髓芯减压游离腓骨移植治疗ARCOⅢ期股骨头缺血性坏死的保髋疗效分析  

Efficiency of core decompression and free vascularized fibula grafting for ARCO Ⅲ-stage avascular necrosis of femoral head

作　　者：徐建强 周密 樊丽洁 刘琳琳 赵广立 张树明 XU Jian-qiang;ZHOU Mi;FAN Li-jie;LIU Lin-lin;ZHAO Guang-li;ZHANG Shu-ming(Department of Orthopedics,PLA Rocket Force Characteristic Medical Center,Beijing 100088,China)

机构地区：[1]火箭军特色医学中心骨科,北京100088

出　　处：《中国骨与关节损伤杂志》2021年第2期113-117,共5页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨髓芯减压、游离腓骨移植保髋手术治疗中青年ARCOⅢ期股骨头缺血性坏死的临床疗效。方法回顾性分析自2011-01-2019-12诊治的20例(23髋)中青年ARCOⅢ期股骨头缺血性坏死,作股骨粗隆下切口,经股骨颈钻孔到达坏死区进行髓腔减压及死骨清除,于同侧小腿切取带血管蒂腓骨段经隧道植入股骨头;于大腿前外侧另作切口,游离旋股外侧血管降支,将移植腓骨的血管蒂引至该切口并与旋股外侧降支动静脉吻合。结果 19例(22髋)获得随访,随访时间平均5.2(1.5~8.5)年。1例术后切口裂开,1例术后出现第1~3趾僵硬,3例术后出现拇趾僵硬。术后1例疼痛未减轻,1例(双髋)疼痛减轻幅度较小,1例疼痛缓解4年后再次疼痛。末次随访时疼痛VAS评分为(2.1±1.5)分,较术前明显降低;末次随访时髋关节功能Harris评分为(86.6±7.2)分,较术前明显提高,差异均有统计学意义(P<0.05)。末次随访时X线片评估结果:2髋改善,16髋稳定,4髋加重;股骨头坏死加重患者的疼痛没有加重,髋关节功能尚好。结论髓芯减压、吻合旋股外侧血管降支、经股骨颈游离腓骨移植联合松质骨植骨是中青年ARCOⅢ期股骨头缺血性坏死的有效保髋手术治疗方法,而且技术路线与手术操作相对简单。ObjectiveTo investigate the effectiveness of core decompression and free vascularized fibula grafting for ARCOⅢ-stage avascular necrosis of femoral head(ANFH)in middle-aged patients.MethodsTwenty patients(23 hips)with ARCOⅢ-stage ANFH treated from January 2011 to December 2019 were observed retrospectively.A subtrochanteric incision was made and the necrosis area of the femoral head was decompressed and debrided with a trephine through the femoral neck.An ipsilateral vascularized fibula segment was harvested and implanted into the femoral head through the tunnel.Another incision on the anterolateral side of the thigh was made,the descending branch of the lateral femoral circumflex femoral vessels was freed and anastomosed with the vessel pedicle of the fibula.ResultsNineteen patients(22 hips)were followed up for 1.5-8.5 years,averaging 5.2 years.One case had incision dehiscence,1 case had stiffness of the first to third toes,and 3 cases had stiffness of the first toe.After operation,1 case had no pain relief,1 case(both hips)had less relief,and 1 case had pain recurrence after 4 years of pain relief.The VAS score at the last follow-up was(2.1±1.5),which was significantly lower than the pre-operative score.Harris score of hip joint function at the last follow-up was(86.6±7.2),which was significantly higher than the pre-operative score,and the difference was statistically significant(P<0.05).X-ray results at the last follow-up showed that 2 hips were improved,16 hips were stable and 4 hips were aggravated.However,pain of patients with radiologically aggravated necrosis were not worse,and hip joint function was still good.ConclusionCore decompression,anastomosis of the descending branch of lateral circumflex femoral vessels,free fibula transplantation via femoral neck and cancellous bone grafting are effective for hip-preserving in ARCOⅢ-stage ANFH in middle-aged patients.Its technical route and operation are relatively simple.

关 键 词：ARCOⅢ期股骨头缺血性坏死 髓芯减压 游离腓骨移植 旋股外侧血管降支 保髋治疗 

分 类 号：R687.3[医药卫生—骨科学]