可降解高纯度镁金属螺钉固定旋股外侧动脉横支大转子骨瓣治疗中青年股骨头缺血性坏死12例  

Degradable high purity magnesium screw in fixing the greater trochanter bone flap pedicled with transverse branch of lateral circumflex femoral artery:Treatment of avascular necrosis of femoral head in 12 young and middle-aged patients

作　　者：黄诗博 刘宇鹏[2] 覃开蓉[3] 程亮亮 王志强[2] 曹放[1,2] 李卫荣 赵德伟 HUANG Shibo;LIU Yupeng;QIN Kairong;CHENG Liangliang;WANG Zhiqiang;CAO Fang;LI Weirong;ZHAO Dewei(School of Biomedical Engineering,Faculty of Electronic Information and Electrical Engineering,Dalian University of Technology,Dalian,Liaoning Province 116024,China;Department of Orthopaedic,Affiliated Zhongshan Hospital of Dalian University,Dalian,Liaoning Province 116001,China;Optoelectronic Engineering and Instrumentation Science,Dalian University of Technology,Dalian,Liaoning Province 116024,China;Dongguan Eontec Co.,Ltd,Dongguan,Guangdong Province 523000,China)

机构地区：[1]大连理工大学电子信息与电气工程学部生物医学工程学院,辽宁大连116024 [2]大连大学附属中山医院骨科,辽宁大连116001 [3]大连理工大学光电工程与仪器科学学院,辽宁大连116024 [4]东莞宜安科技股份有限公司,广东东莞523000

出　　处：《中华显微外科杂志》2022年第4期411-417,共7页Chinese Journal of Microsurgery

基　　金：国家骨科与运动康复临床研究中心创新基金(2021-NCRC-CXJJ-ZH-28);大连市登峰计划医学重点专科建设项目(大卫发(2021)243号)。

摘　　要：目的探讨应用可降解高纯度镁金属螺钉固定旋股外侧动脉横支大转子骨瓣治疗中青年股骨头缺血性坏死的疗效。方法 2017年2月-2019年2月, 大连大学附属中山医院骨科共收治12例(15髋)股骨头缺血性坏死患者, 年龄30~53岁, 按国际骨循环研究协会(ARCO)制订的股骨头坏死分期为Ⅱ b 2髋,Ⅱ c 4髋,Ⅲ a 1髋,Ⅲ b 5髋,Ⅲ c 2髋,Ⅳ 1髋。选取旋股外侧动脉横支大转子骨瓣对坏死区域进行填充, 应用可降解高纯度镁金属螺钉对移植骨瓣进行固定。术后3、6、12个月定期来院门诊复诊随访, 之后每年复诊一次, 对比患者术前及术后影像学评价影像学疗效, 术后12和24个月时进行Harris评分及疼痛视觉模拟(VAS)评分。术前、术后评分采用Friedman检验进行比较, P<0.05为差异有统计学意义。结果 12例(15髋)患者随访时间24~36个月。术后12个月及24个月Harris评分分别为87(86,92)分和90(87,92)分, 均较术前[59(52,74)分]显著升高, 差异有统计学意义(分别为Z=-3.743,Z=-4.473,P<0.05);术后12个月与24个月Harris评分比较差异无统计学意义(Z=-0.730,P>0.05)。术后12个月及24个月VAS评分为3(2,3)分及2(1,3)分, 均较术前[6(5,6)分]显著降低, 差异有统计学意义(分别Z=-3.560,Z=-4.656, P<0.05);术后12个月与术后24个月VAS评分比较差异无统计学意义(Z=-1.095,P>0.05)。X线和CT检查示骨瓣愈合良好, 完成了对骨坏死区域的修复,13髋股骨头外形良好,2髋出现进一步塌陷。末次随访时无患者行关节置换手术。结论应用可降解高纯度镁金属螺钉固定旋股外侧动脉橫支大转子骨瓣, 可保证骨瓣在植入部位的愈合, 避免骨瓣移位及脱落。该方法为中青年股骨头缺血性坏死保头治疗的一种新的治疗选择。Objective To investigate the effect of a degradable high-purity magnesium screw in fixing the greater trochanter bone flap of a lateral circumflex femoral artery transverse branch in the treatment of ischemic necrosis of femoral head in young and middle-aged adults.Methods From February 2017 to February 2019,12 cases(15 hips)of young and middle-aged patients with avascular necrosis of femoral head were treated in the Department of Orthopaedic of Affiliated Zhongshan Hospital of Dalian University.The age of patients was 30-53 years old.According to Association Research Circulation Osseous(ARCO),2 hips were graded in stage II b,4 in ARCO II c,1 in ARCO III a,5 in ARCO III b,2 in ARCO III c and 1 in ARCO IV.The greater trochanter bone flap with a lateral circumferential vascular branch was used to fill the necrotic area,and fixed by a biodegradable high purity magnesium screw in the bone flap transfer.At 3,6 and 12 months postoperation,the patient came to the hospital outpatient clinic for follow-up,and then were reviewed once a year.Imaging efficacy was evaluated by comparing preoperative and postoperative imaging.The Harris score and Visual Anoalogue Scale(VAS)score were tested at 12 and 24 months after surgery.The Harris score and VAS score before and after surgery were compared by Friedman test,and P<0.05 was considered statistically significant.Results All 12 patients(15 hips)were entered in the 24-36 months of follow-up.At 12 and 24 months after surgery,Harris score was found at 87(86,92)and 90(87,92)respertively,which were both higher than that before surgery[59(52,74)]with a significant statistical difference(Z=-3.743,Z=-4.473,P<0.05).However,there was no significant difference in Harris scores between 12 and 24 months after the surgery(Z=-0.730,P>0.05).At the 12 and 24 months after surgery,VAS score was found at 3(2,3)and 2(1,3)respertively,which were both lower than that before surgery[6(5,6)]with a significant statistical difference(Z=-3.560,Z=-4.656,P<0.05).There was no statistical difference in VAS scor

关 键 词：股骨头缺血性坏死 带血管蒂大转子骨瓣 旋股外侧动脉横支 可降解高纯度镁金属螺钉 显微外科技术 

分 类 号：R687.3[医药卫生—骨科学]