[游离带血管腓骨移植治疗股骨头坏死的技术总结及改良器械]

[Technical summary and modified instruments of free vascularized fibular grafting for osteonecrosis of femoral head].

作者信息

Dong Shuai, Cai Xiyu, Zhu Zhengwei

机构信息

Department of Orthopaedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China.

Department of Orthopaedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052,

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Feb 15;31(2):129-133. doi: 10.7507/1002-1892.201608131.

DOI:10.7507/1002-1892.201608131

PMID:29786240

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8458146/

Abstract

OBJECTIVE

To summarize retrospectively the clinical technology of repairing osteonecrosis of femoral head (ONFH) by free vascularized fibular grafting (FVFG), and the value of modified instruments in operation.

METHODS

Between March 2011 and January 2013, 35 patients with ONFH (47 hips) who underwent FVFG with modified instruments. There were 24 males (32 hips) and 11 females (15 hips), aged 34 years on average (range, 22-43 years). The unilateral hip was involved in 23 cases and the bilateral hips in 12 cases. The disease duration ranged from 5 to 9 months (mean, 7 months). Based on etiology, 25 hips were classified as alcohol ONFH, 12 hips as corticosteroids ONFH, 3 hips as trauma ONFH, and 7 hips as idiopathic ONFH. According to the Association Research Circulation Osseous(ARCO) stage, 3 hips were rated as stage I, 39 hips as stage II, and 5 hips as stage III on the X-ray films. The preoperative Harris score was 58.2±6.1.

RESULTS

The time to get fibula was 15-35 minutes (mean, 25 minutes). The operation time was 90-200 minutes (mean, 130 minutes), and the blood loss during operation was 150-500 mL (mean, 270 mL). All the patients achieved primary healing of incision, without complication of infection or deep vein thrombosis. All 35 patients were followed up 12-42 months, with an average of 28 months. The Harris score at final follow-up was 87.3±5.7, showing significant difference when compared with preoperative score ( =102.038, =0.000). Radiographic results at final follow-up showed good position of fibula; and necrosis was improved in 9 hips, had no changes in 36 hips, and aggravated in 2 hips.

CONCLUSION

FVFG for ONFH can improve hip function effectively, and modified instruments can improve operation efficiency.

摘要

目的

回顾性总结游离带血管腓骨移植（FVFG）修复股骨头坏死（ONFH）的临床技术及改良器械在手术中的应用价值。

方法

2011年3月至2013年1月，35例ONFH患者（47髋）采用改良器械行FVFG手术。其中男性24例（32髋），女性11例（15髋），平均年龄34岁（22 - 43岁）。单侧髋关节受累23例，双侧髋关节受累12例。病程5至9个月（平均7个月）。根据病因，酒精性ONFH 25髋，激素性ONFH 12髋，创伤性ONFH 3髋，特发性ONFH 7髋。根据国际骨循环研究学会（ARCO）分期，X线片显示I期3髋，II期39髋，III期5髋。术前Harris评分为58.2±6.1。

结果

获取腓骨时间为15 - 35分钟（平均25分钟）。手术时间为90 - 200分钟（平均130分钟），术中出血量为150 - 500毫升（平均270毫升）。所有患者切口均一期愈合，无感染及深静脉血栓形成并发症。35例患者均获随访，随访时间12 - 42个月，平均28个月。末次随访时Harris评分为87.3±5.7，与术前评分比较差异有统计学意义（ =102.038， =0.000）。末次随访时影像学结果显示腓骨位置良好；9髋坏死改善，36髋无变化，2髋加重。