Epiphyseal distraction and hybrid reconstruction using polymethyl methacrylate construct combined with free non-vascularized fibular graft in pediatric patients with osteosarcoma around knee: A case report

BACKGROUND In children with osteosarcoma around the knee joint without epiphysis involvement,joint-sparing surgery seems to be an ideal way to retain knee joint function.However,there are two points of debate with regard to the technique:How to accurately achieve a safe surgical margin,and how to achieve intercalary reconstruction of the massive bone defect following resection of the tumor.CASE SUMMARY We present the case of an 8-year-old girl with osteosarcoma of the distal femur without involvement of the epiphysis.Epiphyseal distraction was applied to separate the epiphysis and metaphysis,and this provided a safe surgical margin.The massive bone defect was reconstructed with a custom-made antibioticloaded polymethyl methacrylate(PMMA)construct combined with a free nonvascularized fibular graft.Six months after surgery,bone union between the autograft and host bone was confirmed in both the proximal and distal femur by computer tomography(CT)examination.Moreover,considerable callus formation was found around the PMMA construct.After 28 mo of follow-up,there was no sign of recurrence or metastasis.The patient could walk without any aid and carry out her daily life activities satisfactorily.CONCLUSION In cases of osteosarcoma without epiphysis involvement,epiphyseal distraction can be easily applied to obtain a safe margin.Hybrid reconstruction with an antibiotic-loaded PMMA construct combined with a free non-vascularized fibular graft has the advantages of being easy to manufacture,less time-consuming to place,and less likely to get infected,while also ensuring bone union.Our case provides an alternative technique for biological reconstruction after joint-sparing surgery in patients with osteosarcoma around the knee without epiphyseal involvement.

Recurrent Giant Cell Tumor of the Distal End Radius: A Case Report and Surgical Treatment with Wide Resection and Reconstruction with Non-Vascularised Autologous Proximal Fibular Graft

Giant cell tumour of the distal radius is the 3rd most common site after proximal tibia and distal femur. It is locally aggressive and is associated with a high rate of recurrence. Although it is usually treated with various modalities of treatment, wide resection and reconstruction with proximal fibular autograft is most commonly accepted in recurrent cases. The following is a case report of such a case with surgical management.

Endosteal Fibular Strut Graft with Proximal Humeral Locking Plate in Delayed and Neglected Fractures of the Proximal Humerus

Purpose: The purpose of this study was to define a treatment protocol in which a non-vascularized endosteal fibular strut graft, a corticocancellous grafts and a locking plate construct are used for stabilization of the delayed and neglected proximal humerus fractures and to report its outcome. Patients & Methods: Eleven patients (6 females and 5 males) with delayed, neglected proximal humerus fractures were included in this study, conducted between March 2015 and December 2019. Average age of the patients was 57 years (range: 41 to 67 yrs). All patients were treated with the debridement, decortication and shingling of the bone at the site of the fracture followed by using an endosteal fibular strut graft, corticocancellous bone grafts and stabilization with locking plate. The patients were followed up for a mean time of 16.3 months (range: 13 to 40 months). The patient outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand Questionnaire, and the modified scoring system of Constant and Murley. Results: Union at the fracture site was achieved in all patients at a mean of 8.5 months (range: 6 to 11 months). The DASH score improved from an average pre-operative score of 71.1 (range: 64 to 78) to an average post-operative score of 25.2 (range: 21 to 35) at the final follow-up. Albeit with a small sample size of n = 11, this difference was found to be statistically significant (p < 0.05). The CM score improved from an average pre-operative score of 33.2 (range: 20 to 48) to an average post-operative score of 66.8 (range: 59 to 72) at the final follow-up. This difference was also found to be statistically significant in this patient cohort (p < 0.05). The results were excellent in 3 patients, good in 6 and moderate in 2. Conclusions: An endosteal fibular strut, subperiosteally placed cortico-cancellous grafts with a locking plate fixation helps in biological healing of neglected fractures of proximal humerus.

Live Fibular Graft for the Treatment of Long Bone Tumors in Children

Purposes: We would like to inform the characteristics of recurred osteo-fibrous dysplasia (OFD), and also the possible use of vascularized composite autograft and allografts (VCA) combined with live fibular graft (LFG) for the treatment of aggressive benign bone tumor and osteogenic sarcomas in children. Materials and Methods: We reviewed one boy with recurred OFD after LFG, and other four children with osteogenic sarcoma in long bone which was treated with LFG and VCA, and followed them for average 9 years (3 - 14 years). Survival of the LFG and VCA was estimated by the ISOLS Functional Radiologic Scoring System, but not with Kaplans-Meier’s scoring system because of a small series of case reports. Results: All succeed after surgeries initially, but the cause of recurrence of OFD was still unclear, and one girl with osteogenic sarcoma on distal femur died with skip and lung metastasis, 4 years after surgeries. Conclusions: The causes of recurred OFD are not found thru pathologic studies of our patient, but we believe the multifocal origin of tumor cells even on the adjacent soft tissues in OFD is one of the causes. The excised long bone tumor is recycled by pasteurization or autoclaving, or allograft, then LFG, and neo-adjuvant chemotherapy would be one of elective surgery for the treatment of malignant long bone tumors in children. The LFG into recycled autograft or allograft bone is difficult to perform simultaneously, but very effective to increase more earlier regenerative vascularities and also the stabilities of the dead bones in children.

TREATMENT OF ISCHEMIC NECROSIS OF FEMORAL HEAD BY THE FREE TRANSFERRING FIBULAR BONE GRAFT WITH VASCULAR PEDICLE IN ADULTS: A REPORT ON 95 CASES

cases (97 hips) with avascular necrosis of femoral head caused by variors factors treated by the free transferring fibular graft with vascular pedicle in the Second Teaching Hospital of Xi'an Medical University are reported. All patients have ben followed up for 2 to 11 years. Excellent and good rate of operative results was 86. 6%. A long observation indicated that this procedure was superior to the other operations for the osteonecrosis of femoral head. Successful interim and final operative results can warrant its continued use in management of this kind of patients.

Treatment of proximal humeral fractures accompanied by medial calcar fractures using fibular autografts:A retrospective,comparative cohort study

BACKGROUND Severe proximal humerus comminuted fractures are often accompanied by medial calcar comminuted fractures and loss of medial support,which are important factors that lead to internal fixation failure.The appropriate treatment for proximal humerus comminuted fractures has not been established.Therefore,this study assessed the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures.AIM To investigate the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures.METHODS This retrospective,comparative cohort study included two groups of patients.Group 1 comprised 22 patients and group 2 comprised 25 patients with complete follow-up data.Group 1 was treated with a fibular autograft with open reduction and locking plates to enable internal fixation.Group 2 was treated with open reduction and locking plates to enable internal fixation.The intraoperative blood loss volume from the shoulder wound,operative time,shoulder wound pain,bone fracture healing time,Constant-Murley score of the shoulder joint,preoperative Holden walking function score,Mallet score of the shoulder joint,and humeral neck-shaft angle during surgery of the two groups were compared,and the differences were analysed using an independent sample t-test.RESULTS Group 1 had a shorter mean operative time than group 2(2.25±0.30 h vs 2.76±0.44 h;P=0.000).Group 1 had a lower shoulder wound pain score on the first day after surgery than group 2(7.91±1.15 points vs 8.56±1.00 points;P=0.044).Group 1 had a shorter fracture healing time than group 2(2.68±0.48 mo vs 3.64±0.64 mo;P=0.000).Group 1 had higher Constant-Murley scores of the shoulder joint at 3,6,and 12 mo after surgery than group 2(76.64±4.02 points vs 72.72±3.02 points,86.36±3.53 points vs 82.96±3.40 points,and 87.95±2.77 points vs 84.68±2.63 points,respectively;P=0.000,0.002,and 0.000,respectively).Group 1 had higher Mallet scores of the shoulder joint at 3,6,and 12 mo after surgery than group 2(10.32±0.57 points vs 9.96±0.54 points,13.36±1.00 points vs 12.60±0.87 points,and 13.91±0.75 points vs 13.36±0.70 points,respectively;P=0.032,0.007,and 0.013,respectively).CONCLUSION Using locking plates with a fibular autograft can recreate medial support,facilitate fracture healing,and improve shoulder function;therefore,this may be an effective treatment option for severe proximal humerus comminuted fractures.

Reconstruction Using a Free Vascularized Fibular Graft after Frozen Autograft Reconstruction for Osteosarcoma of the Distal Tibia: A Case Report

Recently we have been performing biological reconstruction for malignant bone tumors of the extremities using frozen autografts. Here we present a case treated with free vascularized fibular graft (FVFG) after this method. A 23-year-old man developed osteosarcoma in his left distal tibia. There was nonunion after frozen autograft reconstruction, which we treated with FVFG. Twenty-four months later, bridging between the host bone and the frozen autograft was achieved. Our department has achieved bone union in almost all cases, but we sometimes encounter cases of nonunion after this method because of delayed blood supply. In these instances, reconstruction using FVFG may represent an attractive choice for salvage treatment.

Three-Dimensional Finite Elemental Analysis of Bone Stress near an Implant Placed at the Border between Mandible and Fibular Graft in Mandibular Reconstruction

Purpose: The aim of the present study was to use finite elemental analysis (FEA) to evaluate bone stress near an implant placed at the border between the mandible and fibular graft in mandibular reconstruction. Materials and Methods: A fibular model (FM) and transplantation model (TM) were constructed for FEA. In TM, mandible was on the mesial side and the fibular graft was on the distal side. The implant was positioned at the center of both bone models. In TM, it was placed on the border between the mandible and fibular graft. A 10-mm implant was used in the monocortical model and a 15-mm implant was used in the bicortical model. The loading force was set at 100 N, the angle was set at 90°, and the loading position was set as center, mesial, or distal on the upper surface of the prosthesis. Von Mises equivalent stress values of the bone near the implant collar and apex at the middle line between buccal and lingual side were measured. Results: In all models, stress values were significantly lower with center loading than with distal loading and mesial loading. In center loading, the stress values were significantly lower in the bicortical model than in the monocortical model. There were no significant differences in stress values between FM and TM in all conditions. Conclusions: Bone stress was least with the center loading position, which was further decreased by bicortical fixation. There was no increase in mechanical stress associated with placing an implant at the border between the mandible and the fibular graft.

Recalcitrant distal humeral non-union following previous Leiomyosarcoma excision treated with retainment of a radiated non-angiogenic segment augmented with 20 cm free fibula composite graft: A case report

BACKGROUND Leiomyosacromas in the Extremities are rare malignant smooth muscle tumors.Adjuvant radiation therapy, in combination with wide surgical excision allows the best chance of treatment. During the follow up pathological fractures are common complications that can be accompanied by Implant failure and defect situations that are most challenging in their management.CASE SUMMARY We present a case of a 52-year-old female suffering from a pathological fracture of the humeral shaft 10 yr after resection of a Leiomyosarcoma and postoperative radiotherapy. She developed implant failure after retrograde nailing and another failure after revision to double plate fixation. In a two-stage revision, the implants were removed and the huge segmental defect created after debridement was bridged by a compound osteosynthesis with nancy nails and bone cement for formation of the induced membrane. Due to the previous radiotherapy treatment,20 cm of the humeral shaft were declared devascularized but were left in situ as a scaffold. In the second stage, a vascularized fibula graft was used in combination with a double plate fixation and autologous spongiosa grafts for final reconstruction.CONCLUSION This combinatory treatment approach led to a successful clinical outcome and can be considered in similar challenging cases.

吻合血管腓骨瓣治疗股骨头缺血性坏死的疗效观察

目的分析吻合血管腓骨瓣治疗股骨头缺血性坏死(ONFH)的临床疗效。方法2016年3月至2022年9月中南大学湘雅二医院骨科收治股骨头缺血性坏死患者23例(26髋),按照国际骨循环协会(ARCO)分期:Ⅱ期6例、ⅢA期15例、ⅢB期5例。术前髋关节Harris评分为(60.9±9.0)分。所有患者均采用吻合血管的腓骨瓣进行治疗,腓骨瓣近端距离腓骨头约10 cm,腓骨瓣长度约7 cm。除少数早期病例外,其余病例术中均未使用植骨材料或内固定装置。术后定期随访,进行影像学检查评估腓骨瓣愈合及股骨头坏死区域变化情况,评价髋关节功能。结果术后无伤口感染、下肢深静脉血栓形成等并发症。患者均获得随访,随访时间13~93个月。末次随访患髋Harris评分为(90.9±4.5)分,与术前相比差异有统计学意义(P=0.000)。影像学未见腓骨瓣移位,均愈合良好,无坏死区域进展。结论吻合血管的腓骨瓣治疗股骨头缺血性坏死能够有效改善患者髋关节功能。改良的手术方法和技术,使得腓骨瓣的切取、植入、固定等更加精准、有效。

吻合血管游离腓骨移植治疗股骨头坏死

背景:吻合血管游离腓骨移植是治疗股骨头坏死常用的有效保髋治疗手段,但其影响因素仍存在争议。目的:探究吻合血管游离腓骨移植治疗股骨头坏死的临床疗效,及股骨头坏死的病因分类和病变严重程度对其疗效的影响。方法:采集吻合血管游离腓骨移植治疗股骨头坏死患者63例(共73髋)的临床资料及术前、术后髋关节的临床疗效评分。按股骨头坏死的病因分类标准分为激素性、酒精性和特发性3组,参照Ficat分期标准分为FicatⅡ期、FicatⅢ期和FicatⅣ期3组,分析病因分类和病变程度对吻合血管游离腓骨移植治疗股骨头坏死临床疗效的影响。结果与结论:①吻合血管游离腓骨移植治疗股骨头坏死术后各阶段的目测类比评分均较术前明显降低(P<0.001),术后各阶段的Harris评分均较术前明显升高(P<0.001);②在激素性、酒精性和特发性3组中,除激素性组术后2,3年,其余各组术后各时点Harris评分均较术前明显升高(P<0.05);③在FicatⅡ期、FicatⅢ期和FicatⅣ期3组中,FicatⅡ期和FicatⅢ期各组术后Harris评分均较术前明显升高(P<0.05),FicatⅣ期术后Harris评分与术前比较差异无显著性意义(P>0.05);④结果提示,吻合血管游离腓骨移植治疗股骨头坏死临床疗效显著,可以减轻患者髋部疼痛和改善髋关节功能;其疗效可能不受病因的影响,而受病变严重程度的影响。

Free vascularized fibular grafting for treatment of old femoral neck fractures

The internal fixation failure for treatment of femoral neck fracture is mainly due to improper fixation, loss of fixation stability and premature ambulation. Bone nonunion and avascular osteonecrosis of the femoral head caused by the internal fixation failure for femoral neck fracture are always the complex topics in orthopedics. With regard to patients who sustain these complications, total hip arthroplasty is a proper choice for elderly patients, but is not acceptable by young patients. We report nine patients with the failure of internal fixation for femoral neck fracture who were treated with free vascularized fibular grafting and internal fixation with cannulated screw from November 2001 to October 2003. All of them achieved good results.

骨科机器人辅助下使用新型嵌合套筒移植自体血管化腓骨治疗股骨头坏死的疗效分析

目的探究在骨科机器人辅助下,使用新型嵌合套筒移植自体血管化腓骨治疗股骨头坏死的疗效。方法于2022年5月至2023年12月收集首都医科大学附属北京积水潭医院手外科收治的股骨头坏死患者8例(8髋),平均年龄34.8岁(27~54岁),平均体质量指数(BMI)26.5(20.2~30.0)。FicatⅡ期6例(6髋),FicatⅢ期2例(2髋)。术中使用骨科机器人辅助确定植入腓骨方向和长度,辅助植入导针,并配合新型嵌合套筒制备个性化骨隧道用以植入血管化腓骨,术后定期随访髋关节X线和Harris评分。结果8例患者显露旋股外侧动静脉降支、切取血管化腓骨、股骨头髓芯减压及使用新型嵌合套筒移植血管化腓骨过程顺利。经骨科机器人工作站计算后,最终平均入点误差为1.2 mm(1.2~1.3 mm),平均靶点误差为1.9 mm(1.8~2.1 mm)。术后影像学提示腓骨远端位于股骨头负重区域中央,腓骨远端距离关节面平均7.4 mm(7.0~8.0 mm),植入腓骨血运良好。所有患者术后恢复良好。术后平均随访7.5个月,有效率100%,早期临床效果令人满意。结论骨科机器人辅助下使用新型嵌合套筒可以更加精准、稳固地植入血管化腓骨,并通过个性化的骨隧道确保腓骨血运良好,早期临床效果良好。

带血管蒂游离腓骨移植联合髋关节外固定架治疗早中期股骨头坏死的临床疗效分析

目的探究带血管蒂游离腓骨移植(FVFG)联合髋关节外固定架治疗早中期股骨头坏死(ONFH)的临床疗效。方法回顾性分析了2020年1月至2021年1月就诊的50例早中期ONFH患者,其中25例患者进行FVFG联合髋关节外固定架牵开治疗,设为治疗组;另外25例仅进行单纯FVFG,设为对照组。观察各组Harris评分、VAS评分及X线分级评定的改善情况,分析相关影像学指征。结果术后两组患者Harris评分、VAS评分均较术前有明显改善(P<0.001),且观察组明显优于对照组(P<0.05)。X线分级评定显示观察组96%患者有效,而对照组84%的患者有效,差异有统计学意义(P<0.05)。结论FVFG联合髋关节外架牵开治疗早中期ONFH疗效优良,值得临床推广。

FVFG术与髓芯干细胞植入术治疗股骨头坏死的临床价值比较

目的对比分析吻合血管游离腓骨移植(FVFG)术、髓芯干细胞植入术治疗股骨头坏死(ONFH)的临床价值。方法收集南阳文和骨科医院2021年3月至2023年5月103例ONFH患者临床资料,依照手术方案差异分为两组,对照组(51例)行髓芯干细胞植入术治疗,研究组(52例)行FVFG术治疗,比较两组围术期情况、术后并发症发生率以及术前、术后3个月Harris髋关节功能评分、血液流变学指标、骨代谢指标。结果研究组手术时间为(98.41±10.37)min,长于对照组(47.62±5.19)min(P<0.05);术后3个月,研究组血清25羟基维生素D3[25-(OH)D3]、Harris髋关节功能评分、血清骨碱性磷酸酶(BAP)分别为(24.16±2.55)ng/mL、(91.28±4.57)分、(0.75±0.12)pg/mL,均高于对照组(20.38±2.14)ng/mL、(88.51±6.02)分、(0.64±0.09)pg/mL,全血高切黏度、血清Ⅱ型胶原C端肽(CTX-Ⅱ)、血浆黏度、全血低切黏度分别为(4.27±0.65)mPa·s、(132.71±18.69)ng/L、(1.84±0.52)mPa·s、(7.36±1.80)mPa·s,均低于对照组(4.80±0.71)mPa·s、(161.80±21.43)ng/L、(2.16±0.47)mPa·s、(8.94±1.72)mPa·s(P<0.05);研究组术后并发症发生率5.77%较对照组19.61%低(P<0.05)。结论与髓芯干细胞植入术比较,FVFG术治疗ONFH的手术时间较长,但对患者髋关节功能、血液流变学指标、骨代谢指标水平的改善效果更好。

桡骨远端瘤段切除后单纯自体腓骨移植与吻合血管腓骨移植重建桡腕关节疗效比较

目的 分析单纯自体腓骨移植与吻合血管腓骨移植在桡骨远端瘤段切除后修复桡骨远端缺损和重建桡腕关节远期效果。 方法 1979年 1月～ 2 0 0 2年 9月对 15例桡骨远端肿瘤患者行瘤段切除后 ,6例行单纯自体腓骨移植 ,9例行吻合血管腓骨移植重建桡腕关节。随访 1年 ,参照 Enneking系统及国际肢体修复讨论会所制定的同种 /带血管蒂骨移植的影像学评价方法 ,进行肢体功能、影像学及供区的功能评价。 结果 8例吻合血管腓骨移植恢复肢体功能的 80 % ,6个月内完成骨愈合 ;6例单纯自体腓骨移植恢复肢体功能的 6 7% ,其中 4例移植骨在 5 cm以内术后 6个月骨愈合可 ,2例骨移植超过 12 cm者愈合延迟 ,分别为 13个月和 16个月 ;1例术后 2个月行肘下截肢术。 结论 应用腓骨头替代桡骨远端重建腕关节是合适的 ;吻合血管腓骨移植重建桡腕关节不受骨缺损长度影响 ,且植骨愈合率高、时间短 ,无骨吸收。可作为桡骨远端肿瘤手术治疗的一种有效手段。

股骨头髓心减压加异体腓骨移植术治疗股骨头坏死

目的探讨股骨头髓心减压加异体腓骨移植术治疗早期股骨头缺血性坏死的疗效. 方法 1998年6月～2004年8月,采用股骨头髓心减压加异体腓骨移植术治疗Ⅰ～Ⅲ期股骨头缺血性坏死22例39髋,其中男17例,女5例.年龄22～60岁.术前疼痛时间2～12个月,平均6.5个月.所有患者于术前及术后15 d,3个月和6个月行双髋关节功能、常规X线片、ECT、CT和MRI检查. 结果患者均获随访3～74个月,平均31.4个月.17例临床症状缓解明显,Harris评分从术前平均78分升至术后91.6分.18例X线片显示髋关节形态基本保持完好,无明显坏死进展.ECT、CT和MRI检查均见植骨成骨征象.有2例4髋于1年半后改行人工全髋关节置换术.另有3例4髋症状有所加重,但未行人工关节置换术. 结论股骨头髓心减压加异体腓骨移植术治疗早期股骨头缺血性坏死,手术损伤小,术后关节功能2～4周即可恢复或超过术前水平,临床症状改善.其短期疗效肯定,中长期疗效仍需进一步观察.

肱骨远端难治性骨不连的修复

目的 探索肱骨远端难治性骨缺损与骨不连的显微外科修复方法。 方法 肱骨远端骨缺损与骨不连 12例 ,均有外科手术史及植骨史 ,病程 8个月～ 3年 10个月 ,平均 12 .5个月。肢体短缩 4～ 11cm,其中 8例假关节形成 ,4例缺损 3～ 5 cm。采用解剖钢板固定为支架 ,取吻合血管的腓骨移植修复 ,移植腓骨长 5～ 15 cm,平均 8.5 cm。 结果 术后 12例均获随访 3～ 18个月 ,平均 8.5个月。移植腓骨 3～ 8个月全部愈合 ,随愈合时间延长 ,移植腓骨增粗 ,髓腔再通。退行变的肘关节面骨质恢复正常 ,肘关节伸屈、前臂旋转功能获得恢复 ,肢体短缩获得纠正 ,持重及精细操作均达到满意效果。 结论 钢板内固定加吻合血管腓骨移植用于邻近关节疑难骨缺损、骨不连的修复 ,可重建关节功能 ,免除关节假体置换。

游离腓骨移植重建胫骨骨纤维结构不良病灶切除后骨缺损

目的 探讨吻合血管的游离腓骨移植重建胫骨骨纤维结构不良病灶切除后骨缺损的疗效。方法 对 2 7例胫骨骨纤维结构不良患者 ,行病灶彻底切除 ,所遗骨缺损以吻合血管的游离腓骨移植重建。移植腓骨长 6cm～ 2 6cm ,平均 14 .2cm。术后随访 2年～ 12年 ,平均 6 .6年。结果 移植的腓骨术后平均 4 .2个月 (3～ 8个月 )达到骨性愈合 ,双下肢等长 ,功能接近正常。结论 吻合血管的游离腓骨移植重建胫骨骨纤维结构不良病灶切除后骨缺损 ,可最大限度地恢复患肢功能 。

腓骨联合髂骨移植治疗陈旧性股骨颈骨折

目的对陈旧性股骨颈骨折行吻合血管腓骨部分联合髂骨移植治疗,并观察临床效果。方法1994年1月-1997年1月,收治76例陈旧性股骨颈骨折患者。男54例,女22例;年龄24～48岁,平均31.5岁。骨折均为外伤所致。根据Garden分型:Ⅱ型20例,Ⅲ型41例,Ⅳ型15例。骨折部位:头下型26例,经颈型42例,基底型8例。伤后曾行内固定治疗者65例,皮牵引治疗者7例,单纯卧床者4例。Harris评分52～72分,平均65.6分。受伤至该次手术时间2～24个月。术中采用6～8cm带血管蒂腓骨移植加单侧外固定支架固定骨折,对股骨颈缺损超过5mm者联合3.0cm×2.0cm×1.5cm的带旋髂深动静脉蒂的髂骨瓣移植。结果术后68例获随访,骨折愈合时间4～6个月,平均5.2个月。其中5例因股骨头坏死或髋关节脱位行人工全髋关节置换术;余63例获随访10.1～12.4年,平均10.5年。63例髋关节活动恢复正常。随访10年Harris评分84～94分,平均87.5分。X线片示患者股骨头在术后1年骨密度均增高;术后10年股骨头结构基本正常,植入腓骨和髂骨与股骨头颈部完全融合,无囊变及骨塌陷。结论对选择保留股骨颈的陈旧性股骨颈骨折患者,吻合血管腓骨联合髂骨移植是一种较好的方法。