带血管腓骨移植治疗塌陷前期骨坏死：是否可能长期髋关节保护？
The vascularized fibular graft in precollapse osteonecrosis: is long-term hip preservation possible?
机构信息
Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Orange Zone, Durham, NC 27710, USA.
出版信息
Clin Orthop Relat Res. 2012 Oct;470(10):2819-26. doi: 10.1007/s11999-012-2429-x. Epub 2012 Jun 26.
BACKGROUND
Osteonecrosis of the femoral head (ONFH) is a debilitating condition affecting primarily young patients. Free vascularized fibular grafting (FVFG) may provide a durable means to preserve the femoral head. When used in the precollapse stages of ONFH, this treatment may alter the course of disease.
QUESTIONS/PURPOSES: We asked: (1) In what percentage of patients does FVFG preserve the femoral head beyond 10 years? (2) When long-term preservation is not achieved, what is the duration of femoral head preservation? (3) Do demographic or etiologic factors predict FVFG survivorship? (4) What long-term improvements in function and activity can be anticipated?
METHODS
We retrospectively reviewed 61 patients (65 hips) who underwent FVFG for precollapse ONFH. We calculated graft survivorship, SF-12 scores, activity levels, and Harris hip scores. Minimum followup was 10.5 years (mean, 14.4 years; range, 10.5-26 years). Results Forty-nine of 65 hips (75%) had surviving FVFG for at least 10 years. At last followup, 39 of 65 hips (60%) had surviving FVFG, with a mean graft survival time of 15 years (range, 10.5-26.1 years). Twenty-six of the 65 hips with FVFG (40%) underwent conversion to THA at a mean of 8 years postoperatively. Demographic factors, lesion size, additional procedures, and low preoperative function were not associated with changes in graft survivorship. Pain and function were similar in patients with surviving FVFG and patients who had conversion to THA. Patients with surviving FVFG were more likely to engage in impact sports or active events than were patients who had conversion to THA.
CONCLUSIONS
When patients with precollapse ONFH undergo FVFG, the majority have preservation of the hip lasting for greater than 10 years with low levels of pain and reasonable function. In patients who ultimately undergo conversion surgery to THA, the mean duration of hip preservation before conversion is 8 years. We continue to use FVFG for treating patients younger than 50 years with symptomatic, precollapse ONFH.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See Instructions to Authors for a complete description of levels of evidence.
背景
股骨头坏死（ONFH）是一种主要影响年轻患者的致残性疾病。游离腓骨血管化移植（FVFG）可能是一种持久保留股骨头的方法。当用于 ONFH 的塌陷前阶段时，这种治疗方法可能会改变疾病的进程。
问题/目的：我们提出了以下问题：（1）FVFG 在超过 10 年的时间内保留股骨头的百分比是多少？（2）当不能长期保留时，股骨头保留的时间是多长？（3）人口统计学或病因因素是否可以预测 FVFG 的存活率？（4）可以预期哪些长期功能和活动的改善？
方法
我们回顾性分析了 61 例（65 髋）接受 FVFG 治疗的塌陷前 ONFH 患者。我们计算了移植物存活率、SF-12 评分、活动水平和 Harris 髋关节评分。随访时间至少为 10.5 年（平均 14.4 年；范围 10.5-26 年）。结果：65 髋中有 49 髋（75%）的 FVFG 至少存活 10 年。末次随访时，65 髋中有 39 髋（60%）有存活的 FVFG，平均移植物存活时间为 15 年（范围 10.5-26.1 年）。65 髋中有 26 髋（40%）在术后平均 8 年内改行全髋关节置换术（THA）。人口统计学因素、病变大小、附加手术和术前功能较低与移植物存活率的变化无关。有存活 FVFG 的患者的疼痛和功能与行 THA 转换的患者相似。有存活 FVFG 的患者比行 THA 转换的患者更有可能参加撞击性运动或积极活动。
结论
当患有塌陷前 ONFH 的患者接受 FVFG 治疗时，大多数患者的髋关节可保留 10 年以上，疼痛程度较低，功能合理。在最终行 THA 转换手术的患者中，转换前髋关节的平均保留时间为 8 年。我们继续使用 FVFG 治疗 50 岁以下有症状、塌陷前 ONFH 的患者。
证据水平
IV 级，治疗性研究。有关证据水平的完整描述，请参见作者说明。
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