吻合血管游离腓骨移植治疗股骨头缺血性坏死技术总结及手术器械改进  

Technical summary and modified instruments of free vascularized fibular grafting for osteonecrosis of femoral head

作　　者：董帅[1] 蔡喜雨[1] 朱征威 

机构地区：[1]郑州大学第一附属医院骨科,郑州450052

出　　处：《中国修复重建外科杂志》2017年第2期129-133,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结吻合血管游离腓骨移植(free vascularized fibular grafting,FVFG)治疗股骨头缺血性坏死(osteonecrosis of femoral head,ONFH)的临床技术,以及改进的手术器械在术中应用价值。方法2011年3月—2013年1月,采用改进的手术器械行FVFG治疗ONFH患者35例(47髋)。男24例(32髋),女11例(15髋);年龄22~43岁,平均34岁。单髋23例,双髋12例。病程5~9个月,平均7个月。ONFH类型:酒精性25髋,激素性12髋,创伤性3髋,特发性7髋。术前行X线片检查,根据国际骨循环协会(ARCO)分期标准:Ⅰ期3髋,Ⅱ期39髋,Ⅲ期5髋。术前髋关节Harris评分为(58.2±6.1)分。结果术中切取腓骨时间为15~35 min,平均25 min;手术时间90~200 min,平均130 min。术中出血量为150~500 m L,平均270 m L。术后切口均Ⅰ期愈合,无感染、下肢深静脉血栓形成等并发症发生。患者均获随访,随访时间12~42个月,平均28个月。末次随访时Harris评分为(87.3±5.7)分,较术前显著提高,比较差异有统计学意义(t=102.038,P=0.000)。X线片复查示,腓骨瓣位置良好,末次随访时股骨头坏死改善9髋,无进展36髋,进展2髋。结论采用FVFG治疗ONFH能有效改善患者髋关节功能,术中应用改进的手术器械能提高手术效率。Objective To summarize retrospectively the clinical technology of repairing osteonecrosis of femoral head （ONFH） by free vascularized fibular grafting （FVFG）, and the value of modified instruments in operation. Methods Between March 2011 and January 2013, 35 patients with ONFH （47 hips） who underwent FVFG with modified instruments. There were 24 males （32 hips） and 11 females （15 hips）, aged 34 years on average （range, 22-43 years）. The unilateral hip was involved in 23 cases and the bilateral hips in 12 cases. The disease duration ranged from 5 to 9 months （mean, 7 months）. Based on etiology, 25 hips were classified as alcohol ONFH, 12 hips as corticosteroids ONFH, 3 hips as trauma ONFH, and 7 hips as idiopathic ONFH. According to the Association Research Circulation Osseous（ARCO） stage, 3 hips were rated as stage Ⅰ, 39 hips as stage Ⅱ, and 5 hips as stage Ⅲon the X-ray films. The preoperative Harris score was 58.2±6.1. Results The time to get fibula was 15-35 minutes （mean, 25 minutes）. The operation time was 90-200 minutes （mean, 130 minutes）, and the blood loss during operation was 150-500 mL （mean, 270 mL）. All the patients achieved primary healing of incision, without complication of infection or deep vein thrombosis. All 35 patients were followed up 12-42 months, with an average of 28 months. The Harris score at final follow-up was 87.3±5.7, showing significant difference when compared with preoperative score （t=102.038, P=0.000）. Radiographic results at final follow-up showed good position of fibula; and necrosis was improved in 9 hips, had no changes in 36 hips, and aggravated in 2 hips. Conclusion FVFG for ONFH can improve hip function effectively, and modified instruments can improve operation efficiency.

关 键 词：吻合血管游离腓骨移植 股骨头缺血性坏死 手术器械 

分 类 号：R687.3[医药卫生—骨科学]