摘要
目的 探讨吻合血管的腓骨移植治疗股骨头坏死效果及其影响因素。方法对接受吻合血管腓骨移植治疗的95例（131髋）股骨头坏死病例进行前瞻性随访。调查评估术前的发病诱因、坏死单双侧、术前坏死范围、部位、塌陷程度；术前及末次随访时Harris评分；术中腓骨植入的位置及腓骨顶端离头下软骨的距离；末次随访时股骨头修复状况，外形塌陷进展及人工关节置换等，并进行统计学分析。结果末次随访时x线显示，88．44％（108例）病灶缩小、77．86％（102例）坏死界面出现较好修复效应、90．07％（118例）植入腓骨出现明显成骨效应。78．6％（103例）未出现塌陷或塌陷未进展，术前与末次随访时Harris评分比较，后者（85．79±15．19分）显著高于前者（76．10＋20．90分）（P〈0．05），有85％（111／131例）患髋症状改善明显。多因素Logistic回归分析显示，坏死范围大、术前（Steinberg Ⅲ期）坏死病程是导致术后病程进展的独立危险因素，相对其他几种发病诱因而言，激素性坏死效果较好，为保护因素。结论吻合血管的游离腓骨移植治疗股骨头坏死有确切的疗效。影响术后疗效的因素主要与术前病程、坏死范围及发病诱因等有关。
Objective To evaluate its effect on free vascularized fibular flap grafting for avascular necrosis of the femoral head and explore factors associated with its effect. Methods Ninety five （131 hips） with vascular necrosis of the femorol head were followed up clinically, in which all the patients were treated with free vascularized fibular grafting in our hospital. Some factors including the etiologies was investigated, unilateral or bilateral hips , fibular grafting location, its end distance from the subcartilage of the femoral head in operation, and Harris hip scores of pre- and postoperative, preoperative radiolographs （lesion size and location of the necrotic lesion, the presence or absence of collapse and the extent to collapse）, postoperative radiolographs （its improvement and collapse state of the femoral head） and number of conversions to total hip arthroplasty. Then data were analysized statistically. Results At the latest follow-up, X-ray showed that the size of AVN was reduced in 88.44% （108 hips）, the interface of necrosis appeared good repair effect in 77.86%（102 hips）AVN and the articular surfaces didn＇t collapsed or didn＇t collapsed for progression in 78.6% （103/151 hips） AVN and 2.28%（3 hips） was replaced for THA. The Harris hip score of postoperative （85.79±15.19 points） was superior to that of preoperative （76.10 ± 20.90 points） （P 〈 0.05）, 85%（111/ 131 ）hips showed significant improvement in their clinical symptoms. The larger lesion size, staging of preoperative （Steinberg Ⅲ stage） were independently risk factors associated with postoperative deterioration, but the steroid-induced was the protective factor related to the others etiologies. Conclusion The effect of free vascularized fibular grafting for AVN is reliable and advocated. Necrosis lesion size and staging in preoperative and etiologies are the risk factors associated with postoperative progression.
出处
《中华显微外科杂志》
CSCD
北大核心
2009年第4期267-270,共4页
Chinese Journal of Microsurgery
基金
基金项目：上海市医学领军人才计划（LJ06053）
关键词
股骨头坏死
腓骨
移植
Avascular necrosis of the femoral head
Fibular
Transplantation
