带血管蒂髂骨瓣移植治疗中青年股骨头坏死

应用带血管蒂骨瓣移植治疗中青年股骨头坏死 2 1例 ,经 3年以上随访 ,效果满意。我们认为 :其治疗主要解决两方面的问题 ;降低股骨头内压 ,提供良好的血供。此手术采用头颈部开槽即降低了股骨头内高压 ,采用带旋髂深血管骨瓣移植不需吻合血管 ,通畅率高 ,能提供可靠的动脉血供。带血管蒂髂骨瓣移植治疗中青年股骨头坏死$河北省秦皇岛市第二医院骨科@俞汝霞     

带旋髂深血管蒂髂骨瓣移植治疗成人股骨头缺血性坏死

带旋髂深血管蒂髂骨瓣移植治疗成人股骨头缺血性坏死徐恩常李铭李平波我院自１９８６年至１９９２年采用带同侧旋髂深血管蒂髂骨瓣移植治疗成人股骨头缺血性坏死１２０例１４０髋，获得较满意效果，报道如下。临床资料本组１２０例１４０髋，男７６例９２髋，女４４例４８...     

髓芯减压自体骨髓细胞移植与带血管蒂骨瓣转位治疗股骨头缺血坏死的比较

目的 对比研究髓芯减压自体骨髓细胞移植与带血管蒂骨瓣转位两种方法治疗成人股骨头缺血性坏死的疗效.方法 对48例(60髋)成人股骨头缺血性坏死(ARCO分期:Ⅰc～Ⅱc期)分别采用带血管蒂骨瓣转位和髓芯减压自体骨髓细胞移植治疗.髓芯减压自体骨髓细胞移植治疗23例(30髋),带血管蒂骨瓣转位治疗25例(30髋).术后采用髋关节的Harris评分及影像学稳定情况评定疗效.结果 髓芯减压自体骨髓细胞移植与带血管蒂骨瓣转位两组的手术时间和出血量,分别为40.2±16.5 min、57.4±18.5 min(P＜0.05)和180.0±20.5 ml、260.6±19.5 ml(P＜0.05).术中、术后无严重并发症发生.所有患者获平均36.5个月随访,髓芯减压自体骨髓细胞移植与带血管蒂骨瓣转位两组的优良率为别为83.3%、90.0%(P＞0.05);两组影像检查学分别显示24髋、25髋保持稳定(P＞0.05).结论 髓芯减压自体骨髓细胞移植和带血管蒂骨瓣转位治疗成人早期股骨头缺血性坏死的优良率相近,但前者较后者出血少并且手术时间短,是一种安全、有效的治疗早期股骨头缺血坏死的微创治疗方法.     

血管束与血管蒂髂骨瓣联合移植治疗股骨头缺血性坏死

我院自 1992～ 1998年采用旋髂深血管蒂髂骨瓣和旋股外侧血管升降支血管束联合移植治疗股骨头缺血坏死 2 8例 ,效果满意。1　临床资料本组 2 8例 ,男 19例 ,女 9例。年龄 2 3～ 5 0岁。左侧 15髋 ,右侧 13髋。其中 6例与激素治疗有关 ,3例有长期酗酒史 ,外伤性 17例 ,特发性 1例 ,原因不明 1例。术前根据Ｘ线改变进行评定 ,以Ｍａｒｃｕｓ[1] 分期法Ⅱ期 4例 ,Ⅲ期 2 0例 ,Ⅳ期4例。2　治疗方法仰卧位 ,患侧垫高 30°。切口近似倒Ｙ形 ,主切口以Ｓｍｉｔｈ Ｐｅｔｅｒｓｅｎ切口 ,副切口始于腹股沟韧带上方 1 5ｃｍ处 ,平行腹股沟韧带 ,在髂…     

髓芯减压缝匠肌髂骨瓣移植治疗青壮年股骨头缺血性坏死

目的探讨和总结青壮年股骨头缺血性坏死的有效治疗方法。方法1994年9月～2003年8月,对68例75侧青壮年股骨头缺血性坏死患者行髓芯减压的同时清除股骨头内纤维组织及坏死骨,取缝匠肌髂骨瓣植入股骨头内。其中男57例63侧,女11例12侧;年龄16～58岁,平均42.5岁。左侧31例,右侧37例,双侧7例。致病原因:长期饮酒52例,长期服用激素6例,髋部外伤6例,不明原因4例。病程8个月～4年。Ficat分期:期10例11侧,期27例31侧,期31例33侧。结果术后68例获2年6个月～11年随访,平均5.2年。按Harris髋关节评分,优23例,良33例,可10例,差2例,术后无1例复发,优良率82.3%。结论股骨头髓芯减压法具有清除病灶彻底、减压充分、重建股骨头的血循环等特点,缝匠肌髂骨瓣植骨为股骨头带入成骨成分、血液供应,可加速骨的重建,适用于青壮年股骨头缺血坏死Ficat分期、、期患者,是一种较为有效的治疗方法。     

髓芯减压植骨术与带肌蒂骨瓣移植术治疗股骨头坏死的效果比较

目的探讨股骨头髓芯减压植骨术与开窗减压带蒂骨瓣移植术治疗股骨头坏死的临床疗效比较。方法本院自2004-02—2012-02诊治的非创伤性成人早期股骨头缺血坏死58例(64髋),其中28例(32髋)采用髓芯减压植骨术治疗(A组),30例(32髋)采用开窗减压加带蒂缝匠肌骨瓣移植术治疗(B组)。记录2种手术方法的患者术前、术后一般状况、X线平片、Harris评分。结果本组获随访1~36个月,平均20个月。开窗减压带肌蒂骨瓣移植术术后复发率及远期髋关节活动情况较单纯髓芯减压植骨术效果好。结论开窗减压带蒂骨瓣移植术的临床疗效在股骨头坏死的早中期优于单纯髓芯减压植骨术。     

带血管蒂髂骨瓣移位加股骨头髓腔减压术治疗青壮年股骨颈骨折

目的：探讨青壮年股骨颈骨折特点，提高诊治水平。方法：15例22～50岁青壮年股骨颈骨折患者。经选用带血管蒂髂骨瓣移位加股骨头减压术。结果：术后15例经3～5年的随诊，14例股骨颈骨折愈合好，无股骨头坏死情况，效果满意。结论：青壮年股骨颈骨折股骨头血供的改善和重建是治疗的关键。采用带血管蒂髂骨瓣移位加股骨头髓腔减压术不失为治疗该种疾病的有效方法之一。     

自体松质骨及带血管蒂髂骨瓣移植治疗青壮年股骨头坏死的疗效观察

目的 观察自体松质骨及带血管蒂髂骨瓣移植治疗青壮年股骨头坏死的疗效.方法 对56例(58髋)股骨头坏死采用自体松质骨及带血管蒂髂骨瓣移植治疗.结果 经1～6年随访,所有患者均获骨性愈合.术后疗效优28例,良26例,差2例,优良率96.4％.结论 自体松质骨及带血管蒂髂骨瓣移植治疗青壮年股骨头坏死,能有效改善股骨头血运...     

带血管蒂髂骨膜瓣移植术治疗股骨头缺血性坏死

带血管蒂髂骨膜瓣移植术治疗股骨头缺血性坏死王成琪，范启申，王剑利，王增涛，张树明股骨头缺血性坏死发病原因尚不太清楚，但是不论是成人还是小儿，造成股骨头坏死的原因是血供不良，因此在病程的各个时期如何改善股骨头血供是治疗该病的主要措施。￣［１，４］我们自...     

股骨头髓芯减压带旋髂深血管蒂髂骨骨瓣植骨治疗股骨头缺血性坏死

目的　探讨股骨头髓心减压带旋髂深血管蒂髂骨骨瓣植骨术治疗股骨头缺血坏死的疗效及手术适应证。　方法　 1995年 10月～ 2 0 0 0年 8月共进行 18例 (2 6髋 )股骨头髓心减压带旋髂深血管蒂髂骨骨瓣植骨术。根据Harris髋关节评分系统进行关节功能评价 ,根据ARCO分期分型系统进行影像学评价。　结果　随访 16例 2 3髋 ,平均 3 1 5个月。Harris评分由术前平均 61 7改善为随访时 76 0分。 13髋 (5 6% )随访时Harris评分 >80 0分 (内侧型 8髋 ,中央型 3髋 ,外侧型 2髋 ) ,根据ARCO分期分型系统进行分类随访时优良率 ,内侧型 80 % ,中央型 60 % ,外侧型 2 5 %。 8髋分期发生进展。塌陷及失败率内侧型 2 0 % ,中央型 40 % ,外侧型 75 %。　结论　股骨头髓芯减压带旋髂深血管蒂髂骨骨瓣植骨术适用于ARCO分期分型系统中ⅠA中央型、ⅠB内侧型、ⅡA中央型、ⅡB内侧型股骨头缺血性坏死 ,并具有良好的近、中期疗效。对坏死范围较大的股骨头不能防止病程的进展 ,但可缓解症状 ,延缓全髋关节置换的时间     

Analysis of outcome of avascular necrosis of femoral head treated by core decompression and bone grafting

Background

Femoral head is the most common bone affected by avascular necrosis. Core decompression procedure, when done in the initial stages, before collapse, may arrest or reverse the progress of avascular necrosis and thereby may preserve the normal femoral head. Hence, we have analysed the clinical, functional and radiological outcome of core decompression and bone grafting in patients with Osteonecrosis of the femoral head (ONFH) upto stage IIB (Ficat & Arlet).

Materials and method

A study was undertaken at our institute from June 2010 to June 2013 wherein 20 patients (28 hips) of ONFH upto grade II B (Ficat & Arlet) were treated with core decompression and the outcomes were studied. Patients were subjected to core decompression of the affected hip. All the patients were operated in lateral position. In 26/28 hips, cancellous grafting was done after harvesting graft from the posterior iliac crest. In 2 patients cortical non-vascularised fibular graft was used.

Results

Functional outcome was assessed by Harris hip score, wherein 19 hips (67.85%) had good or excellent outcome; 1 hip (3.57%) had fair out come. However, 8 hips (28.57%) showed poor result. For stage I, 12/13 hips (92.3%) improved, whereas for Stage IIA, 6/11 hips (54.54%) showed improvement and for stage IIB, only 2/4 hips (50%) showed improvement. Less than 25% of the hips required a replacement or salvage procedure. Strict non weight bearing was complied by 23 hips (82.14%), whereas 5 hips (17.85%) were not compliant. If we exclude non compliant patients, our success rate was 92.3% for grade I, 100% for grade IIA and 50% for grade IIB.

Conclusion

Core decompression and bone grafting provide satisfactory outcome when patients are carefully selected in early stages of the disease, before the stage of collapse.     

带血管蒂髂骨瓣移植联合活血补肾汤治疗股骨头缺血性坏死的临床研究

目的 观察带血管蒂髂骨瓣移植联合中医活血补肾汤治疗国际骨循环研究学会(ARCO)Ⅱ～Ⅲ期股骨头缺血性坏死患者的Harris评分及X线片改善情况,以验证其治疗优势.方法 40例(49髋)ARCO Ⅱ～Ⅲ期股骨头缺血坏死患者随机分为两组,治疗组22例(28髋)采用带血管蒂髂骨瓣移植治疗,2周后服用活血补肾汤3个疗程;对照组18例(21髋)采用单纯带血管蒂髂骨瓣移植治疗.观察两组术后Harris评分及X线片改善情况.结果 术后18个月治疗组Harris评分及X线片改善情况,均优于对照组.结论 带血管蒂髂骨瓣移植联合活血补肾汤治疗股骨头缺血性坏死的效果明显优于单纯带血管蒂髂骨瓣移植,中药活血补肾汤在缓解患者症状和改善功能方面有明显的作用.     

介入和髓芯减压植骨治疗股骨头缺血性坏死

目的探讨介入和髓芯减压、坏死区域掏空植骨治疗股骨头缺血性坏死的疗效。方法对57例患者采用介入和髓芯减压、坏死区域掏空植骨。结果57例经1~4·5年(平均2·9年)随访,效果满意。结论该方法损伤小,操作简便,是治疗股骨头缺血性坏死的有效方法。     

Use of vascularized pedicle iliac bone graft in the treatment of avascular necrosis of the femoral head

A vascularized pedicle iliac bone graft was performed in patients with extensive necrosis in whom the necrotic area occupied more than two-thirds of the femoral head. The purpose of this procedure is to supply vascularity and mechanical strength to the avascular femoral head. Our series consisted of 18 hips. The patients’ age at surgery ranged from 21 to 55 years. Fourteen hips were identified as stage II and 4 hips as stage III. Iliac bone graft alone was performed in 4 stage II joints. Transtrochanteric anterior rotational osteotomy of the femoral head was done additionally in 10 stage II joints and 4 stage III joints. In the group who underwent iliac bone graft alone, the mean Japanese Orthopedic Association (JOA) score improved from 58.5 to 63.8 (mean follow-up 52 months). In the group who underwent combination procedure with osteotomy, the mean JOA score improved from 71.7 to 85.0 (mean follow-up 43 months). Stage progression was noted in 3 of 4 joints in the group who underwent iliac bone graft alone. In the group who underwent the combined procedure, stage progression was noted in 2 of 10 joints at more than 1 year after operation. A vascularized pedicle iliac bone graft to treat avascular necrosis of the femoral head is considered promising for joint preservation. Received: 19 October 2000     

Free vascularized fibular grafting following failed core decompression for femoral head osteonecrosis

The results of treatment of femoral head osteonecrosis with free vascularized fibular grafting (FVFG) following failed core decompression (core decompression-FVFG [CD-FVFG] group: 32 hips) were reviewed and compared with those of a control group that underwent FVFG only (54 hips). Outcome was considered unsuccessful if total hip arthroplasty was subsequently performed. Total hip arthroplasty was performed in 15 and 20 hips of the CD-FVFG and control groups, respectively. When considering age, sex, and presence of bilateral disease, patients with previous core decompression did not have a significantly different failure rate from patients with FVFG only. However, patients with preoperative stage V osteonecrosis or corticosteroid use had worse outcomes after vascularized fibular grafting if they had a previous core decompression of the femoral head.     

Drilling and cancellous bone grafting for avascular necrosis of the femoral head

Objectives  

Maintenance of form and function and prevention of further deterioration of avascular necrosis of the femoral head through core decompression and cancellous bone grafting.     

关节镜引导下髓芯减压植骨联合选择性动脉灌注治疗早期股骨头坏死

目的:观察关节镜引导下髓芯减压植骨术联合选择性动脉灌注治疗早期股骨头坏死的疗效。方法 :自2010年1月至2014年12月,将76例76髋FicatⅡ期股骨头坏死患者分为试验组与对照组。试验组35例,男27例,女8例;年龄24~55(43.96±6.81)岁;行关节镜引导下髓芯减压植骨术,沿股骨颈方向钻直径8 mm骨隧道至坏死区,在关节镜监视下准确刮除死骨,取自体髂骨进行充分植骨,并联合选择性动脉灌注治疗。对照组41例,男29例,女12例;年龄26~56(44.62±7.33)岁;以直径3 mm的克氏针经皮行髓芯减压并联合选择性动脉灌注治疗。分别记录术前及术后随访时Harris评分,进行疗效比较,并判断影像学变化情况。结果:所有患者获得随访,平均随访时间30个月。术后12个月随访时两组患者影像学差异有统计学意义(P0.05),试验组优于对照组。参照Harris髋关节评分系统,末次随访时试验组(86.72±4.37)分,优6例,良24例,可4例,差1例;对照组(78.62±5.62)分,优2例,良20例,可15例,差4例;两组患者术后评分均高于术前(P0.05),末次随访时两组患者Harris评分和疗效比较差异均有统计学意义(P0.05)。结论:两种手术方式对早期股骨头坏死的治疗均有效,关节镜引导下进行髓芯减压,可以更加准确定位死骨,有效进行死骨刮除,取得更加满意的疗效。     

经转子髓芯减压植骨治疗股骨头缺血坏死

目的 总结经转子髓芯减压植骨术治疗股骨头缺血性坏效果。方法 ５３例股骨头缺血性坏死患者行经转子髓芯减压植骨术。其中Ｆｉｃａｔ分期Ⅱ期２１例,Ⅲ期２５例,Ⅳ期７例。结果 平均随访４．５年,髋关节功能优良率７５．５％。结论 经转子髓芯减压植骨术可有效治疗股骨头缺血性坏死,具有手术简单,不破坏股骨头残余血供,不妨碍日后行人工关节置换术等优点。     

股骨头髓心减压加异体腓骨移植术治疗股骨头缺血性坏死

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临床疗效。方法：2004年1月至2008年11月治疗Ⅰa-Ⅲb期股骨头缺血性坏死25例32髋,其中男17例,女8例,年龄20～55岁,平均39．1岁。采用股骨头髓心减压加异体腓骨移植、空心拉力螺钉内固定治疗。术前疼痛时间2-14个月,平均5．5个月。所有患者于术前术后行常规X线片、MRI检查、Harris评分。结果：25例均获随访,时间24-48个月,平均36-4个月。X线片显示18例21髋改善,4例6髋不变,关节面未塌陷,2例3髋恶化,1例2髋失败,总有效率84_4％。Harris评分术前（77．0±8．0）分,术后（90．6±2．5）分,差异有统计学意义（t=1．67,P〈0．05）。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,创伤小,关节功能影响小,术后卧床时间短,恢复快,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。