半骨盆切除术后带血管蒂股骨上端移植重建髋关节的解剖学分析

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1、摘要2)血管解剖学观测比较结果显示：臀上动脉出梨状肌孔处与旋股内动脉起始端吻合后长度比臀上动脉起始点到耻骨联合下缘要长出17．36—22．25m，臀上动脉出梨状肌孔处与旋股外动脉起始端吻合后长度比臀上动脉起始点到耻骨联合下缘要长23．86—25．74ram，能够满足吻合需要，且血管吻合后张力不大；臀下动脉出梨状肌孔处与旋股内动脉起始端吻合后长度比臀下动脉起始点到耻骨联合下缘要长58．7—64．38ram，臀下动脉出梨状肌孔处与旋股外动脉起始端吻合后长度比臀下动脉起始点到耻骨联合下缘要长65．13-68．

2、29m，能够满足吻合需要，且血管吻合后张力不大。臀下动脉瓮内段比臀上动脉瓮内段长，且起始点更靠下，可利用长度更长。臀上动脉起始处至出梨状肌孔处及臀下动脉起始处至出梨状肌孔处外径变化不大，臀上动脉起始处及出梨状肌孔处、臀下动脉起始处及出梨状肌孔处、旋股内动脉和旋股外动脉起始处外径相仿，因此，供区血管我们选择旋股内动脉、离断降支后的旋股外动脉，受区血管我们选择臀上动脉、臀下动脉，将髂外动脉作为备用受区血管。结论：应用游离吻合血管的股骨近端翻转180。再造髋臼重建骨瓮环在解剖学上是可行的。股骨近端翻转移植再造

3、髋臼重建骨盆环，可将结扎掉降支的旋股外动脉与臀上动脉或臀下动脉进行端端吻合，或与髂外动脉端侧吻合，旋股内动脉与臀下动脉＼臀上动脉进行端端吻合，或与髂外动脉端侧吻合，将第一穿动脉升支结扎，旋股外动脉降支与股深动脉或股动脉吻合。这样即保证了供区软组织的充分血供，从而保留供区软组织功能，同时也保证了移植再造髋臼的股骨上段有充分的血供，有利于移植骨的存活和促进移植骨与受区骨的骨性愈合，降低感染率，更快达到骨盆重建、髋臼再造后的稳定。关键词：半骨盆切除术，髋臼重建，游离吻合血管骨移植，自体骨，解剖学nAbstra

4、ctBackground：Turnoverthevascularizedupperfemurabove180·transplantationandreconstructtheacetabulumonthegreatertrochantertorestoretheintegrityofthepelvicringafterhemipelvectomy,thenitbecomesatotalhiparthroplasty，andthedisabilitydegreeandcomplicationsandinf

5、ectionratewilldecreasealot．Itisknownthatvasculariedautologousbonegraftisbetterthanthenonanastomoticautologousbonegraft．Howtodefinethelengthoftheupperfemur．'?Canthenutrientarteryofthefemurbepreserved?Howtodefinethefightvesselstoanastomosis?Alloftheseprobl

6、emsshouldbesettledbeforethisdifficultoperation．Objective：Toobservetheexternaldiameterandpositionofcorrelatedbloodvesselsinpelvisandgraftingbonegrafts，comparethemwithmeasureddatesofpelvicreconstructionanddecidethesuitablebloodvesselsforrevascularizetooffe

7、rtheoreticalsupportandreferringforreconstructionofpelviswithpedicledautograftsafterhemipelvectomy．Methods：MeasurementofthereconstructedpelvisandobservationofcorrelatedbloodvesselsWascarriedouttoanalyzethevascularchoiceforrevascularization．PartI：Reconstru

8、ctedpelvicmeasurement．nediatancefromthesuperioredgeoftheauricularplaneofsacralbonetotheinferioredgeofthepubicsymphysison10pelvesandthelengthofupperfemurforpelvicreconstructionweremeasured，andthelocationsofthenutrientforame