改良吻合血管腓骨移植治疗股骨头缺血性坏死

Modified free vascularized fibular grafting for the osteonecrosis of the femoral head

目的 评价采用Smith-Peterson入路、不切断股直肌直头、进行吻合血管腓骨移植治疗股骨头缺血性坏死的近期疗效. 方法 选取我院自2009年1月至2012年9月期间,25 - 46岁FicatⅡ-Ⅲ期（Ⅱ期8例、Ⅲ期6例）股骨头坏死手术病例14例、共14髋进行回顾性分析,其中男10例,女4例,平均年龄35岁,随访时间24个月,分别比较术前、术后症状缓解程度、髋关节功能改善（Harris评分）、影像学评估（X线）. 结果 术后2年,患者Harris评分明显改善,术前、术后分别为（68.47±5.33）分和（86.80±4.72）分,评分平均提高18.33,两者差异有统计学意义（t=18.724,P＜0.01）;X线显示术后术侧股骨头坏死无进展,无塌陷.结论 通过Smith-Peterson入路、不切断股直肌直头、吻合血管腓骨移植治疗股骨头缺血性坏死,近期疗效满意,是一种较为实用的手术方式.

Objective To evaluate the short term results of repairing osteonecrosis of the femoral head by modified free vascularized fibular grafting through Smith-Peterson approach without cutting the rectus femoris.Methods Between January,2009 and September,2012,14 osteonecrotic hips of 14 patients who underwent free vascularized fibular grafting were retrospectively studied including 10 male and 4 female.The follow up period was 24 months.The preoperative and postoperative symptoms relief,recovery of hip function （Harris score）,radiographic assessment （X-ray）.Results All patients got postoperative ipsilateral hip pain relief.Average Harris hip score improved significantly （68.47 ± 5.33,86.80 ± 4.72 points in preoperation and postoperation,respectively; paired t test,t =18.724,P 〈 0.01）.Postoperative X-ray results showed there were no progresses of osteonecrosis and no collapse in the operative side within 2 years follow-up.Conclusion The short term treatment results of femoral head avascular necrosis were satisfactory by using free vascularized fibular graft through Smith-Peterson approach without cutting off the rectus femoris and it may be a relatively practical option of surgical approach.