吻合血管腓骨瓣治疗股骨头缺血性坏死的疗效观察  

Clinical experiences of free vascularized fibular grafting for the treatment of osteonecrosis of femoral head

作　　者：魏建伟[1] 蒋颖良 李开虎 刘立宏[1] 张理军 陶世斌 熊珏铭 任珍锐 董忠根[1] Wei Jianwei;Jiang Yingliang;Li Kaihu;Liu Lihong;Zhang Lijun;Tao Shibin;Xiong Yuming;Ren Zenrui;Dong Zhonggen(Department of Orthopedics,Second Xiangya Hospital of Central South University,Changsha 410012,China)

机构地区：[1]中南大学湘雅二医院骨科,长沙410011

出　　处：《骨科临床与研究杂志》2024年第2期72-77,共6页Journal Of Clinical Orthopedics And Research

基　　金：湖南省自然科学基金面上项目(2022JJ30852)。

摘　　要：目的分析吻合血管腓骨瓣治疗股骨头缺血性坏死(ONFH)的临床疗效。方法2016年3月至2022年9月中南大学湘雅二医院骨科收治股骨头缺血性坏死患者23例(26髋),按照国际骨循环协会(ARCO)分期:Ⅱ期6例、ⅢA期15例、ⅢB期5例。术前髋关节Harris评分为(60.9±9.0)分。所有患者均采用吻合血管的腓骨瓣进行治疗,腓骨瓣近端距离腓骨头约10 cm,腓骨瓣长度约7 cm。除少数早期病例外,其余病例术中均未使用植骨材料或内固定装置。术后定期随访,进行影像学检查评估腓骨瓣愈合及股骨头坏死区域变化情况,评价髋关节功能。结果术后无伤口感染、下肢深静脉血栓形成等并发症。患者均获得随访,随访时间13~93个月。末次随访患髋Harris评分为(90.9±4.5)分,与术前相比差异有统计学意义(P=0.000)。影像学未见腓骨瓣移位,均愈合良好,无坏死区域进展。结论吻合血管的腓骨瓣治疗股骨头缺血性坏死能够有效改善患者髋关节功能。改良的手术方法和技术,使得腓骨瓣的切取、植入、固定等更加精准、有效。Objective To evaluate the clinical efficacy of free vascularized fibular grafting(FVFG)for osteonecrosis of femoral head(ONFH).Methods From March 2016 to September 2022,23 patients(26 hips)with ONFH were admitted.There were 6 patients with stage Ⅱ,15 patients with stage ⅢA,and 5 patients with stage ⅢB according to the international association research circulation osseous(ARCO).The preoperative Harris score was 60.9±9.0.All patients were treated with FVFG.The proximal end of the fibular flap was about 10 cm from the fibular head and the length of the fibular flap was about 7 cm.For most cases,no bone grafts or internal fixation were used during the operation.Regular postoperative follow-up was performed to assess the union of the fibula flap and the development of ONFH,and to test the hip function.The comparison indicated a statistically significant difference between two groups(P<0.05).Results There were no postoperative complications such as wound infection and deep venous thrombosis.All patients were followed up for 13 to 93 months,and the hip Harris score at the last follow-up was 90.9±4.5.It was statistically significant improved,comparing with the preoperative Harris score(P=0.000).No displacement of the fibula flap was found on the postoperative X-rays and all were healed well.No cases of ONFH progression were found.Conclusions The treatment of ONFH with FVFG can effectively improve the hip joint function of the patients.The fibula flap will be more accurate and effective by improving surgical experiences and skills of cutting and making implantation and fixation.

关 键 词：股骨头坏死 动静脉吻合 吻合血管的游离腓骨移植 

分 类 号：R683.42[医药卫生—骨科学]