缝匠肌

摘要： 微创全髋关节置换术具有术中出血少,手术创伤小、术后疼痛轻、康复快等优点.微创全髋关节手术入路有:前侧入路、前外侧入路、外侧入路等主要经缝匠肌与阔筋膜张肌间隙显现髋关节,不用切断任何肌肉,创口较小,组织损伤小,术后并发症较少[1].快速康复理念(FTS)强调优化围术期护理措施来减少对患者的创伤和应激损害,达到减轻患者痛苦,促进术后快速康复的目的[2].

摘要： 目的 观察缝匠肌蒂髂骨瓣修复青壮年陈旧性股骨颈骨折的疗效.方法 对10例青壮年陈旧性股骨颈骨折患者行缝匠肌蒂髂骨瓣移植联合股骨近端锁定钢板内固定治疗.记录骨折愈合情况及末次随访时髋关节功能恢复情况.结果 患者均获得随访,时间1～7年.1例术后3个月因骨折端无骨痂形成及发生股骨头缺血性坏死,接受髋关节置换;9例骨折均愈合,肢体功能改善明显.末次随访时,患者髋关节功能均恢复良好.结论 缝匠肌蒂髂骨瓣是修复青壮年陈旧性股骨颈骨折的有效方法,临床疗效肯定.

摘要： Objective To investigate the effect of iliac flap pedicled with superficial circumflex iliac artery and sartorius in the treatment of femoral neck fracture of the young adults.Methods From April,2012 to March,2017,50 cadaveric lower limbs were injected with red latex,and the origin,diameter,course and distribution of the superficial circumflex iliac artery and arteries of the sartorius were observed.The iliac flap pedicled with superficial circumflex iliac artery and sartorius was used to treat the femoral neck fracture in young adults in 11 cases.There were 9 males and 2 females with an average age of 34.5(ranged from 16 to 54) years.The fractures were classified ac cording to Garden:4 cases of type Ⅲ and 7 cases of type Ⅳ.Regular outpatient follow-up was made.Results The superficial circumflex iliac artery originated from the femoral artery and the initial diameter was (1.2±0.3) mm.The length of the superficial circumflex iliac artery to the anterior superior iliac spine was (8.8±1.3) cm.The superficial circumflex iliac artery run to the anterior superior iliac spine and sent 1-3 periosteal branches into the iliac crest.The sartorius originates from the anterior superior iliac spine,and its proximal artery arises from the superficial circumflex iliac artery and the femoral artery.Link-pattern arterial anastomosises were formed in sartorius by branches of adja cent vascular pedicles,which nourished the ilium flap.All incisions healed by first intention.All cases were followedup from 16 to 42 months,with an average of 32.3 months.All fractures healed for 3-7 months,with an average of 4.6 months.No fracture nonunion,femoral head necrosis and other complications occurred.Harris hip scores was 93.02± 5.33.Seven cases were excellent and 4 cases were good.Conclusion The iliac flap pedicled with superficial cir cumflex iliac artery and sartorius has rich blood supply,easily performed conducive to promoting fracture healing,and reducing the occurrence of femoral head necrosis.It is an effective method for the treatment of femoral neck fracture in young adults.%目的 探讨旋髂浅动脉联合缝匠肌蒂髂骨瓣移植治疗青壮年股骨颈骨折的解剖与临床疗效.方法 从2012年4月至2017年3月,对50侧经动脉灌注红色乳胶的成人尸体下肢标本,解剖观测旋髂浅动脉、缝匠肌的动脉来源、外径、走行与分布.设计旋髂浅动脉联合缝匠肌蒂髂骨瓣移植治疗青壮年股骨颈骨折11例,其中男9例,女2例,年龄16～54岁,平均34.5岁.Garden Ⅲ型骨折4例,Ⅳ型7例.门诊定期随访.结果 旋髂浅动脉起源于股动脉,起始处外径(1.2±0.3) mm,起点至髂前上棘(8.8±1.3) cm,其走行至髂前上棘区并发出1～3条分支入髂嵴.缝匠肌起于髂前上棘,近段动脉来源于旋髂浅动脉和股动脉,动脉呈节段性进入缝匠肌并在肌内形成链型吻合营养髂骨瓣.临床应用旋髂浅动脉联合缝匠肌蒂髂骨瓣移植治疗青壮年股骨颈骨折11例,术后切口全部一期愈合.术后随访16～42个月,平均32.3个月,骨折全部愈合,愈合时间3～7个月,平均4.6个月.末次随访时髋关节Harris评分为(93.02±5.33)分:优7例、良4例.所有患者均无骨折不愈合、股骨头坏死等并发症发生.结论 旋髂浅动脉联合缝匠肌蒂髂骨瓣移植治疗青壮年股骨颈骨折手术简便,骨瓣血供丰富,有利于促进骨折愈合、减少股骨头坏死的发生,是治疗青壮年股骨颈骨折的一种有效方法.

摘要： 目的 探究强斜低位空心钉联合缝匠肌骨瓣治疗老年GardenⅢ、Ⅳ型股骨颈骨折疗效.方法 入选秦皇岛市工人医院骨科2016年6月至2017年8月老年GardenⅢ、Ⅳ型股骨颈骨折患者86例,随机数字表法分为对照组和研究组,每组43例.对照组使用常规平行加压空心钉内固定术治疗,研究组使用强斜低拉空心钉联合缝匠肌骨瓣进行治疗,比较2组患者术中指标、视觉模拟量表(VAS)评分、Harris髋关节功能评分和不良事件发生率.采用SPSS 21.0统计软件对数据进行分析.组间比较采用t检验或χ2检验.结果 对照组相比研究组手术时间[(72.56±10.48)vs(84.17±12.33)min]和术中出血量[(125.48±11.52)vs(164.72±14.89)ml]减少,差异具有统计学意义(P<0.05).研究组VAS评分相比对照组术后5 d[(4.82±1.02)vs(5.69±1.07)分]和10 d[(3.28±0.85)vs(4.34±0.94)分]降低,差异具有统计学意义(P<0.05).研究组Harris评分相比对照组术后1个月[(58.79±4.28)vs(51.25±3.63)分]、3个月[(78.46±6.47)vs(70.54±5.89)分]和6个月[(84.07±6.98)vs(79.22±6.51)分]显著高,差异具有统计学意义(P<0.05).对照组相比研究组不良事件发生率高[48.83％(21/43)vs 20.93％(9/43)],差异具有统计学意义(χ2=7.371,P=0.007).结论 强斜低位空心钉联合缝匠肌骨瓣治疗能有效降低老年GardenⅢ、Ⅳ型股骨颈骨折患者术后疼痛,改善术后关节功能,减少不良事件发生.

摘要： 目的:定位缝匠肌的神经入肌点(NEP)和肌内神经密集区中心(CINDR)位置,为缝匠肌痉挛神经阻滞术提供形态学指导.方法:12具24侧成年尸体下肢.连接股骨大转子与耻骨结节和股骨外上髁间的曲线分别为NEP的横向参考线(H线)和纵向参考线(L1线);髂前上棘和股骨内上髁间的曲线为CINDR的纵向参考线(L2线).Sihler染色CINDR,硫酸钡标记NEP和CINDR,CT扫描.NEP和CINDR在股前、后体表上的投影点分别为P和P'点,经P点的垂线与H线、水平线与L线的交点分别记为PH和PL点.结果:缝匠肌的2个NEP的PH点分别位于H线的51.57％、63.93％处;PL点位于L1线的1.71％、0.71％处;深度分别位于pp'线的7.32％、8.10％处.缝匠肌内5个CINDR的P点分别位于L2线的17.18％、26.56％、42.18％、56.25％和72.65％处;深度分别位于pp'线的5.1％、14.81％、19.23％、22,5％和45.45％处.结论:这些位置应为成人缝匠肌痉挛肌外和肌内神经阻滞术的最佳靶点部位.

摘要： 目的:探讨空心加压螺钉内固定加缝匠肌骨瓣移植联合愈髋饮水煎剂治疗青壮年股骨颈骨折的疗效.方法:选取80例青壮年股骨颈骨折患者,随机分为对照组和观察组,各40例.观察组实施空心加压螺钉内固定带缝匠肌髂骨瓣移植术及愈髋饮水煎剂治疗.对照组实施单纯3枚空心螺钉内固定术,术后常规药物治疗.记录骨折愈合时间及并发症等.采用Harris评分评价临床疗效,SF-36表评价生活质量.结果:观察组临床疗效的优良率显著高于对照组,且股骨头缺血性坏死发生率明显低于对照组(P＜0.05).观察组骨折愈合时间明显短于对照组(P＜0.05),治疗后生活质量明显高于对照组(P＜0.05).结论:空心钉加带缝匠肌骨瓣移植给骨折愈合创造便利条件,配合愈髋饮水煎剂中药活血祛淤的功效,重建局部血液循环,增强软骨内成骨活跃,促进骨折的愈合及功能的恢复.

摘要： Objective To investigate the effect of retrograde sartorius myocutaneous flap for reparing skin defects of leg.Methods In the anatomic study,50 cadaveric lower limb were injected with red latex and the origin,diameter,course,distribution and anastomosis of sartorius's arteries were observed.Arteriographies were made in 4 sides of fresh specimens to study the arterial anastomosis in sartorius.Based on anatomic research results,we designed the retrograde sartorius myocutaneous flap for reparing skin defects of leg.Results Nutrient arteries of sartorius represented segnental distribution,Link-pattern arterial anastomosises were formed in sartorius by branches of adjacent vascular pedicles.Cutaneous arteries and musculocutaneous arteries above deep fascia formed interlocking arterial anastomosises net which provided blood supply for the skin on sartorius.The arterial branches in the distal 2/5 of sartorius came from saphenous artery,composed an arterial network around knee joint,which consist of anatomic basis for the blood supply of retrograde sartorius myocutaneous flap.Form February,2010 to April,2014,the retrograde sartorius myocutaneous flap were used to repair skin defects of leg in 2 cases.The flap size ranged from 7 cn×18 cm to 12 cm×25 cm.All flaps survived successfully with no ulcer.2 cases were followed up for 7 to 16 months.The skin color and texture were satisfactory.Conclusion the retrograde sartorius myocutaneous flap has constantly,reliable blood supply,and easily performed.It is an effective method for the reconstruction skin defects of leg.%目的 探讨逆行缝匠肌皮瓣修复小腿皮肤缺损的解剖与手术方法.方法 用50侧经动脉灌注红色乳胶的成尸下肢标本,解剖观测缝匠肌的动脉来源、外径、走形、分布及吻合.取4侧新鲜尸体下肢标本进行动脉造影,观察缝匠肌肌内动脉吻合.设计逆行缝匠肌皮瓣修复小腿皮肤缺损.结果 营养动脉呈节段性进入缝匠肌,相邻节段动脉的分支在肌内形成链型吻合.节段动脉发出皮动脉和肌皮动脉营养缝匠肌及表面皮肤.隐动脉营养缝匠肌下2/5段,并参与膝关节动脉网,为逆行缝匠肌皮瓣的供血动脉.2010年2月至2014年4月,临床应用该肌皮瓣2例,肌皮瓣切取范围7 cm×18 cm ～ 12 cm×25 cm,术后皮瓣均成活,随访7～ 16个月,皮瓣色泽、质地良好,无肿胀、破溃、骨折愈合,皮瓣外观较为满意.结论 逆行缝匠肌皮瓣解剖位置恒定,血供可靠,手术简便,是修复小腿中、上段皮肤缺损的一种有效方法.

摘要： 目的:探讨非感染性髋臼节段性骨缺损的人工髋关节置换术(THR)经验. 方法:回顾分析13例非感染性髋臼节段型骨缺损的髋关节置换经验,研究带缝匠肌髂骨瓣植骨、固定、髋臼置换和功能康复的新方法.根据美国骨科学会(AAOS)的分类方法13例均为节段型骨缺损. 结果:本组手术全部成功,术后无感染发生.术后均获24～60个月(平均33.2个月)随访,随访时间,随访时关节无疼痛,关节功能较术前明显改善,对手术结果满意. 结论:使用带缝匠肌髂骨瓣植入修复髋臼节段型缺损为活骨移植,成骨效果良好.对于节段型骨缺损,植骨时应辅以颗粒骨,并尽量选用较稳固的钉板系统固定.