Zhao Dewei, Xie Hui, Xu Yongqing, Wang Yisheng, Yu Aixi, Liu Youwen, Wang Aimin, He Wei, Wang Xiuli, Li Zirong, Sun Wei, Tian Simiao, Wang Benjie, Liu Baoyi
Orthopedic Department, Affiliated Zhongshan Hospital of Dalian University, No 6 Jiefang Street, Zhongshan District, Dalian, China.
Orthopedic Department, Kunming General Hospital of the Chengdu Military Area Command, Yunnan Province, China.
Microsurgery. 2017 Nov;37(8):896-901. doi: 10.1002/micr.30195. Epub 2017 Aug 14.
Osteonecrosis of the femoral head (ONFH) often affects young active adults and leads to destruction of the hip joint and disabling arthritis. Several procedures have been developed to arrest the progress of osteonecrosis and postpone the procedure of total hip replacement especially in young patients. The aim of this multicenter study was to analyze the results of the use of the vascularized iliac bone flap transfer for management of ONFH.
From January 1985 to December 2012, a total of 2190 patients (2690 hips) with the mean age of 43.15 years (ranging from 18 to 65 years) underwent hip-preserving surgery with the pedilced iliac bone flap transfer for management of ONFH with Ficat and Arlet stage II-IV in 8 hospitals. There were 1733 hips in stage II, 776 hips in stage III, and 181 hips in stage IV preoperatively. The complications were recorded. The outcomes were evaluated by radiograph, the Harris hip-scoring system (HHS).
Postoperative complications occurred in 128 patients (5.84%). Among them, 25 patients had deep venous thromboses, 16 patients had sensory deficits, 40 patients had superficial infection and hematoma, and 47 patients had wound dehiscence. A total of 1912 patients (2179 hips) were followed up with a median time of 12 years (ranging from 5 to 25 years). There were 1787 hips with no radiographic osteonecrotic progress during follow-up, while osteonecrosis progress was observed in 186 hips with stage II (13.1%), 170 hips with stage III (25.6%) and 36 hips with stage IV (36.4%; P < .001). Two hundred fifteen hips (9.87%) in 203 patients were converted to THA during follow-up, including 19 hips with stage II (1.34%), 162 hips with stage III (24.4%), and 34 hips with stage IV (34.3%).The mean HHS at the end of follow-up was significantly improved when compared to preoperative mean HHS (83.63 ± 5.03 vs. 66.54 ± 6.05, P < .001).
In this evaluation of a large series of cases, the vascularized iliac bone flap transfer showed good results for arresting the osteonecrosis progress and improving the hip function of patients with pre-collapse stages of ONFH.
股骨头坏死（ONFH）常影响年轻的活跃成年人，导致髋关节破坏和致残性关节炎。已经开发了几种手术来阻止骨坏死的进展并推迟全髋关节置换手术，尤其是在年轻患者中。这项多中心研究的目的是分析使用带血管蒂髂骨瓣转移治疗ONFH的结果。
从1985年1月至2012年12月，8家医院共2190例（2690髋）平均年龄43.15岁（18至65岁）的患者接受了保留髋关节手术，采用带蒂髂骨瓣转移治疗Ficat和Arlet II-IV期的ONFH。术前II期有1733髋，III期有776髋，IV期有181髋。记录并发症情况。通过X线片、Harris髋关节评分系统（HHS）评估结果。
128例患者（5.84%）发生术后并发症。其中，25例发生深静脉血栓形成，16例有感觉障碍，40例有浅表感染和血肿，47例有伤口裂开。共1912例患者（2179髋）得到随访，中位随访时间为12年（5至25年）。随访期间1787髋无影像学骨坏死进展，而II期186髋（13.1%）、III期170髋（25.6%）和IV期36髋（36.4%）观察到骨坏死进展（P＜0.001）。随访期间203例患者中的215髋（9髋（9.87%）转为全髋关节置换，包括II期19髋（1.34%）、III期162髋（24.4%）和IV期34髋（34.3%）。与术前平均HHS相比，随访结束时的平均HHS显著改善（83.63±5.03对66.54±6.05，P＜0.001）。
在对大量病例的这项评估中，带血管蒂髂骨瓣转移在阻止ONFH塌陷前期患者的骨坏死进展和改善髋关节功能方面显示出良好效果。
