Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China.
Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China.
Biomed Res Int. 2020 Jun 14;2020:6493585. doi: 10.1155/2020/6493585. eCollection 2020.
The aim of this study was to report the histopathology of failed free vascularized fibular grafting (FVFG) for osteonecrosis of the femoral head (ONFH) after a mean follow-up of 11.5 years (ranged from 10.6 to 14.2 years).
Six hips of 5 patients with a history of steroid use, aged 34-67 years, were in stage II of ONFH as classified by the Ficat and Arlet classification at the time of FVFG treatment. Grafting failure led to osteoarthritis of the hip joint during a mean of 11.5 years of follow-up. Femoral head specimens were first evaluated macroscopically. Bone specimens were sectioned into long strips, divided into necrotic, transitional, and healthy zones, and then prepared for nondecalcified and decalcified histopathological examination using hematoxylin and eosin (HE) staining, Goldner's trichrome staining, and immunofluorescence (IF) staining.
Femoral head articular cartilage surfaces appeared thin, opaque, and partially cartilaginous missing, with gradual collapse detected in weight-bearing areas. The interface with the fibular graft showed well union, with no obvious gaps between graft and host bone, as observed macroscopically. The necrotic area was filled with fibular graft, cancellous bone, and cartilaginous or soft tissue invasion. Histopathology results revealed well integration between fibular graft and host bone, with thickened trabecular bone. Gaps occurred in transitional and healthy zones. In the necrotic zone, cartilaginous or soft tissue invasion occurred, while thin or missing articular cartilage exposed subchondral bone to hip joint surfaces. By IF counterstaining with CD-31 and -SMA, blood vessel transplanted during fibular grafting could be clearly observed along the graft from healthy to necrotic zones. In the necrotic zone, blood vessels presented obviously and spread into the surrounding area of the graft tip.
After FVFG procedure with a mean follow-up of 11.5 years, fibular grafts retained their integrity as viable, vascularized, cortical bone that fused well with host bone and formed thickened trabecular bone surrounding the surface of the graft. However, the revascularization of FVFG's blood vessels spreading from the tip of the fibular graft into subchondral area of necrotic lesion did not improve significantly in these failure cases. The local necrotic lesion failed to be repaired as healthy trabecular bone to buttress articular surface and was occupied by soft tissues.
本研究旨在报道游离腓骨移植（FVFG）治疗股骨头坏死（ONFH）后失败的组织病理学表现，平均随访时间为 11.5 年（10.6-14.2 年）。
5 例患者 6 髋，均有类固醇使用史，年龄 34-67 岁，FVFG 治疗时按 Ficat 和 Arlet 分期均处于 ONFH Ⅱ期。平均 11.5 年随访后，移植失败导致髋关节骨关节炎。首先对股骨头标本进行大体评估。将骨标本切成长条，分为坏死区、过渡区和正常区，然后进行非脱钙和脱钙组织病理学检查，使用苏木精和伊红（HE）染色、Goldner 三色染色和免疫荧光（IF）染色。
股骨头关节软骨表面变薄、不透明，部分软骨缺失，负重区逐渐塌陷。从大体上观察到，与腓骨移植物的界面愈合良好，移植物与宿主骨之间无明显间隙。坏死区充满腓骨移植物、松质骨和软骨或软组织浸润。组织病理学结果显示，腓骨移植物与宿主骨整合良好，骨小梁增厚。在过渡区和正常区出现间隙。在坏死区，发生软骨或软组织浸润，而薄的或缺失的关节软骨使软骨下骨暴露于髋关节表面。通过 IF 用 CD-31 和-SMA 对移植物进行复染，可以清楚地观察到沿移植物从正常区到坏死区的血管移植。在坏死区，血管明显出现并扩散到移植物尖端周围区域。
FVFG 手术后平均随访 11.5 年，腓骨移植物保持完整，为有活力的、血管化的皮质骨，与宿主骨融合良好，并在移植物表面形成增厚的骨小梁。然而，在这些失败病例中，从腓骨移植物尖端向坏死病变的软骨下区域扩散的 FVFG 血管的再血管化并没有显著改善。局部坏死病变未能修复为健康的小梁骨来支撑关节表面，而是被软组织占据。
