CAJ | 학술논문

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.
목적 탐토부분둔중기가골판중건고골두경부혈공적료효.방법 2004년6월지2009년12월공수치20례고골경골절혹고골두결혈성배사환자,남15례,녀5례;년령25～56세,평균38.6세.고골경골절조10례,남7례,녀3례;골절안Garden분형:Ⅱ형2례,Ⅲ형5례,Ⅳ형3례.수상지수술시간위11～23 d,평균14.3 d.고골두결혈성배사조10례,남8례,녀2례;고골두결혈성배사안Ficat분기:Ⅱ기6례,Ⅲ기4례.고골경골절환자채용내고정치료,고골두결혈성배사환자채용청제배사골、식골치료,량조환자균응용부분둔중기가골판이식우고골두경부,이수복중건고골두경부혈공.결과 20례환자술후획1～5년(평균3.1년)수방.고골경골절조환자골절균부유합,술후3개월관관절Harris평분위81～97분,평균92분;기중우5례,량4례,차1례,우량솔위90%.1례출현고골두배사.고골두결혈성배사감환자증상명현개선,술후3개월관관절Harris평분위73～95분,평균84분;기중우4례.량3례,가1례,차2례,우량솔위70%.3례출현고골두배사가중,기중2례행관절치환술치료.결론부분둔중기가골판혈공봉부、조작간단、안전가고차술후불영향둔중기공능,시일충중건고골두경부혈공적유효방법.
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.