Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
J Bone Joint Surg Am. 2019 Jul 17;101(14):1294-1300. doi: 10.2106/JBJS.18.01132.
The purpose of this study was to evaluate the long-term efficacy and prognostic factors predicting success of revision surgery with free vascularized fibular grafting (FVFG) for treatment of femoral neck nonunion.
We prospectively enrolled patients who underwent revision surgery with FVFG between January 2001 and January 2013 in a tertiary hospital in China. A total of 98 patients with a minimum 5-year follow-up were included for analysis. The criteria for FVFG failure were conversion to hip arthroplasty, recommendation for a hip arthroplasty, or a Harris hip score of <80 points. Demographic information, the preoperative neck shortening ratio (NSR), the fixation method, and postoperative radiographic parameters including the postoperative NSR and neck-shaft angle (NSA) were recorded for prognostic analysis.
At an average of 9.8 ± 3.5 years (range, 3 to 17 years) postoperatively, the overall success rate of this surgical procedure was 77% (75 of 98). The success and failure groups had no significant differences in age, fixation method, interval between initial fixation and revision surgery, or postoperative NSA. The success group had a significantly higher NSR than the failure group both preoperatively (77.8% versus 62.4%, p < 0.001) and postoperatively (87.6% versus 78.4%, p = 0.001). The receiver operating characteristic (ROC) curve analysis revealed an optimal cutoff for preoperative NSR of 60% to predict the outcome. Patients with a preoperative NSR of >60% had a success rate of 91% (68 of 75).
Revision surgery with FVFG and internal fixation is an effective and important option for treating nonunion of the femoral neck in young patients without severe preoperative shortening and neck resorption (preoperative NSR of >60%).
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在评估游离腓骨血管化移植（FVFG）翻修术治疗股骨颈骨不连的长期疗效和预测成功的预后因素。
我们前瞻性地纳入了 2001 年 1 月至 2013 年 1 月在中国一家三级医院接受 FVFG 翻修手术的患者。共有 98 例患者获得了至少 5 年的随访，纳入分析。FVFG 失败的标准为转换为髋关节置换术、建议行髋关节置换术或 Harris 髋关节评分<80 分。记录了人口统计学信息、术前颈缩短比（NSR）、固定方法以及术后包括术后 NSR 和颈干角（NSA）在内的影像学参数，用于预后分析。
术后平均 9.8±3.5 年（范围 3 至 17 年），该手术的总体成功率为 77%（98 例中有 75 例）。成功组和失败组在年龄、固定方法、初次固定与翻修手术的间隔时间以及术后 NSA 方面无显著差异。成功组术前 NSR（77.8%比 62.4%，p<0.001）和术后 NSR（87.6%比 78.4%，p=0.001）均显著高于失败组。受试者工作特征（ROC）曲线分析显示，术前 NSR 的最佳截断值为 60%，可预测结局。术前 NSR>60%的患者成功率为 91%（68/75）。
FVFG 联合内固定的翻修术是治疗年轻患者股骨颈骨不连的有效且重要的选择，前提是术前缩短和颈吸收不严重（术前 NSR>60%）。
治疗性 IV 级。欲了解完整的证据水平说明，请参见作者须知。
