吻合血管游离腓骨移植治疗股骨头坏死  

Free vascularized fibular grafting in treatment of femoral head osteonecrosis

作　　者：黄捷 施扬华[2,3] 谭桢 薄占东[2] Huang Jie;Shi Yanghua;Tan Zhen;Bo Zhandong(Department of Joint and Sports Medicine Surgery,Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,Guangxi Zhuang Autonomous Region,China;Department of Bone and Joint Surgery,First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi Zhuang Autonomous Region,China;Department of Joint and Sports Medicine Surgery,Tenth Affiliated Hospital of Guangxi Medical University,Qinzhou 535099,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西医科大学第二附属医院骨关节外科运动医学科,广西壮族自治区南宁市530007 [2]广西医科大学第一附属医院骨关节外科,广西壮族自治区南宁市530021 [3]广西医科大学第十附属医院关节与运动医学外科,广西壮族自治区钦州市535099

出　　处：《中国组织工程研究》2024年第21期3373-3379,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金项目(82160836),项目负责人:谭桢;广西壮族自治区卫生健康委员会自筹经费科研课题(Z-A20220604),项目负责人:黄捷。

摘　　要：背景:吻合血管游离腓骨移植是治疗股骨头坏死常用的有效保髋治疗手段,但其影响因素仍存在争议。目的:探究吻合血管游离腓骨移植治疗股骨头坏死的临床疗效,及股骨头坏死的病因分类和病变严重程度对其疗效的影响。方法:采集吻合血管游离腓骨移植治疗股骨头坏死患者63例(共73髋)的临床资料及术前、术后髋关节的临床疗效评分。按股骨头坏死的病因分类标准分为激素性、酒精性和特发性3组,参照Ficat分期标准分为FicatⅡ期、FicatⅢ期和FicatⅣ期3组,分析病因分类和病变程度对吻合血管游离腓骨移植治疗股骨头坏死临床疗效的影响。结果与结论:①吻合血管游离腓骨移植治疗股骨头坏死术后各阶段的目测类比评分均较术前明显降低(P<0.001),术后各阶段的Harris评分均较术前明显升高(P<0.001);②在激素性、酒精性和特发性3组中,除激素性组术后2,3年,其余各组术后各时点Harris评分均较术前明显升高(P<0.05);③在FicatⅡ期、FicatⅢ期和FicatⅣ期3组中,FicatⅡ期和FicatⅢ期各组术后Harris评分均较术前明显升高(P<0.05),FicatⅣ期术后Harris评分与术前比较差异无显著性意义(P>0.05);④结果提示,吻合血管游离腓骨移植治疗股骨头坏死临床疗效显著,可以减轻患者髋部疼痛和改善髋关节功能;其疗效可能不受病因的影响,而受病变严重程度的影响。BACKGROUND:Free vascularized fibular grafting is an effective hip preservation treatment for femoral head osteonecrosis,but its influencing factors are still controversial.OBJECTIVE:To explore the clinical efficacy of free vascularized fibular grafting for femoral head osteonecrosis,and the influence of the etiology and severity of femoral head osteonecrosis on its efficacy.METHODS:Clinical data and clinical efficacy scores of preoperative and postoperative hip joints in 63 patients with femoral head osteonecrosis(73 cases of hip)were enrolled.The subjects were divided into three groups by the etiological classification criteria of femoral head osteonecrosis,including glucocorticoidassociated,alcohol-associated,and idiopathic groups,and also were divided into three groups by the Ficat classification system,including Ficat II,Ficat III and Ficat IV groups.The effects of etiological classification and lesion degree on the clinical efficacy of free vascularized fibular grafting for femoral head osteonecrosis were analyzed.RESULTS AND CONCLUSION:(1)The visual analog scale scores in all periods after free vascularized fibular grafting for femoral head osteonecrosis were significantly decreased compared with preoperative data(P<0.001),and Harris scores were significantly increased compared with preoperative data(P<0.001).(2)In the glucocorticoid-associated,alcohol-associated,and idiopathic groups,except the glucocorticoid-associated group,postoperative Harris scores were significantly increased 2 and 3 years after surgery in other groups compared with preoperative data(P<0.05).(3)In the three groups of Ficat II,Ficat III,and Ficat IV,the postoperative Harris scores of Ficat II and Ficat III groups were significantly increased compared with preoperative data(P<0.05),while the difference was not significant in the Ficat IV group between the preoperative and postoperative data(P>0.05).(4)These results indicate that the clinical effect of free vascularized fibular grafting for the femoral head osteonecrosis is significant,

关 键 词：股骨头坏死 保髋治疗 游离腓骨移植 病因分类 Ficat分期 临床疗效 力学特性 生物学特性 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687