带血管蒂骨瓣转移治疗双侧股骨头缺血性坏死的疗效分析

Clinical outcome of vascularized iliac bone flap transplantation for bilateral osteonecrosis of the femoral head

背景：非创伤性股骨头缺血性坏死（ONFH）常双侧发病，治疗更加困难，采用保留股骨头的治疗方法较为理想。目前，采用带血管蒂骨瓣转移治疗双侧ONFH疗效的报道甚少。 目的：探讨应用带血管蒂髂骨瓣转移治疗双侧ONFH的早中期临床疗效。 方法：2009年1月至2010年12月共收治双侧ONFH患者22例44髋，男10例，女12例；年龄22~41岁，平均32.6岁；体重指数（BMI）16.5~30，平均23.9。按ARCO分期标准分为：Ⅱb期9髋，Ⅱc期14髋，Ⅲa期8髋，Ⅲb期5髋，Ⅲc期8髋。术中所取血管蒂均为旋股外侧血管升支髂棘支骨瓣转移术。双髋分两次进行手术，手术间隔12~16个月，平均14个月。 结果：随访时间为36~47个月，平均40.3个月，单髋术中失血量200~500 ml，平均358 ml。双侧髋关节术后6个月、12个月的Harris髋关节评分（HHS）均较各自术前有明显提高；双侧髋关节术后相同时间点的HHS评分比较无统计学差异。初次手术侧1髋术后出现切口脂肪液化经换药痊愈，其余均无围手术期并发症。术后根据ARCO分期标准2髋由Ⅲb期病变进展至Ⅲc期；1髋由Ⅲc期进展至Ⅳ期，并于术后14个月进行人工关节置换手术。 结论：应用带血管蒂髂骨瓣转移分两次手术治疗双侧ONFH，合适的手术间隔对初次手术侧功能恢复影响较小，双侧髋关节术后早期临床功能评价较高，是治疗双侧ARCOⅡ~Ⅲ期ONFH的有效方法。

Background： Non-traumatic osteonecrosis of the femoral head （ONFH） usually affects bilateral hips. Femoral head pre-served treatment is superior to other treatments. But there are few reports on bilateral ONFH treated by vascularized iliac bone flap transplantation in the literature. Objective：To report the application of vascularized iliac bone flap in the treatment of bilateral ONFH. Methods： Twenty two ONFH patients （44 hips） treated between January 2009 and December 2010 were enrolled in the study. There were 10 males and 12 females with a mean age of 32.6 years （range 22-41 years） and a mean body mass index （BMI） of 23.9 （range 16.5-30）. According ARCO staging, there were 9 hips on stageⅡb, 14 on stageⅡc, 8 on stageⅢa, 5 on stageⅢb, and 8 on stageⅢc. All hips were treated with vascularized iliac bone flap pedicled with ascending branch of the lateral femoral circumflex vessel. The bilateral hips were operated separately, and the mean interval of surgery was 14 months （range 12-16 months）. Results： The mean follow-up period was 40.3months （range 36-47 months）. Intraoperative blood loss was 358 ml （range 200-500 ml）. Harris hip score （HHS） of both hips at 6 and 12 months postoperatively was significantly increased as com-pared with preoperative one （P＆lt;0.05）. HHS at 12 months postoperatively was significantly higher than that at 6 months postoperatively （P＆lt;0.05）. But there was no significant difference in the HHS between bilateral hips after surgery （P＆gt;0.05）. There were no perioperative complications except for one case of fat liquefaction cured by change of dressing. Two hips progressed from stageⅢb to stageⅢc, and one hip from stageⅢc to stageⅣ. Total hip replacement was performed 14 months after primary hip surgery. Conclusions：Vascularized iliac bone flap transplantation is an effective method for bilateral ONFH （ARCO stageⅡ-Ⅲ）.