带旋髂深血管蒂髂骨与骨软骨联合移植治疗股骨头坏死

目的 探讨带血管蒂髂骨与自体柱状骨软骨联合移植治疗股骨头坏死(osteonecrosis of the femoral head,ONFH)的疗效及临床应用价值.方法 自2001年11月至2007年5月,采用带血管蒂髂骨与自体柱状骨软骨联合移植治疗ONFH患者13例(13髋),均为男性;年龄26-43岁,平均34.3岁.左侧7髋,右侧6髋.激素性ONFH 9例,股骨颈骨折内固定术后ONFH 4例.按国际骨循环研究学会分期,ⅢA期2例,ⅢB期4例,ⅢC期7例;术后3个月、6个月及每年X线片检查双髋正位及轴位片,必要时行CT或MR检查.采用Harris评分评价髋关节功能.结果 13例患者全部获得门诊随访,随访时间1.5-6.0年,平均(2.4±0.4)年.X线片和CT示,术后3个月可见植入的骨软骨柱和髂骨瓣轮廓,但与周围骨质界限模糊;股骨头内密度不均匀,股骨头外形不规则.术后1-2年.骨软骨柱及髂骨瓣与周围骨愈合良好,股骨头塌陷区不同程度恢复高度2-5 mm,平均(3.1±1.6)mm,囊性变消失或变小.术后1年影像学好转率为100%;Harris评分从术前平均(54.7±7.6)分提高到平均(81.8±13.5)分,差异有统计学意义.结论 带旋髂深血管蒂髂骨与骨软骨联合移植技术治疗青壮年中晚期ONFH患者可获得良好的近期疗效,中远期疗效有待进一步观察.

Treatment of osteonecrosis of the femoral head by transplantation of vascular pedicled iliac bone combined with osteochondral autologous

Objective To discuss the results and clinical application of the treatment in osteonecro-sis of the femoral head (ONFH) by transplantation of vascular pedicled iliac bone combined with cylindrical osteochondral autologous.Methods Thirteen hips have been treated by transplantation of vascular pedicled iliac bone combined with cylindrical osteochondral autologous from November 2001 to May 2007.All pa-tients were male,aging from 26 to 43 years with all average of 34.3 years.Seven cases were in left hip,6 in right.According to Association Research Circulation Osseous stage,2 cases were in stage ⅢA,4 in ⅡB and 7 in ⅢC.The anterior-posterior and axial X-ray of bilateral hip joints were taken at 3 months,6 months,and every year postoperatively.The CT or MRI was taken as well if necessary.The function of hip joint was e-valuated by Harris hip score.Results All patients were well followed up from 1.5 to 6 years,with the mean time of 2.4 years.The contour of the transplanted iliac bone and cylindrical osteochondral was found in the femoral head by X-ray and CT but the edge around the transplanted bone was blurry 3 months post-operatively.The bone density in the femoral head was uneven and the shape of the femoral head was irregular.One to 2 years postoperatively,the transplanted iliac bone and cylindrical osteochondral healed,the height of the collapse were restored from 2 to 5 mm (mean,3.1±1.6 mm),and osteolysis diminished or disappeared.One year postoperatively,the percentage of better results was 100%in X-ray,CT or MRI performance.No patients received the total hip replacement due to collapse or pain.The Harris hip score was increased from 54.7±7.6 pre-operation to 81.8±13.5 one year post-operation with statistically significant difference.Conclu-sion Transplantation of vascular pedicled iliac bone combined with osteochondral autologous is an effective method to treat moderate and advanced ONFH,but long-term effect need to be observed further.