Anatomic study and early clinical effect of modified quadratus femoris bone flap for femoral head necrosis with superior artery preservation
Objective The modified femoral quadratus bone flap with posterior superior supporting artery was designed and anatomized with chilled specimens to observe the clinical efficacy of this method in the treatment of femoral head necrosis.Methods An anatomical study was conducted on 10 chilled specimens to design and observe the clinical efficacy of the modified quadratus femoris bone flap with posterior superior sertorius artery.Additionally,a retrospective analysis was performed on 88 male patients(aged 20-55 years)who underwent hip preservation treatment for femoral head necrosis from January 2019 to August 2023.These patients also underwent preoperative DSA examination for upper support band development of the femoral head.Modified quadratus femoris bone flap with preserved superior supporting artery was used to treat 45 hips in stage Ⅱ and 43 hips in stage Ⅲ.At 12 months postoperatively,hip function was assessed using Harris score,international hip outcome tool score and visual analogue scale.Results The surgical design of 10 chilled specimens was successfully completed.The posterior superior retinacular artery was completely retained.Among these specimens,the posterior superior retinacular artery of the femoral head was derived from the medial femoral elector artery in 7 cadavers(70%),from the inferior gluteal artery in 3 cadaver(30%)and the average length of bone flap was 4 cm.Follow-up data showed that all 88 patients were followed up for 30.2 months(ranging 12-55 months).The Harris score of hip joint increased from(55.98±4.34)points before surgery to(90.55±4.27)points after surgery,and the differences were statistically significant(P<0.05)with the excellent rate of 95.5%.International hip outcome tool score increased from(55.30±3.14)points before surgery to(88.05±1.47)points after surgery,and the differences were statistically significant(P<0.05).Visual analogue scale decreased from(6.35±0.78)points before surgery to(1.98±0.73)points after surgery,and the differences were statistically significant(P<0.05).Complete posterior superior retinacular artery was developed in 96.5%of patients.There was no further necrosis of femoral head and no joint replacement during follow-up.Conclusions Modified quadratus femoris bone flap can effectively preserve the blood supply of the main artery of the femoral head,providing a new method for hip preservation,but long-term follow-up is needed to further evaluate its therapeutic effect.
万方数据
维普
