OBJECTIVE: To investigate the clinical results of transposition of muscular skeletal flap pedicled with straight head of rectus femoris for treatment of avascular necrosis of adult femoral head. METHODS: Eight patients with avascular necrosis of femoral head were adopted in this study. There were 6 males and 2 females, the ages were ranged from 24 to 56 years. According to the criteria of Ficat, there were 5 cases in stage II and 3 cases in stage III. The Smith-Peterson incision was used to expose the capsule of the hip. After complete curettage of the necrotic bone from the femoral head, the muscular skeletal flap pedicled with straight head of rectus femoris was resected and transposited into femoral head. Finally, conventional decompression of head was performed. RESULTS: All the cases were followed up for 1 to 3 years. There were excellent results in 5 cases, good in 2 cases and moderate in 1 case. The rate of excellent and good results were 87.5%. CONCLUSION: Comparing with other pedicled bony flaps, the muscular skeletal flap pedicled with straight head of rectus femoris is characterized by its convenience and efficacy. It is suitable for the treatment of avascular necrosis of femoral head in stage II or III, but the contour of the femoral head should be nearly normal.
Since 1984, the authors have used the iliac bone graft with ascending branch of lateral circomflex femoral vessel for treatment of bone defect, nonunion, and avascular necrosis of femoral head in 88 cases. Seventy-two patients were followed from one to six years. Seventy cases were successful with 2 failure. The applied anatomy and clinical application of the iliac bone graft, and the operative principles were discused in this article.
OBJECTIVE: To provide a series of surgical approaches for treatment of talus neck fracture, ischemic necrosis of talus body, and other bone lesions in ankle and foot. METHODS: The major blood supply to cuboid bone, medial cuneiform bone and navicular bone was observed in 30 adult cadavers, by infiltration of red emulsion via major arteries of the lower limbs. Based on these anatomical investigations, 3 types of vascularized tarsal bone grafting were designed for repair of bone lesions in the area of ankle and foot, and applied in 49 clinical cases, ranging from 10 to 58 years in age, and 43 cases of which were followed up for 4 years and 3 months in average. RESULTS: Primary healing was achieved in 40 cases, and secondary healing achieved after further surgical intervention in other 3 cases. The function of all ankle joints recovered satisfactorily. CONCLUSION: The designed three types of vascularized tarsal bone flaps are easy and reliable for dissection because of their superficial pedicles, and they are available for different clinical cases with various bone lesions in ankle and foot.
Objective To investigate the treatment method of ischemic necrosis of the femoral head by the transplantation of pedicled bone flap with deep iliac circumflex vessel in adult and to assess its curative effect. Methods From February 1996 to September 2003, 46 adult patients with ischemic necrosis of thefemoral head (58 coxas) were treated by transplantation of pedicled bone flap with deep iliac circumflex vessel. The locations were the left side in 34 coxas and the right side in 24 coxas（stage Ⅱ in 16 coxas, stage Ⅲ in 39 coxas and stage Ⅳ in 3 coxas）.Results Thirty-seven patients (40 coxas) were followed up 6 months to 10 years after operation. According to the assess of FanQishen,the result was excellent in 19 cases (21 coxas), good in 11 cases (12 coxas), fair in 5 cases (5 coxas) and poor in 2 cases (2 coxas). The postoperative excellent and good rate was 81%. Conclusion Operative treatment of ischemic necrosis of the femoral head in adult by transplantation of bone flap pedicled with deep iliac circumflex vessel has the characteristics of restoration of blood supply ofthe femoral head, decompression of marrow cavity, elimination of necrotic bone and support of the femoral head. It is an effective and advanced method for treatment of ischemic necrosis of the femoral head in adult.
OBJECTIVE To study the anatomical basis of vascularized spina scapular bone flap, which was used in mandibular reconstruction. METHODS Fifteen adult cadavers were adopted in this study. The two common carotid arteries of each cadaver were intubed and perfused with red emulsion respectively. Then the course and distribution of the transverse cervical artery(TCA) and its spina scapular branches were observed on 30 sides. RESULTS The TCA was divided into two segments: the cervical segment originated from the origin of the artery to the superior margin of the trapezius muscle, and the dorsal segment originated from the superior margin of the trapezius muscle to the site where the TCA bifurcated into the superficial and deep branches. The average length and original caliber of the cervical segment were(4.7 +/- 0.1) cm and (4.0 +/- 0.1) mm. The average length and original caliber of the dorsal segment were (5.88 +/- 0.63) cm and (3.30 +/- 0.35) mm. 86.7% spina scapular branches originated from the superficial branch of TCA and 13.3% from TCA. The length of the spina scapular branch was (4.97 +/- 1.68) cm and its external diameter was (2.08 +/- 0.27) mm. It constantly sent 4-8 periosteal branches to spina with 0.20-1.25 mm in caliber. CONCLUSION The spina scapular branch of TCA is one of the main blood supplier to the spina scapular area. The spina scapular flap pedicled with spina scapular branch of TCA may provide a new operation for mandibular reconstruction, whose circumpoint locates at the origin of the dorsal segment and the average length of the pedicle is 10.85 cm which enough to transposite to mandibular area.
摘要:目的:进行深低温贮存回植自体颅骨瓣的临床应用效果研究。方法:将74例患者术后骨瓣深低温(零下80℃)贮存,2～12月后予以原位回植,术中取骨标本病检,随诊1～36月。结果:74例中72例伤口Ⅰ期愈合,颅骨复位良好。病检示回植骨有正常骨细胞,与新鲜颅骨对照无骨母细胞。2例患者回植骨吸收明显,失去支撑作用而再次行修补钛网,2例感染,余下70例患者2～4月后骨缝不同程度增宽1～2 mm,6月后骨缝不再增宽,12～36月后骨缝部分变窄,达骨性愈合,而颅骨钻孔处及颞下骨缝较宽区未见骨性结构,为纤维疤痕愈合。结论:深低温贮存的自体颅骨部分骨细胞能长时间存活,回植后无免疫排异性。回植手术简便,患者容易接受,临床应用效果较好。