摘要
目的:前瞻性研究不带血运自体腓骨移植(non - vascularized fibular grafting NVFG)与吻合血管自体腓骨移植(freevascularized fibular grafting FVFG)治疗青中年股骨头坏死的疗效,探讨手术简单,创伤小,效果肯定的治疗方法。方法:总结分析2009年7月-2016年9月我科收治的40例(63髋)青中年股骨头缺血坏死的患者,随机采取FVFG和NVFG治疗股骨头坏死,其中FVFG组30髋(19例),男14例,女5例,年龄31 -49岁,平均年龄41岁。股骨头坏死Ficat分期:ⅡA期21髋,ⅡB期7髋,Ⅲ期2髋;NVFG组33髋(21例),Ficat分期:ⅡA期22髋,ⅡB期8髋,Ⅲ期3髋,21例均男性,年龄32 -50岁,平均年龄42. 5岁。以接受全髋关节置换手术为终点。至少随访12个月,平均20个月;术后随访复查髋关节X片或MRI评估影像学进展,临床评估采用Harris髋关节评分系统。结果:34例(49髋)得到随访,6例(11髋)失访。FVFG组24髋疼痛明显减轻,影像学显示股骨头坏死区无增加甚至减少,Harris髋关节评分由术前的平均(52.03 ±3.99)分增加到术后的(83. 17 ±8.25)分,两者之间具有统计学差异(P<0.05),3髋术后症状加重转为全髋关节置换术。NVFG组25髋疼痛明显减轻,影像学显示股骨头坏死区无增加,Harris 髋关节评分由术前的平均(56.19 ±6. 59)分增加到术后的(85.45 ±8.60)分,两者之间具有统计学差异(P<0.05),4髋疼痛加重行人工髋关节置换术。FVFG术前至术后改善的Harris髋关节评分为(31. 13 ±9. 16)分,NVFG术前至术后改善的Harris髋关节评分为(29.90 ±10.90)分,两者之间无统计学差异(P>0.05).结论:FVFG治疗青中年股骨头坏死患者的临床效果肯定,是治疗股骨头坏死的有效方法之一,但手术方法复杂,并发症多,要求较高的显微外科技术。NVFG治疗股骨头坏死有一定的临床效果,手术方法简单,基层医院容易开展。
Objective: Prospectie study on the treatment of middle - aged femoral head necrosis with free vascularized fibular grafting (FVFG) and non 一 vascularized fibular grafting ( NVFG), and to explore the treatment of simple operation, small trauma and positive effect. Methods: Summary analysis 40 cases (63 hips) middle 一 aged femoral head necrosis from July 2009 to September 2016 of my department ,FVFG and NVFG were randomly used to treat femoral head necrosis, including FVFG group 30 hips ( 19 cases), male 14 cases, 5 cases were female, aged 31 to 49 years old, the average age of 41. Ficat stages:ⅡA period of 21 hips,Ⅱ B period of 7 hips,Ⅲ period of 2 hips;33 hips NVFG group (21 cases), Ficat stages:ⅡA period of 22 hips,ⅡB period of 8 hips,Ⅲ period of 3 hips, 21 cases were male, 32 years old to 50 years old, the average age of 42. 5 years. The end point is total hip replacement surgery. At least follow - up 12 months, on average, 20 months;Postoperative follow 一 up using hip joint X or MRI assessment imaging progress, clinical assessment using Harris hip scoring system. Results: 34 cases were followed up and 6 lost. FVFG group of 24 hips pain significantly reduce, imaging showed femoral head necrosis area without the increase or decrease, Harris hip score increased by an average of 52. 03 ± 3. 99 points preoperatively to postoperative 83. 17 ± 8. 25 points, with statistically difference ( P <0. 05 ), 3 hip postoperative symptom aggravating to a total hip replacement. NVFG group 25 hip pain significantly reduce, imaging showed femoral head necrosis area without the increase or decrease, Harris hip score increased by an average of 56. 19 ±6. 59 points preoperatively to postoperative 85.45 ± 8. 60 points, with statistically difference ( P < 0. 05 ), 4 hip postoperative symptom aggravating to a total hip replacement. The improved Harris hip score of FVFG before and after surgery was 31. 13 ±9. 16, and the improved Harris hip score of NVFG was 29. 90 ± 10. 90 before the operation ,and there was no
作者
陶建宏
TAO Jian - hong(The People 's hospital of Santai county,Mianyang 621100)
出处
《中国伤残医学》
2019年第11期3-8,共6页
Chinese Journal of Trauma and Disability Medicine
关键词
吻合血管自体腓骨移植
不带血运自体腓骨移植
股骨头坏死
Free vascularized fibular grafting
Non -vascularized fibular grafting
Osteonecrosis of the femoral head
