股骨头缺血性坏死修复重建术后血运重建观察

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1、股骨头缺血性坏死修复重建术后血运重建观察【摘要】目的评估股骨头缺血性坏死(ONFH)带旋股外血管升支髂骨瓣转移治疗后，股骨头内血运变化情况。方法24例单侧股骨头缺血性坏死患者，男19例,女5例，ARCO分期标准Ⅱ期20髋,Ⅲ期4髋，应用带旋股外血管升支髂骨瓣转移术治，术后行患侧DSA检查。全部患者在术后6周~5年再次行患侧DSA复查。结果24例术前股动脉DSA造影均显示股骨头供血的异常改变，旋股外侧动脉升支血管充盈良好。术后6周DSA显示22侧转移骨瓣血管蒂充盈良好,股骨头内供血明显改善;2例术后DSA显示转移骨瓣血管蒂充盈不佳或股骨头内无造影剂充盈,其中1例术后12个

2、月复查DSA显示血管蒂充盈满意,股骨头血供良好。1例术后2年随访，DSA造影显示股骨头内无造影剂充盈，行人工关节置换。本组病例临床成功率为91%,影像学成功率为85%。结论①旋股外血管升支解剖位置恒定,无较大变异，适于切取带血管骨瓣进行移植。②带旋股外血管升支髂骨瓣转移术治疗股骨头缺血性坏死能有效重建股骨头内血运【关键词】股骨头坏死;数字减影血管造影术;骨重建Theclinicalobservationofrevascularizationafterrepairrevascularizationinpatientswith9avascularnecrosisLIUYu-

3、peng,ZHANODe-wei,WANGWei-ming,etal.ZhongshanAffiliatedHospitalofDalianUniversity,Dalian116001,China【Abstract】ObjectiveToassesstheeffectivenessofdigitalsubtractionangiography(DSA)inevaluationofthehemodynamicchangesafterthetreatmentofavascularosteonecrosisoffemoralhead(ONFH)withascendingbr

4、anchoflateralfemoralcircumflexarteryboneflaps.MethodsTotally24patientsincluding19malesand5femaleswith20hipsofstageⅡand4hipsofstageⅢ,weretreatedbyusingIliacboneflapspedicledwithascendingbranchoflateralfemoralcircumflexartery.SelectiveDSAwasperformedonall24patientspreoperativelyand6monthst

5、o5yearspostoperatively.ResultsSixmonthsafteroperationreconstructionofbloodsupplyonthefemoralheadwasseenin22cases.2patientsshowedpoorfillingorfailureoffillingofthevesselpediclesintransplantedboneflapsandre-examinationofDSAconductedat12monthsafter9operationshowedsatisfactoryfillinginoneoft

6、hose2cases.1casesfailurefillingafter2yearspostoperative。Totalhiparthroplastywereperformedinthe1patients.Theclinicalsuccessrateofthisprocedurewas91%,andtheradiologicalsuccessratewas85%.Conclusion①Theanatomicalpositionofascendingbranchoflateralfemoralcircumflexarteryisconstant,andbeseemtou

7、seasvascularisedboneflaps.②thetreatmentofavascularosteonecrosisoffemoralheadusingIliacboneflapspedicledwithascendingbranchoflateralfemoralcircumflexarteryisaeffectivemethod.【Keywords】Femoralheadnecrosis;Digitalsubtractionangiography;Boneremodelling股骨头缺血性坏死研究委员会(ARCO)分期标准的