股骨头坏死伞状植骨联合带血管蒂髂骨移植（开放获取）

Umbrella-shaped bone grafting combined with vascular pedicle iliac bone transfer for femoral head necrosis

摘要:

[目的] 探索应用伞状植骨联合带血管蒂髂骨移植治疗成人股骨头坏死的临床效果。[方法] 对本院2018 年6 月—2022 年12 月收治的21 例（25 髋） 成人股骨头坏死病例临床资料进行了回顾性分析。均以伞状植骨联合带血管蒂髂骨移植治疗，评价临床疗效及影像学结果。[结果] 所有病患术程顺利，术中无神经、血管损伤等并发症，术后伤口延迟愈合2 例。均获随访，平均（18.5±4.2） 个月。末次随访显示：II 期15 髋均有明显改善：III 期7 髋中有6 髋有改善，1 髋不变；Ⅳ期中3 个髋，1 髋有改善，1 髋未变，1 髋进展后行关节置换治疗。与术前相比，术后6 个月和末次随访时VAS 评分有显著降低[(6.0±1.2), (2.0±0.7), (1.2±0.4), P＜0.001]；而Harris 评分[(66.3±7.4), (87.8±6.1), (90.0±4.5), P＜0.001]、髋关节屈曲[(75.8±5.7)°, (90.3±5.6)°, (97.6±2.9)°, P＜0.001]、外旋[(24.6±1.2)°, (29.1±1.5)°, (32.0±1.0)°, P＜0.001] 和内旋ROM [(25.5±1.2)°, (30.2±2.0)°, (32.2±1.6)°,P＜0.001] 均显著增加。影像学显示末次随访时Ficat 分期、坏死面积和股骨头关节面塌陷情况均较术前显著变化，总体明显改善（P＜0.05）。[结论] 股骨头坏死伞状植骨联合带血管蒂髂骨移植临床疗效满意，带血运髂骨移植可能为股骨头提供新的血液供应系统，利于防止股骨头塌陷。

Abstract:

[Objective] To explore the clinical effect of umbrella-shaped bone grafting combined with vascular pedicle iliac bone trans-fer in the treatment of adult femoral head necrosis. [Methods] A retrospective study was conducted on 21 adults (25 hips) who received hippreservation treatment for femoral head necrosis in our hospital from June 2018 to December 2022. All patients were treated with umbrellashapedbone grafting combined with vascular pedicle iliac bone transfer, and the clinical efficacy and imaging results were evaluated. [Re-sults] All the patients had operation performed smoothly, with no complications, such as nerve and vascular injury, despite of delayedwound healing after operation noted in 2 cases. All patients were followed up for (18.5±4.2) months, and at the final follow-up, all 15 hipsin stage II showed significant improvement, while 6 hips showed improvement and 1 hip remained unchanged in the 7 hips of stage III , and1 hip improved, 1 hip remained unchanged, and 1 hip underwent revision total hip arthroplasty in the 3 hips in stage IV. As time went fromthat preoperatively, 6 months postoperatively and the latest follow-up, the VAS scores significantly decreased [(6.0±1.2), (2.0±0.7), (1.2±0.4), P＜0.001]; whereas Harris score [(66.3±7.4), (87.8±6.1), (90.0±4.5), P＜0.001), hip flexion [(75.8±5.7)°, (90.3±5.6)°, (97.6±2.9)°, P＜0.001], external rotation range of motion (ROM) [(24.6±1.2)°, (29.1±1.5)°, (32.0±1.0)°, P＜0.001] and internal rotation ROM [(25.5±1.2)°,(30.2±2.0)°, (32.2±1.6)°, P＜0.001] significantly increased. Imaging showed that Ficat stage, necrotic area and articular surface collapse offemoral head at the last follow-up were significantly changed compared with those before surgery, with overall significant improvements (P＜0.05). [Conclusion] The umbrella bone grafting combined with vascular pedicle iliac bone transfer for femoral head necrosis does achievesatisfactory clinical consequences, and transported vascularized iliac bone may provide a new blood supply system for femoral head to bebenefit to prevent the collapse of the femoral head.