摘要
目的:通过对术后股骨颈骨折患者两侧旋髂深血管的数字减影血管造影(DSA)或计算机断层扫描血管造影(CTA),以及股骨头的ECT、MRI检查,探讨带旋髂深血管蒂髂骨瓣转移对股骨颈骨折术后股骨头血供重建的作用。方法:45例股骨颈囊内骨折,男30例,女15例;年龄16～50岁,平均36.5岁;病程6～25d,平均10.2d。头下型20例,头颈型10例,经颈型15例。应用带旋髂深血管蒂髂骨瓣转移结合空心拉力螺钉固定治疗,术后平均随访3年6个月,对术后两侧旋髂深血管的数字减影血管造影(DSA)或计算机断层扫描血管造影(CTA),并行股骨头的ECT、MRI检查,动态观察转移血管的充盈情况并监测受区血供重建变化。结果:术后3周,38例行DSA检查显示,转移的旋髂深血管均通畅;7例行CTA的患者中2例显影不确切,再次DSA检查见血管通畅。术后1年以后的DSA或CTA检查均显示转移血管通畅。术后3、6、12个月ECT检查显示患侧的股骨头内核素浓集,分布均匀,两侧股骨头的放射性比值(ROI)的患侧与健侧的比值(D/N)均大于1.0,D/N平均值术后3个月为(2.12±0.21),术后6个月为(2.04±0.14),术后12个月为(1.71±0.11),术后3、6个月之间的D/N值无明显差异(P>0.05),术后12个月的D/N值较术后3、6个月明显下降(P<0.05)。但MR检查未发现股骨头密度下降、形态改变。结论:DSA、CTA、ECT、MRI证实带旋髂深血管蒂髂骨瓣可以为股骨头提供有效的血供,有利于股骨颈骨折后股骨头血供的重建。
Objective ：To evaluate the contribution of the deep circumflex iliac arterial vascularized iliac bone grafting to the reconstruction of the blood supply of the femoral head through the digital subtraction angiography （DSA） or computied tomographic scanning angiography （CTA） of the both deep circumflex iliac artery and ECT, MRI judgement. Methods： Forty-five patients with the intracapsular fracture of femoral neck included 30 males and 15 females with an average age of 36.5 years ranging from 16 to 50. The course was from 6 to 25 days（means 10.2 days）. There were 20 cases of sub-headfractures, 10 cases of head-neck, 15 cases of trans-neck. All patients were treated by 3 titanium alloy cannulated screws and deep circumflex iliac arterial vascularized iliac bone grafting. A follow-up for an average of 3 years and 6 months was performed. The engorging of the artery and reconstruction of the blood supply of the femoral head was viewed dynamicly,using digital subtraction angiography （DSA） or computied tomographic scanning angiography （CTA） of the both deep circumflex iliac artery and ECT, MRI judge- ment of the femoral head. Results ： Three weeks after operation, 38 transferred arteries were engorging via DSA, 2 of 7 not via CTA, but engorging via DSA. One year later after operation ,all arteries were engorging via DSA or CTA. ECT examination in 3,6,12 months after operation displayed nuclide enriching in the femoral head and distributing uniformity. The region of interest （ROI ratios of the fractured head of femur to contralateral counterpart （D/N） in all cases〉1.0. The average D/N after 3 months was （2.12±0.21）, （2.04±0.14） after 6 months, （1.71±0.11）after 12 months. There was statistical differation between D/N after 12 months and 3 or 6 months（P〈0.05 ） ,but not between 3 and 6 months（P〉0.05 ） ,and MRI examination in all cases no founded decreasing of the density and changing of the form of the femoral head. Conelnsion：DSA,CTA,ECT,MRI confirmed that the deep circumflex iliac arterial vascularized iliac bone can provide effective blood supply and is profit to the reconstruction of the blood supply of the femoral head after the fracture of the femoral neck.
出处
《中国骨伤》
CAS
2009年第8期609-611,共3页
China Journal of Orthopaedics and Traumatology
关键词
股骨颈骨折
旋髂深血管
数字减影血管造影(DSA)
Femoral neck fractures
Deep circumflex iliac artery
Digital subtraction angiography （DSA）
