吻合血管游离腓骨移植治疗股骨头坏死的系统回顾  

Free vascularized fibular grafting for osteonecrosis of femoral head:a systemic review

作　　者：薛锋[1] 张长青[2] 柴雷子[1] 陈圣宝[2] 丁亮[1] 

机构地区：[1]上海交通大学医学院附属第六人民医院南院骨科,上海市201499 [2]上海交通大学附属第六人民医院

出　　处：《中国骨与关节损伤杂志》2014年第4期322-324,共3页Chinese Journal of Bone and Joint Injury

基　　金：上海市科学技术委员会科研计划项目(11411950405)

摘　　要：目的通过综合分析关于吻合血管游离腓骨移植治疗股骨头坏死相关文献,探讨其疗效及安全性。方法系统检索自1980-01—2013-05吻合血管游离腓骨移植治疗股骨头坏死相关文献,按照纳入标准和剔除标准进行筛选,提取需要数据,通过循证医学分析方法,加权汇总分析。结果共检索出96篇相关文献,共10篇被纳入分析,共553例(656髋),男426例,女127例,加权平均年龄(37.08±5.10)岁,加权平均随访时间(7.91±4.20)年。术后加权平均髋关节功能Harris评分(82.57±5.78)分较术前(62.69±10.07)分明显提高,差异有统计学意义(t=63.30,P<0.05)。纳入文献中6篇(373髋)中78髋术后进展至髋关节置换,加权平均进展至髋关节置换时间为术后(5.96±2.51)年,术后髋关节幸存率79%。并发症主要深静脉血栓(6.60%)、拇趾趾间关节伸直功能受限(6.51%)、腓神经麻痹(3.76%)、术后感染(3.74%)、异位骨化(1.54%)、股骨粗隆部滑囊炎(1.00%)。结论吻合血管游离腓骨移植是一种治疗股骨头坏死安全有效的手术方法,但需要重视术后并发症问题。Objective To systematically review the safety and efficacy of free vascularized fibular grafting for osteonecrosis of the femoral head. Methods The literatures about free vascularized fibular grafting for osteonecrosis of the femoral head were searched at home and abroad from Jan 1980 to May 2012. According to established inclusion and exclusion criteria, literatures met evaluation criteria were selected, and data were analyzed with the weighted meta-analysis of evidence-based medicine analysis. Results Ten trials involving 533 patients （656 hips） were included in this study. There were 426 males and 127 females. The results showed： weight average age was （37.08±5.10） years old, and weight average follow-up was （7.91±4.20） years. Postoperative weight average Harris score（82.57＋5.78 points） was higher than preoperative score（62.69±10.07 points）, showing significant differences between postoperative and preoperative ones （t =63.30, P 〈0.05）. Seventy-eight of 373 hips with FVFG converted to total hip arthroplasty at a weight average of （5.96±2.51） years postoperatively, survival rate was 79%. The complications mainly included deep vein thrombosis（6.60%）, flexion contracture of the interphalangeal joints of great toe （6,51% ）, the sensory peroneal neuropathy （3.76%）, wound infection （3.74%）, ectopic ossification （1.54%）, and trochanteric bursitis （1.00%）. Conclusion Free vascularized fibular grafting for osteonecrosis of the femoral head is a safe and effective surgical method, but the attention should be paid to its complications.

关 键 词：股骨头坏死 游离腓骨移植 系统回顾 

分 类 号：R687.3[医药卫生—骨科学]