吻合血管游离腓骨移植治疗股骨头坏死近期临床疗效分析

Recent clinical curative effects of vascularized fibular graft transplantation for femoral head necrosis

目的探讨吻合血管游离腓骨移植治疗股骨头坏死的手术技巧及近期临床疗效。方法回顾性分析2009年3月～2011年11月期间,采取吻合血管游离腓骨移植治疗15位患者19例髋关节股骨头坏死,通过临床髋关节功能Harris评分和影像学X线片及其术后并发症评价此方法的临床疗效。结果术后所有患者均获得随访,随访时间15～24个月,平均18个月。1例患者出现股前外侧神经支配区域皮肤的麻木和感觉减退,4月后基本恢复;1例足背感觉减退,2例出现小腿外侧肌群力量减弱。未出现股骨颈骨折、髋关节不稳、感染等不良情况。末次随访髋关节Harris评分：Ⅱ期4例92.3分,Ⅲ期12例85.8分,IV期3例73.8分。X线片显示15例髋关节有不同程度改善;3例髋关节无明显变化;1例髋关节出现了恶化表现（术前为IV期）。改善率为78.94%。结论吻合血管游离腓骨移植是一种治疗股骨头坏死安全有效的手术方法,尤其是早中期患者。早期恰当的治疗可使相当数量的患者免除或推迟行人工关节置换术。

Objective To evaluate the surgical technique and clinical results of free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head. Methods From March 2009 to November 2011, we have treated 15 patients（19 cases hip）, useing free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head. The Harris hip score, results of the X-ray and the postoperative complications were used to evaluate the clinical curative effectofthe surgical method. Results The patients were followed up after operation, the follow-up time 15 to 24 months, an average of 18 months. 1 patien had strands of anterolateral nerve innervation region skin numb and hypesthesia, and has recoveried after 4 months; 1 case of dorsalis pedis hsd hypoesthesia; 2 patiens in the lateral crus muscle strength was abate. All cases did not appear femoral neck fracture, ankle instability, infection and other side effects. The last follow-up Harris hip score ： Ⅱ stage（4 hips 92.3 points）, Ⅲ stage（12 hips 85.8 points）, IV stage（3 hips 73.8 points）. X ray shows that15 hips have different degree improvement; 3 hips have not been obviously changed; 1 hip has been worsened in performance（preoperative for stage IV）. Period rate is 78.94%. Conclusion The treatment of femoral head necrosis with free vascularized fibula grafting is safe and effective, especially in early to mid patients. And the early proper treatment of this surgical technique can make many patients exempt or delay artificial joint replacement.