改良带血管游离腓骨移植治疗股骨头坏死的手术技术

[Surgical technique of modified free vascularized fibular grafting for treatment of osteonecrosis of the femoral head].

作者信息

Zhang Changqing, Zeng Bingfang, Sui Shuping, Yuan Ting, Xu Zhengyu, Shao Lei, Li Hongshuai, Zhang Kaigang

机构信息

Department of Orthopedics, Shanghai No. 6 People's Hospital, Shanghai Jiaotong University, Shanghai, 200233, P. R. China

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2005 Sep;19(9):692-6.

PMID:16206753

Abstract

OBJECTIVE

To evaluate the surgical technique, clinical results, and the complications of modified free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head.

METHODS

From October 2000 to August 2004, 124 patients (139 hips) with osteonecrosis of the femoral head were treated with modified free vascularized fibular grafting. There were 83 males(93 hips) and 41 females (46 hips), with a mean age of 36.4 years (16-57). The disease was caused by trauma in 49 cases(54 hips), use of steroids in 29 cases (32 hips), consumption of alcohol in 19 cases (21 hips) and idiopathic condition in 27 cases (32 hips). Of 139 hips, 50 were classified as stage II ; 71 as stage II, 18 as stage IV according to Steinberg system; the Harris hip scores were 79.3, 69.3 and 58.4, respectively. At the operation, modified technique of the fibular osteotomy was adopted. A front-hip operative approach was designed and a modified technique of removing the necrotic bone in femoral head was applied. During operation, the duration of operation, the bleeding volume, and the length of incisions were recorded. The follow-up items included the results of X-ray examination, the Harris score of the hip, and the evaluation of the complications.

RESULTS

The duration of the fibular osteotomy was 10 to 30 min (15 min on average). The duration of the total operation was 80 to 120 min (90 min on average). The length of incision at the hip was 6 to 12 cm (8 cm on average). The bleeding volume was 100 to 300 ml (200 ml on average). The average hospitalization days was 7 days. After operation, Harris hip scores in most cases were improved. According to postoperative X-ray, 62 hips (79.5%) were improved to different extents and 14 hips (17.9%) had no significant changes. Deterioration occurred in 2 hips (2.6%).

CONCLUSION

The modified free vascularized fibular grafting has lots of virtues, such as less bleeding volume, more clear anatomic structure, more convenience for operation, less damage, less complications, and better results of function recovery. It is an effective method for treating osteonecrosis of the femoral head.

摘要

目的

评估改良带血管游离腓骨移植术治疗股骨头坏死的手术技术、临床疗效及并发症。

方法

2000年10月至2004年8月，采用改良带血管游离腓骨移植术治疗124例（139髋）股骨头坏死患者。其中男性83例（93髋），女性41例（46髋），平均年龄36.4岁（16 - 57岁）。病因包括创伤49例（54髋）、使用类固醇29例（32髋）、酗酒19例（21髋）、特发性27例（32髋）。根据Steinberg分期系统，139髋中，II期50髋，III期71髋，IV期18髋；Harris髋关节评分分别为79.3分、69.3分和58.4分。手术采用改良腓骨截骨技术，设计髋关节前方手术入路，应用改良股骨头坏死骨清除技术。术中记录手术时间、出血量及切口长度。随访项目包括X线检查结果、髋关节Harris评分及并发症评估。

结果

腓骨截骨时间为10 - 30分钟（平均15分钟）。总手术时间为80 - 120分钟（平均90分钟）。髋关节切口长度为6 - 12厘米（平均8厘米）。出血量为100 - 300毫升（平均200毫升）。平均住院天数为7天。术后多数病例Harris髋关节评分改善。术后X线显示，62髋（79.5%）有不同程度改善，14髋（17.9%）无明显变化。2髋（2.6%）病情恶化。