影像学分析在吻合血管游离腓骨移植治疗股骨头坏死术中的意义

Significance of imaging analysis in treatment of osteonecrosis of femoral head with free vascularized fibular grafting

目的分析股骨头坏死(ONFH)的影像学特征,并探讨其在吻合血管游离腓骨移植(FVFG)治疗ONFH术中的意义。方法选择2011年3月至2013年1月郑州大学第一附属医院采用改进的手术器械行FVFG治疗的35例(47髋)ONFH患者,根据影像学表现进行ARCO分期,记录不同分期手术前后影像学特征及Harris评分,评价术后影像学特征及Harris评分改善情况。结果 35例(47髋)获12~42个月(平均28个月)随访,术后42髋影像学或Harris评分有不同程度改善。其中股骨头坏死区有硬化、囊性、骨质疏松的Ⅰ、Ⅱ期改善较为明显、部分塌陷的Ⅲ期改善略差。结论对影像学显示股骨头坏死区有硬化带、透亮区及囊变的Ⅰ、Ⅱ期行FVFG治疗后效果明显,对表现"新月征"及塌陷的Ⅲ期效果略差。

Objective To analyze the imaging features of osteonecrosis of femoral head（ONFH）, and explore the significance of free vascularized fibular grafting for treating ONFH. Methods 35 patients （47 hips） with ONFH were treated with modified FVFG from March of 2011 to January of 2013 in the First Affiliated Hospital of Zhengzhou University. ARCO staging was based on imaging findings. The imaging features and Harris scores were recorded before and after different stages of operation. The imaging features and the improvement of Harris score were evaluated after operation. Results 35 cases （47 hips） were followed up for 12～42 months （mean 28 months）. 42 hips were improved in different degree after operation, and the score of Harris was significantly improved than that before operation. For the ONFH patients with sclerosis, cystic and osteoporosis stage Ⅰand Ⅱ, the improvement was more obvious. For the new moon sign of the Ⅲ stage phase, the improvement was slightly poor. Conclusion For the ONFH patients in stage Ⅰand Ⅱ of imaging with sclerosing zones, clear areas and cystic lesions in the necrotic zone of the femoral head, the effect of FVFG treatment is obvious, but the effect on ＂crescent sign＂ and stage Ⅲ of collapse is slightly poor.