带旋髂深血管蒂髂骨转位移植治疗股骨头坏死

Treatment of Osteonecrosis of the Femoral Head Using Vascular Pedicle Bone Graft

目的探讨采用改进后手术器械带血管蒂髂骨移植治疗股骨头坏死的长期随访效果,为股骨头坏死治疗提供一种有效的手术方法。方法自1983年11月至2006年5月,采用沿股骨颈纵轴开窗减压,带旋髂深血管蒂髂骨转位移植治疗股骨头坏死。术后仍有部分病例股骨头出现二次塌陷。因此,特殊设计了手术器械,沿股骨颈前下方向股骨头外上方开窗减压植骨。结果患者髋关节疼痛均明显缓解或消失,术后股骨头未出现二次塌陷,关节功能恢复。平均随访13.6年(10～18年)。手术前与随访时髋关节功能评价,采用髋关节创伤后的功能评分(Sanders),手术前平均35.6分,手术后增加到末次随访时的52.8分,总分明显增加,优良率94.1%。结论手术器械及术式改进后,移植骨支撑股骨头负重区,更加符合生物力学要求,能有效防止股骨头塌陷。

Objective To analyze the long-term follow-up results of the t reatraent of osteonecrosis of the femoral bead using vaacular pediele bone graft after surgical instruments improvement and provide an operation method. Methods To adop decompression by fenestration along the femoral head longitudinal axis and vascular pediele bone graft for osteonecrosis of the femoral head since 1983,we designed special surgical instreuments for decompression by fenestration and bone graft from before the bottom to outside the top of the femoral head to avoid secondary collapse of the femoral head. Results Joint pain was alleviated and disappear, no secondary collapse of the femoral head, join function recovered. Average follow-up time is 13.6 （104 18）years, the function of joint was evaluated according to Sanders criteria, joint functional score significant increased from 35. 6 points before operation significant to 52. 8 points of last follow-up. Patients（94.1% ）for decompression by fenestration and bone graft from before the bottom to outside the top of the femoral head were rated as fine and excellent. Conclusion Surgical instruments and surgical improvements,weight-bearing bone support of the femoral head area,more in line with the biomechanical requirements ,would effectively prevent the collapse of the femoral head