单侧供体吻合血管游离腓骨移植治疗双侧股骨头缺血性坏死  

TREATMENT OF BILATERAL AVASCULAR NECROSIS OF FEMORAL HEAD BY FREE VASCULARIZED FIBULA GRAFTING WITH UNILATERAL FIBULA AS DONOR

作　　者：刘晓琳[1] 盛加根[1] 张长青[1] 金东旭[1] 梅国华[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《中国修复重建外科杂志》2011年第6期641-645,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨单侧供体吻合血管游离腓骨移植治疗双侧股骨头缺血性坏死的临床疗效。方法 2007年6月-2008年1月,采用单侧供体吻合血管游离腓骨移植治疗双侧股骨头缺血性坏死14例。男12例,女2例;年龄17～57岁,平均36.6岁。病因:激素性3例,酒精性4例,特发性7例。Steinberg分期:Ⅱ期16髋,Ⅲ期10髋,Ⅳ期2髋;各期髋关节术前Harris评分分别为(77.50±4.19)、(69.70±2.76)、(59.50±0.50)分。记录手术时间和术中出血量,术后根据X线片表现、Harris评分及并发症情况评价疗效。结果术中切取腓骨时间为10～32 min,平均20 min;手术时间为100～240 min,平均140 min;术中出血量200～500 mL,平均280 mL。术后患者切口均Ⅰ期愈合。14例均获随访,随访时间12～40个月,平均24个月。术后1例出现大腿前外侧皮肤麻木和感觉减退,1例足背感觉异常,1例踝关节活动不适,均于术后1年恢复正常。术后1年,X线片示23髋(82.1%)股骨头缺血性坏死改善,5髋(17.9%)稳定;SteinbergⅡ、Ⅲ、Ⅳ期髋关节Harris评分分别为(93.90±4.84)、(88.50±8.13)、(78.00±0.00)分,与术前比较差异均有统计学意义(P<0.05)。结论 单侧供体吻合血管游离腓骨移植治疗双侧股骨头缺血性坏死具有手术时间短、损伤小、术中出血少,以及术后髋关节功能恢复好等优点。Objective To investigate the effectiveness of free vascularized fibula grafting with unilateral fibula as donor in treatment of bilateral avascular necrosis of femoral head（ANFH）.Methods Between June 2007 and January 2008,14 patients with bilateral ANFH were treated with free vascularized fibula grafting with unilateral fibula as donor.There were 12 males and 2 females with an average age of 36.6 years（range,17-57 years）.The necrosis was caused by use of steroids in 3 cases,consumption of alcohol in 4 cases,and idiopathic condition in 7 cases.According to Steinberg system,16 hips were classified as stage II,10 hips as stage III,and 2 hips as stage IV.The preoperative Harris hip scores were 77.50± 4.19,69.70 ± 2.76,59.50± 0.50 in patients at stages II,III,and IV,respectively.The duration of operation and the bleeding volume were recorded.The X-ray examination,the Harris hip score,and the complications were used to evaluate the effectiveness.Results The duration of the fibula osteotomy was 10-32 minutes（mean,20 minutes）.The duration of the total operation was 100-240 minutes（mean,140 minutes）.The bleeding volume was 200-500 mL（mean,280 mL）.All patients achieved healing of incision by first intention.The patients were followed up 12-40 months（mean,24 months）.One case had numbness and hyperthesia of the anterolateral thigh;1 case had abnormal sensation of the dorsal foot;1 case had discomfort of the ankle;and they restored to normal at 1 year after operation.According to X-ray films 1 year after operation,the improvement was achieved in 23 hips（82.1%） and no deterioration in 5 hips（17.9%）.At 1 year after operation,the Harris hip scores were 93.90 ± 4.84,88.50 ± 8.13,and 78.00 ± 0.00 in patients at stages II,III,and IV,respectively,showing significant differences when compared with preoperative ones（P 〈 0.05）.Conclusion Unilateral free vascularized fibula grafting has lots of virtues,such as short surgical time,less bleeding volume,little injury,and good results of function

关 键 词：股骨头缺血性坏死 游离腓骨移植 单侧供体 

分 类 号：R687.3[医药卫生—骨科学]