Brunelli G, Brunelli G
Department of Orthopaedics, Brescia University Medical School, Italy.
J Reconstr Microsurg. 1991 Oct;7(4):285-95. doi: 10.1055/s-2007-1006786.
The authors discuss free microvascular bone transfers in general, and propose a new classification for idiopathic femoral head necrosis. They then present a technique they have been using for 11 years, with the goals of providing both mechanical support and an improved blood supply to the femoral head. This technique involves clearing the necrotic area of the femoral head, filling the area with cancellous bone taken from the greater and lesser trochanters, and transferring a fibular microvascular graft. The approach is transtrochanteric and spares the capsule. Vascular anastomosis is done with the lateral branches of the deep femoral artery, sparing the anterior circumflex artery which is important to the blood supply of the femoral head. Forty-five cases have been surgically managed over 11 years. Eighteen cases with follow-up longer than five years were analyzed, providing an 84 percent successful outcome with both very good and good results.
作者总体讨论了游离微血管骨移植，并提出了一种针对特发性股骨头坏死的新分类方法。然后，他们介绍了一种他们已经使用了11年的技术，其目标是为股骨头提供机械支撑并改善血液供应。该技术包括清除股骨头的坏死区域，用取自大转子和小转子的松质骨填充该区域，并移植腓骨微血管移植物。手术入路为经转子入路，保留关节囊。血管吻合采用股深动脉的外侧分支，保留对股骨头血液供应很重要的旋股外侧动脉。在11年中对45例患者进行了手术治疗。分析了18例随访时间超过5年的病例，结果显示成功率为84%，效果非常好和良好。
