带旋髂深血管髂骨瓣治疗股骨头无菌性坏死  

Vascularized iliac bone graft for treatment of osteonecrosis of the femoral head

作　　者：孙红振[1] 王爱民[1] 蒋祖言[1] 杜全印[1] 尹良军[1] 郭庆山[1] 赵玉峰[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所全军战创伤中心骨创伤科,重庆400042

出　　处：《创伤外科杂志》2004年第5期333-336,共4页Journal of Traumatic Surgery

摘　　要：目的　观察带旋髂深血管的髂骨瓣治疗股骨头无菌性坏死的临床效果。方法　 1992～ 2 0 0 2年共收治股骨头无菌性坏死患者 2 2 1例 2 4 3髋 ,其中创伤性 5 6例 ,酒精性 4 8例 5 4髋 ,激素性 6 8例 76髋 ,原因不明 4 9例 5 7髋。Ficat分期 :Ⅰ期 6 5髋 ,Ⅱ期 92髋 ,Ⅲ期 75髋 ,Ⅳ期 11髋。全部采用股骨头减压 ,死骨清除 ,带髂深血管的髂骨瓣移植手术。结果　经 2～ 11年 (平均 5 .8年 )随访 ,患者疼痛症状明显缓解 ,有效率98%。Ⅰ～Ⅱ期 15 7髋 ,X线检查患者股骨头外形好 ,关节活动度满意 ;Ⅲ～Ⅳ期患者 ,一部分股骨头外形好 ,关节间隙清晰 ,髋臼没有创伤性改变 ,另一部分股骨头可见进一步塌陷 ,关节活动受限。Harris评分 ,总体优良率 83.6 %。结论　带旋髂深血管的髂骨瓣治疗股骨头无菌性坏死 ,对缓解疼痛有明显的效果 ,在疾病早期可减缓甚至阻止病变的进一步发展。Objective To evaluate the technique of vascularized iliac bone grafting for treatment of osteonecrosis of the femoral head.Methods From 1992 to 2002,243 hips (221 patients) with osteonecrosis of the femoral head were treated using the vascularized iliac bone grafting technique.Of the patients,56 were caused by trauma,48 (54 hips) by alcohol,68 (76 hips) by steroid and 49(57 hips) unknown.Ficat's classification was used to categorize the severity of hip disease.In 65 hips the necrosis was classified as Ficat Stage I,in 92 hips as Stage Ⅱ,in 75 hips as Stage Ⅲ and in 11 hips as Stage Ⅳ.The patients were treated with core decompression,necrosis bone removal and vascularized iliac bone grafting.Results All patients were followed up for 5.8 years (2-11 years) on average.Pain was relieved in most patients.The total effective rate of the vascularized iliac bone grafting technique was 98%.Roentgenographic and hip function assesment showed that 157 hips in Ficat Stage Ⅰ-Ⅱ had good contour of the femoral head and satisfactory range of hip joint motion,however,a portion of patients in Ficat Stage Ⅲ-Ⅳ progressed to femoral head sinking and traumatic arthritis.Overall, 83.6% of the hips had good to excellent results.Conclusion The vascularized iliac bone grafting technique can effectively relieve the pain in treating osteonecrosis of the femoral head.In the early stages of osteonecrosis of the femoral head,the technique can put off or prevent progression of the disease.

关 键 词：髂骨瓣 股骨头 无菌性坏死 移植 

分 类 号：R681.8[医药卫生—骨科学]