摘要
目的：探讨一种治疗儿童股骨头坏死的新术式---部分带阔筋膜张肌骨膜瓣移植术，进行随访观察并评估其早期疗效。方法时间为2011年3月至2013年12月，共14例14髋。外伤性4例，原因不明10例；男11例，女3例；年龄6～15岁，平均（10.28＆#177;2.98）岁。 CatterallⅡ期4例，Ⅲ期10例。术前Harris评分为62～87分，平均（71.9＆#177;6.9）分：良2例，可7例，差5例。 VAS疼痛评分为0～5分，平均（3.0＆#177;1.8）分。手术中保留逢匠肌，切取部分带阔筋膜张肌的骨膜瓣，股骨头减压和植入骨膜瓣，缝合固定骨瓣，手术后常规蛙式位置固定3个月。结果14例手术全部成功，所有切口均一期愈合，随访时间8～33个月，平均（22.61＆#177;8.60）个月。随访时患儿疼痛基本消失，步态基本正常，髋关节活动度良好，X线提示股骨头坏死改善，股骨头高度较术前增加明显，股骨颈骨折愈合。随访时Harris评分为79～95分，平均（89.5＆#177;4.7）分；优6例（42.9％），良7例（50％），可1例（7.1％）；总体优良率达92.9％。所有患者术后Harris评分与术前相比差异有统计学意义（P＜0.01）。随访时VAS疼痛评分为0～1分，平均（0.2＆#177;0.6）分，与术前相比差异有统计学意义（ P＜0.01）。StulbergⅠ期3例，Ⅱ期10例，Ⅲ期1例。结论部分带阔筋膜张肌骨膜瓣移植治疗儿童股骨头坏死可以明显改善患者症状，相关文献未见报道，是一种治疗儿童股骨头坏死有效的新方法。
Objective To design a new operation method which uses the periosteal bone-flap transplantation with the partial tensor fasciae latae for the treatment of the femur head necrosis in child. Methods From March 2011 to December 2013, there were 14 patients with 14 hips.Four patients had＆amp;nbsp;the history of trauma and the others had unkown aetiology.There were 11 male and three female patients. The age was from 6 to 15 years （mean 10.28）.Four patients were in Catterall Stage II and 10 patients were in stageⅢ.The pre-operative Harris score were 62 to 87 points （mean 71.9）：good in two patients, fair in seven patients, and poor in five patients.The pre-operative VAS pain score was 0 to 5 points （ mean 3.0） .All the patients underwent surgery with reserving the satorius, the decompression of the femoral head and the periosteal bone-flap （ with part of the tensor fasciae latae） implantation.After the operation, the hip was put in the frog position for at least three months.Results All the patients were operated successfully.The patients were followed up for 22.61 months （8 to 33 months） in average.In the last follow up, the pain relief and normal gait were achieved.The range of motion of the hip was good.The height of the femoral head increased significantly and the femoral neck fracture was healed.The Harris hip score were 79 to 95 points （mean 89.5）：excellent in six patients, good in seven patients, and fair in one patient.The results had obviously statistical significance （ P〈0.01 ） .The VAS pain score was 0 to 1 points （mean 0.2）.The results had obviously statistical significance （P〈0.01）.According to the evaluation of Stulberg stage, there were three patients in stageⅠ, 10 patients in stageⅡ, and one patient in stageⅢ.Conclusion The periosteal bone-flap transplantation with the partial tensor fasciae latae in the treatment of the femur head necrosis in child can effectively improve the clinical symptoms.It is a new and efficient surgery method to treat the femu
出处
《中华关节外科杂志（电子版）》
CAS
2014年第5期8-12,共5页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
股骨头坏死
儿童
骨移植
阔筋膜张肌
新手术
Femur head necrosis
Child
Bone transplantation
Tensor fasciae latae
New operation
