吻合旋髂深血管的游离髂骨瓣移植治疗股骨头缺血性坏死  

Free graft of vascularized iliac bone flap based on deep iliac circumflex vessels for the treatment of osteonecrosis of the femoral head

作　　者：唐举玉[1] 杜威[1,2] 吴攀峰[1] 周征兵[1] 俞芳[1] 庞晓阳[1] 曾磊[1] 潘丁[1] 肖勇兵[1] 刘睿[1] 卿黎明[1] 欧淇峰 张兴 Tang Juyu;Du Wei;Wu Panfeng;Zhou Zhengbing;Yu Fang;Pang Xiaoyang;Zeng Lei;Pan Ding;Xiao Yongbing;Liu Rui;Qing Liming;Ou Qifeng;Zhang Xing(Department of Hand and Microsurgery, Xiangya Hospital, Central South University, Changsha 410008, China;Department of Rehabilitation Medicine, Xiangya Hospital, Central South University, Changsha 410008, China;Department of Orthopedic, Zhanhe Orthopedic Hospital, Pingdingshan, Henan Province 467000, China)

机构地区：[1]中南大学湘雅医院手显微外科,长沙410008 [2]中南大学湘雅医院康复医学科,长沙410008 [3]平顶山市湛河骨伤科医院骨科,河南平顶山467000

出　　处：《中华显微外科杂志》2019年第4期313-316,共4页Chinese Journal of Microsurgery

摘　　要：目的探讨吻合旋髂深血管的游离髂骨瓣移植治疗股骨头坏死(ONFH)的可行性及临床效果。方法2016年4月至2017年7月,收治ONFH患者12例(13髋),患髋Harris评分:Arco分期二期患者平均(74.7±6.9)分,三期患者平均(68.6±9.2)分。坏死病灶清除后,设计对侧髂骨瓣游离移植,将旋髂深动、静脉分别与旋股外侧动脉横支(或升支)及其伴行静脉吻合。术后"人"形支具固定髋部3周,分别于术后1、3、6、9、12个月行X线片检查了解髂骨瓣愈合及股骨头恢复情况。术后6、12个月行Harris评分了解髋关节功能恢复情况,并进行统计学分析,P<0.05为差异有统计学意义。结果本组术后随访平均15(12~20)个月,所有患者移植髂骨瓣均愈合良好,除1髋因负重过早出现轻度塌陷,其余12髋股骨头未见继发坏死与塌陷;Arco分期二期患者术后Harris评分平均为(91.6±4.5)分,三期平均为(84.8±6.1)分,与术前相比,差异均有统计学意义(P<0.05)。结论吻合旋髂深血管的髂骨瓣移植可能是一种治疗中、晚期股骨头缺血性坏死的可靠方法。Objective To investigate the feasibility and clinical efficacy of free graft of vascularized iliac bone flap based on deep iliac circumflex vessels for the treatment of osteonecrosis of femoral head (ONFH). Methods Twelve cases of ONFH (13 hips) received free graft of vascularized iliac bone flap based on deep iliac circumflex vessels from April, 2016 to July, 2017. The average Harris score was (74.7±6.9) in the second stage and (68.6±9.2) in the third stage. After debriding the necrosis bone of the femoral head, the contralateral vascularized iliac bone flap had been harvested, and then implanted into the femoral head. The deep iliac circumflex artery and its accompanying vein were anastomosed with the transverse branch (or ascending branch) of the lateral circumflex femoral artery and concomitant vein respectively. The herringbone brace was used for hip fixation for 3 weeks after operation. X-ray examination(1, 3, 6, 9 and 12 months after operation, respectively) and Harris hip score (6 and 12 months after operation, respectively) were performed to evaluate the recovery results of the femoral head. Scores were recorded and analyzed by paired t-test. The difference was considered to statistically significant if P<0.05. Results The patients were followed-up for 15 (12-20) months. The iliac bone flap of 12 patients (13 hips) healed well. There was no necrosis and collapse in 12 hips, except 1 femoral head collapsed slightly because of weight loading too early. The average Harris score was (91.6±4.5) of the second stage and (84.8±6.1) of the third stage. Compared with scores before the operation, the difference was statistically significant (P<0.05). Conclusion Free vascularized iliac bone grafting based on deep iliac circumflex vessels is an ideal treatment for ONFH head in middle and advanced stage.

关 键 词：股骨头坏死 髂骨瓣 旋髂深血管 移植 HARRIS评分 

分 类 号：R687.3[医药卫生—骨科学]