吻合血管游离腓骨移植治疗股骨头坏死的临床疗效

The Curetive Effect of Vascularized Free Fibula Transplantation in Patients with Avascular Necrosis of Femoral Head

目的评价吻合血管游离腓骨移植治疗股骨头坏死的临床疗效。方法收集2001年5月～2004年5月采用吻合血管游离腓骨移植治疗股骨头坏死50例(75髋),FicatⅠ期20髋,FicatⅡ期20髋,FicatⅢ期20髋,FicatⅣ期15髋。结果本组优35髋(46.7%),良13髋(17.3%),可18髋(24.0%),差9髋(12.0%),优良率为64.0%;Ⅰ期优良率(100.0%)明显高于Ⅲ期(40.0%)和Ⅳ期(13.3%)(P<0.05或0.01);手术前后髋关节的疼痛、功能、关节活动度及X线表现总分有显著性差异(P<0.05);X线片显示,60髋(80.0%)的股骨头坏死有不同程度改善,13髋(17.3%)无明显变化,2髋(2.7%)恶化;Ⅰ期平均为96.5分,Ⅱ期平均为94.4分,Ⅲ期为86.0分,Ⅳ期为74.1分,均较术前明显提高(χ2=6.87,P<0.05)。结论植入的带血管游离腓骨可增加股骨头部的血供和支撑作用,防止股骨头进一步塌陷。

Objective evaluation of curetive effect of Vascularized free fibula transplantation in patients with avascular necrosis of femoral head. Methods 50 cases （75 hip）of avascular necrosis of femoral head,Ficat Ⅰ period of 20 hip,Ficat Ⅱ period of 20 hip,Ficat Ⅲ period of 20 hip, Ficat Ⅳ period of 15 hip. Results The excellent of hip 30（46.7% ）,fine of hip-13 （17.3%）, appeove of 18 hips （24.0%）,poor of 9 poor hip （ 12.0% ）, excellent rate of 48 hip （64.0%） ; Ⅰ period excellent rate （ 100.0% ） was significantly higher than the stage Ⅲ （40.0%） and Ⅲ （13.3% ）（P 〈 0.05 or 0.01 ）;the surgery before and after the pain, function and range of motion and X-ray total there were significant differences（P 〈 0.05 ）;X-ray display：60 hip （80.0%） of the femoral head necrosis have improved to varying degrees, 13 hips （17.3%） no signilicant changes in two hip（2.7 percent） worsened; Ⅰ period an average of 96.5%, Ⅱ period An average of 94.4%, Ⅲ period of 86.0%, Ⅳ period of 74.1%, compared with significantly improved （ x ^2= 6.87, P 〈 0.05 ）. Conclusion the implantation of vascular free fibula increase the femoral bead blood supply and supporting, the femoral head to prevent further collapse.