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目的探讨骨盆肿瘤切除后带血管蒂股骨上段翻转重建髋关节的可行性。方法 1)选取10具骨盆标本,测量骨盆重建所需股骨截骨长度,并测量50例股骨干标本滋养孔位置,将截骨长度与滋养孔位置进行比较,确定股骨干滋养动脉在截骨长度内能否得到保留。2)对34具尸体标本髂内动脉和股深动脉主要分支的分布、外径、长度以及臀上、下动脉起始处至耻骨联合下缘距离进行解剖学观测,比较供、受区血管长度和外径,确定合适的吻合血管。结果 1)股骨近端第1滋养孔和第2滋养孔均在截骨范围外,不能作为移植骨的供血管。2)臀上动脉出孔处分别与旋股内、外动脉起始端吻合后总长度比臀上动脉起始处到耻骨联合下缘分别长出1.74～2.23 cm和2.39～2.57 cm;臀下动脉出孔处分别与旋股内、外动脉起始端吻合后总长度比臀下动脉起始处到耻骨联合下缘分别长5.87～6.44 cm和6.51～6.83 cm,能够满足吻合需要,且血管吻合后张力不大。臀上、下动脉出梨状肌孔处、旋股内、外动脉起始处外径相仿,P<0.05,差异没有显著性。结论骨盆肿瘤尤其是髋臼部位肿瘤切除后利用带血管蒂自体股骨上段翻转移位重建骨盆环、再造髋臼在解剖学上是可行的。
Objective To investigate the feasibility of reconstructing hip joint by revascularization of upper femoral pedicle after resection of pelvic tumor. Methods 1) 10 pelvic specimens were selected to measure the length of femur osteotomy needed for pelvic reconstruction, and the position of nostril in 50 femur specimens was measured. The length of osteotomy and the position of nostril were compared to determine the length of osteotomy Can be retained within. 2) The distribution, external diameter and length of the major branches of the internal iliac artery and femoral artery in 34 corpse specimens were observed and compared with the distance from the inferior gluteal margin to the lower edge of the superior gluteal artery. And outer diameter, determine the appropriate anastomosis blood vessels. Results 1) The first nostril and the second nostril in the proximal femur were outside the range of osteotomy, and could not be used as the grafts. 2) The total length of the outlet of the superior gluteal artery after anastomosis with the beginning of the internal and external arteries were 1.74-2.23 cm and 2.39-2.57 cm, respectively, from the beginning of the superior gluteal artery to the lower pubic symphysis. The inferior gluteal artery The total length of the exit hole after anastomosis of the starting end of the internal and external arteries was 5.87 ~ 6.44 cm and 6.51 ~ 6.83 cm, respectively, from the beginning of the inferior gluteal artery to the lower edge of the pubic symphysis, which could meet the need of anastomosis Tension is not big. Buttocks, inferior arteries out of the piriformis hole, spinous femoral artery, external artery at the beginning of similar external diameter, P <0.05, the difference was not significant. Conclusion pelvic tumors, especially after resection of the acetabulum resection using the vascularized autologous upper femur overtransposition of the pelvic ring reconstruction of the acetabulum is feasible anatomically.