Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China.
Department of Rehabilitation Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China.
Eur J Trauma Emerg Surg. 2023 Jun;49(3):1417-1424. doi: 10.1007/s00068-022-02183-8. Epub 2022 Dec 5.
To explore the clinical and radiological effects of the free vascularized iliac bone flap (FVIBF) based on deep iliac circumflex vessels for Association Research Circulation Osseous (ARCO) stage 3 traumatic osteonecrosis of the femoral head (TONFH) in young adults.
From February 2017 to August 2020, a total of 29 (29 hips) TONFH patients with ARCO stage 3 were enrolled in this study. Following the FVIBF standard procedure, the necrotic area of the femoral head was removed and a free vascularized iliac bone flap was harvested and grafted. X-rays were performed at 1, 3, 6, 9, and 12 months and every 6 months thereafter postoperatively for evaluation of the degree of femoral head collapse. The Beijing University of Chinese Medicine X-ray Evaluation Method (BUCMXE) was used to evaluate the hip preservation effects based on anteroposterior hip radiographs. Hip functions were evaluated using the Harris hip score (HHS) every 6 months and annually after 24 months, and the quality of life was assessed using the SF-36 questionnaire at 18 months postoperatively.
The mean follow-up time was 30 months (range 12-54 months). None of the patients was lost to follow-up, and the wounds healed primarily without infection and deep venous thrombosis of lower limbs. The HHS at 12 months postoperatively was significantly improved than that before surgery (83.4 ± 7.4 vs. 64.8 ± 14.1; p < 0.05). The BUCMXE radiographic score at 12 months postoperatively did not reveal any significant differences in femoral head morphology and osteonecrotic lesion, when compared to preoperation. The SF-36 questionnaire showed significant improvements in social functioning, role physical, bodily pain, and general health (p < 0.05). However, eight patients had varying degrees of femoral head collapse after surgery, and only one of them underwent THA due to pain and collapse aggravation. BUCMXE-Osteoarthritis scores showed that 23 hips were stable and six hips were advanced, among which five hips staged ARCO 3B and one staged ARCO 3A preoperatively, with statistically significant differences (p < 0.05).
Although some patients showed no improvement of radiological outcomes, most patients with severe TONFH could still benefit from the FVIBF procedure. Further studies should attempt to improve this surgical procedure and explore its long-term efficacy.
探讨基于旋髂深血管游离髂骨瓣（FVIBF）治疗青壮年 Association Research Circulation Osseous（ARCO）3 期创伤性股骨头坏死（TONFH）的临床和影像学效果。
自 2017 年 2 月至 2020 年 8 月，共纳入 29 例（29 髋）ARCO 3 期 TONFH 患者。按照 FVIBF 标准手术流程，切除股骨头坏死区，切取游离髂骨瓣并移植。术后 1、3、6、9 和 12 个月及此后每 6 个月进行 X 线检查，评估股骨头塌陷程度。采用北京中医药大学 X 射线评估方法（BUCMXE），根据前后位髋关节 X 线片评估髋关节保留效果。术后每 6 个月和 24 个月后每年采用 Harris 髋关节评分（HHS）评估髋关节功能，术后 18 个月采用 SF-36 问卷评估生活质量。
平均随访时间为 30 个月（范围 12-54 个月）。无患者失访，伤口均一期愈合，无感染及下肢深静脉血栓形成。术后 12 个月 HHS 明显高于术前（83.4±7.4 比 64.8±14.1；p<0.05）。术后 12 个月 BUCMXE 影像学评分与术前比较，股骨头形态和骨坏死病变无明显差异。SF-36 问卷显示社会功能、躯体角色、躯体疼痛和总体健康状况显著改善（p<0.05）。但术后 8 例患者出现不同程度股骨头塌陷，仅 1 例因疼痛和塌陷加重行 THA。BUCMXE-骨关节炎评分显示，23 髋稳定，6 髋进展，其中术前 5 髋 ARCO 3B 期，1 髋 ARCO 3A 期，差异有统计学意义（p<0.05）。
尽管部分患者影像学结果无改善，但大多数严重 TONFH 患者仍可从 FVIBF 中获益。进一步的研究应尝试改进该手术方法并探讨其长期疗效。
