吻合血管游离腓骨移植治疗股骨头坏死的中期及远期疗效评估

Long-term effects of vascularized fibular graft transplantation for avascular necrosis of femoral head

目的评估吻合血管游离腓骨移植治疗股骨头坏死的中、远期疗效。方法 1985年6月至2005年6月,采用吻合血管游离腓骨移植方法治疗股骨头坏死共361例(385髋),实际有效随访到257例(281髋)。男144例,女113例,年龄(39.2±15.3)岁(23～56岁)。按照股骨头坏死Ficat分期:Ⅱ期187髋,Ⅲ期94髋。随访评估内容主要为Harris髋关节疼痛及临床功能评分和影像学评价(X线片)。结果随访率为71.19%,随访(10.7±4.4)年(5～20年)。髋关节疼痛评估结果显示:术前和术后末次随访FicatⅡ期优良率为13.4%、86.6%,疼痛评分为(15.16±3.41)分、(32.99±6.50)分;Ⅲ期优良率为3.19%、54.3%,疼痛评分为(8.47±2.15)分、(30.70±4.25)分。各期患者术前和术后末次随访疼痛评估结果差异经检验均有统计学意义(t=8.472,13.625;P<0.001)。临床髋关节功能综合评估结果示:术前和术后末次随访FicatⅡ期优良率为15.5%、72.2%,综合评分为(53.08±9.91)分、(88.46±10.02)分;Ⅲ期优良率为4.92%、34.4%,综合评分为(40.32±8.37)分、(82.78±12.16)分,各期术前和术后末次随访综合评估结果差异均有统计学意义(t=6.937,8.720;P<0.001)。术前和术后末次随访的X线片显示FicatⅡ期改良率为16.6%、70.6%,评分为(23.45±2.89)分、(34.50±3.92)分;Ⅲ期改良率为7.45%、43.6%,评分为(15.77±3.06)分、(30.22±6.84)分,各期术前和术后末次随访X线表现评估结果经检验均有统计学意义(t=4.192,9.450;P<0.001)。以上结果间差异比较表明髋关节各项功能指标较术前有明显改善。结论采用吻合血管的腓骨游离移植术是治疗FicatⅡ、Ⅲ期缺血性股骨头坏死的一种有效方法,能够阻止或延缓病情的发展。

Objective To evaluate the long-term efficacy of vascularized fibular graft transplantation for avascular necrosis of the femoral head in Ficat Ⅱ-Ⅲ. Methods From June 1985 to June 2005, 361 cases（385 hips） of femoral head necrosis were treated by vascularized fibular graft-based method,of which the effective follow-up were 257 cases （281 hips）. There were 144 male and 113 female patients, aged from 23 to 56 years, （39. 2 ± 15.3） years in average. According to Ficat staging of femoral head necrosis ： 187 hips were in stage Ⅱ and 94 hips were in stage m. The follow-up assessments mainly included harris scores of pain, clinical function of hip joint and radiographic evaluation （X-ray film ）. Results The follow-up rate was 71.19% ; the follow-up time was five to 20 years, （ 10. 7 ±4. 4） years in average. The results of pain assessments showed： in stage Ⅱ group, the excellent rates of preoperative evaluation and last postoperative follow-up were 13.4% and 86. 6% respectively with pain scores of （15.16 ±3.41） and （32. 99±6. 50） respectively; in stage m group, the excellent rates of preoperation period and last postoperative follow-up were 3.19% and 54. 3%, with pain scores of （ 8.47 ± 2. 15 ） and （30. 70 ＋ 4. 25） respectively. The differences of pain assessments between the preoperation period and last postoperative follow-up were statistically significant （ t = 8. 472, 13. 625 ; P 〈 0. 001 ）. The results of clinical hip function assessments showed the excellent rates of preoperation period and last postoperative follow-up in stage II group, were 15.5% and 72. 2%, with integrated scores of （53.08 ± 9. 91 ） and （88.46± 10. 02） respectively; in stage m group, the excellent rates of preoperation period and last postoperative follow-up were 4. 92% and 34.4% , with integrated scores of （40. 32 ± 8. 37） and （82. 78 ± 12. 16） respectively. The difference of clinical hip function assessments between the preoperation period and last postoperative follow-up was statistically significant （ t = 6. 937, 8. 720 ; P 〈 0001 ）. The results of X- ray films assessments showed that in stage II group, the improved rates of preoperation period and last postoperative follow-up were 16. 6% and 70. 6% , with scores of （23.45± 2. 89 ） and （ 34. 50 ±3.92 ） respectively; in stage Ⅲ group, the improved rates of preoperation period and last postoperative follow-up were 7. 45% and 43.6%, with scores of （ 15. 77 ± 3. 06） and （30. 22 ±6. 84） respectively. The X-ray results between preoperation period and last postoperative follow-up were statistically significant different （t =4. 192, 9.450; P 〈 0. 001）. These differences of all results indicated that the clinical hip function improved significantly compared to that before operation. Conclusions The treatment of the femoral head necrosis using vascularized fibular graft in Ficat Ⅱ - Ⅲ stage may be an effective method to prevent or delay this disease＇s progress.