改良游离腓骨移植结合含BMP异体骨治疗股骨头坏死  

Treatment of osteonecrosis of the femoral head with modified free vascularized fibular grafting and allogenic bone containing BMP

作　　者：吕玉明[1] 程立明[2] 裴国献[3] 

机构地区：[1]南方医科大学南方医院创伤骨科,广州市510515 [2]北京中日友好医院骨关节外科,100029 [3]西安第四军医大学西京医院骨科,710032

出　　处：《实用医学杂志》2011年第11期1985-1987,共3页The Journal of Practical Medicine

基　　金：国家自然基金资助(编号:30772194)

摘　　要：目的:探讨改良的吻合血管游离腓骨移植结合含BMP异体骨治疗股骨头坏死临床疗效。方法:2004年5月至2010年2月,应用改良的游离腓骨移植技术共治疗股骨头坏死38例(38髋),男29例,女9例;年龄21～57岁,平均42.5岁。根据Steinberg分期,Ⅱ期15髋,Ⅲ期19髋,Ⅳ期4髋。患者术前Harris评分为45.0～73.5分,平均64.5分。术后行X线摄片、Harris评分及并发症的评价。结果:患者随访12个月～6年4个月,平均28.5个月。患者的X线片显示26髋有不同程度改善,10髋无明显变化,2髋恶化。术后Harris评分为45.0～92.0分,平均76.8分。无严重并发症。结论:改良的吻合血管游离腓骨移植结合含BMP异体骨是治疗青壮年股骨头坏死的一种有效的保头治疗方法。该术式具有操作简便、创伤小、并发症少及术后功能恢复较好等优点。Objective To evaluate the clinical results of modified free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head. Methods We retrospectively reviewed the results of 38 patients （38 hips） with osteonecrosis of the femoral head who had undergone modified free vascularized fibular grafting with allogeneic bone containing bone morphogenetie protein （BMP）. According to Steinberg classification system, 15 hips were classified as stage Ⅱ , 19 as stage Ⅲ, and 4 as stage Ⅳ. The average duration of follow-up was 28.5 months （range from 12 months to 76 months）. The follow-up items included the X-ray examination, the Harris scores of the hip, and the evaluation of the complications. Results The mean preoperative Harris hip scores was 64.5 points （45.0 - 73.5 points）, and increased to 76.8 points （45.0 - 92.0 points） by the end of the follow-up. Comparing with postoperative X-ray, 27 hips （71.05%） were improved and 9 hips （23.68%） had no significant changes. Deterioration occurred in 2 hips （5.26%）. Conclusion The modified free vascularized fibular grafting and allogeneic bone containing BMP is an effective method for treating osteonecrosis of and preventing the collapse of the femoral head. Our current study displays more convenience for operation, less damage, less complications, and better results of function recovery.

关 键 词：股骨头坏死 腓骨移植 异体骨 骨形态发生蛋白 

分 类 号：R687.3[医药卫生—骨科学]