中华关节外科杂志(电子版)
中華關節外科雜誌(電子版)
중화관절외과잡지(전자판)
CHINESE JOURNAL OF JOINT SURGERY(ELECTRONIC VERSION)
2014年
5期
574-577
,共4页
徐佩君%盛加根%徐镇%吴昊%徐海涛%徐斌%张长青
徐珮君%盛加根%徐鎮%吳昊%徐海濤%徐斌%張長青
서패군%성가근%서진%오호%서해도%서빈%장장청
髋关节%前侧入路%股骨头坏死
髖關節%前側入路%股骨頭壞死
관관절%전측입로%고골두배사
Hip joint%Anterior approach%Femur head necrosis
目的:探讨在保持股直肌完整前提下,经髋关节前侧手术入路行股骨头坏死病灶清除吻合血管游离腓骨移植术治疗股骨头坏死的可行性。方法自2012年06月至2013年06月,选择本组采用常规髋关节前侧入路行股骨头坏死病灶清除吻合血管游离腓骨移植术治疗股骨头坏死病例53例共67髋。男38例(49髋),女15例(18髋);年龄22~57岁,平均37.4岁;身高150~192 cm,平均171.9 cm;体重45~92 kg,平均70.0 kg;身高体重指数( BMI)值为17.1~30.7,平均23.6。在显露股直肌后,观察记录支配股直肌神经的走行和入肌点位置、旋股外侧动、静脉升支的走行和距离股直肌起点距离以及股直肌与切口和髋关节的相对位置关系。结果(1)支配股直肌的神经由股神经分支发出,走行于缝匠肌深面,自内上方走向外下方,在入股直肌前分为两支神经支,外上支于股直肌内侧深面入肌,入肌点距髂前下棘下方(7.07±1.14) cm;内下支切口内未见。将股直肌向外侧牵开可见股直肌外上支张力增大,向内拉开则张力减小。(2)旋股外侧动、静脉升支发自股深动脉,经缝匠肌及股直肌深面、髂腰肌前面向外上走行至股中间肌前侧,旋股外侧动、静脉升支血管束中点距髂前下棘下方(6.16±0.52)cm。所有病例向内拉开股直肌均可很好地显露旋股外侧动、静脉其分支血管束全长。(3)股直肌直头起于髂前下棘,约1/4~1/5肌纤维位于切口线外侧,其余部分位于切口线内侧。股直肌肌腹遮挡髋关节头颈交界处内侧约1/3~1/2部分。结论(1)沿股直肌外侧间隙将股直肌向内侧牵开暴露髋关节,可保护位于内侧的血管神经束,为手术安全间隙。(2)股直肌对于髋关节遮挡较少,大部分肌纤维位于髋关节内侧,向内拉开股直肌可完全显露旋股外侧动、静脉升支及髋关节,故不断股直肌起点髋前侧入路行吻合血管游离腓骨移植术治疗股骨头坏死是可行的。
目的:探討在保持股直肌完整前提下,經髖關節前側手術入路行股骨頭壞死病竈清除吻閤血管遊離腓骨移植術治療股骨頭壞死的可行性。方法自2012年06月至2013年06月,選擇本組採用常規髖關節前側入路行股骨頭壞死病竈清除吻閤血管遊離腓骨移植術治療股骨頭壞死病例53例共67髖。男38例(49髖),女15例(18髖);年齡22~57歲,平均37.4歲;身高150~192 cm,平均171.9 cm;體重45~92 kg,平均70.0 kg;身高體重指數( BMI)值為17.1~30.7,平均23.6。在顯露股直肌後,觀察記錄支配股直肌神經的走行和入肌點位置、鏇股外側動、靜脈升支的走行和距離股直肌起點距離以及股直肌與切口和髖關節的相對位置關繫。結果(1)支配股直肌的神經由股神經分支髮齣,走行于縫匠肌深麵,自內上方走嚮外下方,在入股直肌前分為兩支神經支,外上支于股直肌內側深麵入肌,入肌點距髂前下棘下方(7.07±1.14) cm;內下支切口內未見。將股直肌嚮外側牽開可見股直肌外上支張力增大,嚮內拉開則張力減小。(2)鏇股外側動、靜脈升支髮自股深動脈,經縫匠肌及股直肌深麵、髂腰肌前麵嚮外上走行至股中間肌前側,鏇股外側動、靜脈升支血管束中點距髂前下棘下方(6.16±0.52)cm。所有病例嚮內拉開股直肌均可很好地顯露鏇股外側動、靜脈其分支血管束全長。(3)股直肌直頭起于髂前下棘,約1/4~1/5肌纖維位于切口線外側,其餘部分位于切口線內側。股直肌肌腹遮擋髖關節頭頸交界處內側約1/3~1/2部分。結論(1)沿股直肌外側間隙將股直肌嚮內側牽開暴露髖關節,可保護位于內側的血管神經束,為手術安全間隙。(2)股直肌對于髖關節遮擋較少,大部分肌纖維位于髖關節內側,嚮內拉開股直肌可完全顯露鏇股外側動、靜脈升支及髖關節,故不斷股直肌起點髖前側入路行吻閤血管遊離腓骨移植術治療股骨頭壞死是可行的。
목적:탐토재보지고직기완정전제하,경관관절전측수술입로행고골두배사병조청제문합혈관유리비골이식술치료고골두배사적가행성。방법자2012년06월지2013년06월,선택본조채용상규관관절전측입로행고골두배사병조청제문합혈관유리비골이식술치료고골두배사병례53례공67관。남38례(49관),녀15례(18관);년령22~57세,평균37.4세;신고150~192 cm,평균171.9 cm;체중45~92 kg,평균70.0 kg;신고체중지수( BMI)치위17.1~30.7,평균23.6。재현로고직기후,관찰기록지배고직기신경적주행화입기점위치、선고외측동、정맥승지적주행화거리고직기기점거리이급고직기여절구화관관절적상대위치관계。결과(1)지배고직기적신경유고신경분지발출,주행우봉장기심면,자내상방주향외하방,재입고직기전분위량지신경지,외상지우고직기내측심면입기,입기점거가전하극하방(7.07±1.14) cm;내하지절구내미견。장고직기향외측견개가견고직기외상지장력증대,향내랍개칙장력감소。(2)선고외측동、정맥승지발자고심동맥,경봉장기급고직기심면、가요기전면향외상주행지고중간기전측,선고외측동、정맥승지혈관속중점거가전하극하방(6.16±0.52)cm。소유병례향내랍개고직기균가흔호지현로선고외측동、정맥기분지혈관속전장。(3)고직기직두기우가전하극,약1/4~1/5기섬유위우절구선외측,기여부분위우절구선내측。고직기기복차당관관절두경교계처내측약1/3~1/2부분。결론(1)연고직기외측간극장고직기향내측견개폭로관관절,가보호위우내측적혈관신경속,위수술안전간극。(2)고직기대우관관절차당교소,대부분기섬유위우관관절내측,향내랍개고직기가완전현로선고외측동、정맥승지급관관절,고불단고직기기점관전측입로행문합혈관유리비골이식술치료고골두배사시가행적。
Objective To explore the feasibility of the free vascularized fibular grafting ( FVFG) by hip anterior approach for the treatment of osteonecrosis of the femoral head ( ONFH) under the premise of maintaing the intergrity of the rectus femoris( RF) .Methods fifty three patients with total 67 hips who adopted FVFG treatment for ONFH were collected from June 2012 to June 2013, including 38 male patients (49 hips) and 15 female patients (18 hips), with a mean age of 37.4 years (22-57);the average height was 171.9 cm (150-192 cm);the average weight was 70.0 kg (45-92 kg);and the average BMI was 23.6 (17.1-30.7).The distance between the nerve entering point of RF and the anterior inferior spine, the distance between the lateral femoral circumflex artery and the anterior inferior spine, the relative location of the RF fiber and hip joint, and the relative location of the RF fiber and the incision line were recorded and observed after the exposure of RF.Results (1) The innervations of the RF has two primary branches before entering the muscle.The upper anterior branches enter the muscle medially to RF, and the entering point is (7.07 ±1.14) cm inferior to the anterior inferior spine; the lower posterior innervation branches are not obeserved from the incision site.(2) The lateral femoral circumflex arteriovenous vessels come from the deep femoral arteriovenous vessels and go into the superficial vastus intermedius muscle.The distance from the center point of the lateral femoral circumflex artery to the anterior inferior spine is (6.16 ± 0.52) cm.The medial traction of the RF can expose full length of the lateral femoral circumflex arteriovenous vessels.(3) Only 1/4~1/5 of the RF fibers are outside the incision line.The RF fibers cover 1/3~1/2 interior part of the femoral head and the neck border.Conclusion Because RF covers only little part of the hip joint, the medial traction of the RF can both fully expose the hip joint and protect the nerve bundles of RF.Therefore, it is unnecessary to detach RF.