髋关节滑膜炎对带血管蒂游离腓骨移植长期保髋效果的影响  

Impact of hip synovitis on the long-term outcomes of free vascularized fibular grafting for osteonecrosis of femoral head

作　　者：朱道宇 付凯[1] 何海燕[1] 蔡倩莹 彭昊 陈圣宝[1] 殷吉旻[1] 罗鹏波[1] 金东旭[1] 张长青[1] 高悠水[1] ZHU Daoyu;FU Kai;HE Haiyan;CAI Qianying;PENG Hao;CHEN Shengbao;YIN Jimin;LUO Pengbo;JIN Dongxu;ZHANG Changqing;GAO Youshui(Department of Orthopedic Surgery,Shanghai Sixth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院骨科,上海200233

出　　处：《上海交通大学学报(医学版)》2025年第3期357-364,共8页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海交通大学医学院“双百人”项目(20221818)。

摘　　要：目的·观察髋关节滑膜炎对带血管蒂游离腓骨移植长期保髋效果的影响。方法·纳入2001年10月—2013年12月于上海交通大学医学院附属第六人民医院诊断为股骨头坏死并接受带血管蒂游离腓骨移植手术的患者370例(556个髋关节),通过磁共振成像(magnetic resonance imaging,MRI)扫描评估患者术前滑膜炎严重程度。滑膜炎分级基于HIMRISS(Hip Inflammation MRI Scoring System)评分,将病例分为无滑膜炎组、中度滑膜炎组和重度滑膜炎组。术后平均随访时间为90.5个月(5~215个月),随访期间收集患者Harris关节评分和髋关节置换情况,计算保髋失败率(定义为末次随访Harris评分<80或进行关节置换)。采用多因素Cox回归分析比较不同程度的髋关节滑膜炎对患者长期预后的影响。结果·无滑膜炎组和中度滑膜炎组患者行带血管蒂游离腓骨手术后,保髋失败率分别为28.0%和28.5%,重度髋关节滑膜炎组为60.4%。多因素Cox回归分析显示,校正患者年龄、性别、文化程度、婚姻、股骨头坏死类型、股骨头坏死受累侧、吸烟史、Harris评分基线水平和其他髋关节MRI指标(塌陷、骨髓水肿及退变)等基线协变量后,重度滑膜炎是股骨头坏死患者带血管蒂游离腓骨移植术后不良预后的独立危险因素(HR=2.06,95%CI 1.21~3.53)。结论·对于伴有髋关节滑膜炎的股骨头坏死患者,重度滑膜炎显著增高了带血管蒂游离腓骨移植手术后的保髋失败率;在手术决策中,应考虑滑膜炎的严重程度。Objective·To observe the impact of hip synovitis on the long-term outcomes of free vascularized fibular grafting(FVFG)for osteonecrosis of femoral head(ONFH).Methods·Between October 2001 and December 2013,370 patients diagnosed with ONFH(556 hips)underwent FVFG.Preoperative synovitis was assessed using magnetic resonance imaging(MRI)and quantified with the Hip Inflammation MRI Scoring System(HIMRISS).Patients were divided into no synovitis group,moderate synovitis group,and severe synovitis group.Harris hip scores and the incidence of total hip arthroplasty were collected with an average follow-up duration of 90.5 months(range:5‒215 months).Hip survival failure(defined as a Harris hip score lower than 80 at the final follow-up or the occurrence of total hip arthroplasty)was calculated.Multivariable Cox regression analysis was adopted to compare the influence of different degrees of synovial inflammation on long-term prognosis.Results·The proportion of hip survival failure was 28.0%in patients without synovitis and 28.5%in those with moderate synovitis,whereas it was significantly higher(60.4%)in patients with severe synovitis.The results of multivariable Cox regression analysis showed that severe synovitis was an independent risk factor for poor prognosis(HR 2.06,95%CI 1.21‒3.53)after adjusting for age,gender,education level,marital status,ONFH type,affected side of ONFH,smoking history,baseline Harris hip score and other hip MRI-based covariates(collapse,bone marrow edema,and degeneration).Conclusion·Severe synovitis in patients with ONFH significantly increases the failure rate of hip preservation after FVFG,and the severity of synovitis should be considered in surgical decision-making.

关 键 词：股骨头坏死 带血管蒂游离腓骨移植 滑膜炎 

分 类 号：R684.3[医药卫生—骨科学]