大小密度减低区区,骨质破坏明显,骨皮质膨胀,肺…     

缝匠肌髂骨瓣移植的解剖学研究

为临床应用缝匠肌髂骨瓣移植治疗股骨头缺血性坏死提供解剖学上的依据.在6具(12侧)灌注红色乳胶的成人尸体标本上,对供应缝匠肌髂骨瓣血管的人肌位置、入肌外径及其在髂骨瓣的分布进行观测.结果显示股深动脉分支、旋股外侧动脉横支及降支分别在距髂前上棘(10.8±1.2)cm、(¨.2±2.1)cm、(1 6.3±2.5)cm进入缝匠肌,入肌外径分别为(3.0±0.2)mm、(2.9±0.1)mm、(2.8±0.1)mm,在髂骨分布范围分别为2.0 cm×3.5 cm、2.0 cm×3.0 cm、2.0 cm×2.8 cm.缝匠肌髂骨瓣血供丰富,提示选择分离缝匠肌蒂的最佳长度为(10.8±1.2)cm.     

髂骨滋养孔观测与骨瓣移植治疗股骨头颈疾患术式的比较

观测了８０块髂骨髂嵴及髂嵴内，外唇下方３ｃｍ区域滋养孔的分布。结果显示８６．１％的滋养孔分布于髂骨嵴及其前上外侧面，滋养孔的分布与臀上动脉深上支营养区相符，认为该血管为蒂的髂骨瓣应列为治疗股骨头颈病变的首选。     

改良关节囊旁髂骨截骨术及辅助措施治疗先天性脱位28例

临床资料 ２８例（４６髋）先天性髋脱位中,男６例,女２例。年龄３～７岁,平均４．５岁。其中双髋脱位１８例,单侧脱位１０例,闭合复位失败者为１０髋,４６髋均为Ⅲ０脱位。 Ⅹ线片提示髋臼指数 ３８～６００,平均４５０。本组２８例患者均经２～３年随访,其疗效评价采用计分法,根据临床功能评定１５分,Ⅹ线摄片检查评定１５分,总计２６～３０分为优,２１～２５分为良,１６～２０分为可,１１～１５分为差。本组４６髋评定结果：优１０髋,占２１．７％;良３６髋,占７８．３％。治疗上全部采用改良关节囊旁髂骨截骨术,辅助…