带血管蒂髂骨瓣转移治疗股骨头缺血性坏死30例分析
|
摘要
目的：探讨带血管蒂髂骨瓣转移治疗中期股骨头缺血性坏死的方法及疗效。
方法：收集2007年6月—2008年6月间在我院行带旋股外侧血管升支髂骨瓣治疗中期股骨头缺血性坏死的30例患者资料,对其进行手术效果分析。平均随访时间29.5个月(22个月-35个月)。其中男性17例,女性13例；年龄20～45岁,平均年龄34.7岁,所有患者体重指数(Body Mass Index,BMI)小于30,Ficat分期Ⅱ期11髋,Ⅲ期19髋,按病因分类激素性13例,酒精性10例,创伤性2例,无明确诱因5例,用Harris髋关节功能评分标准进行临床评价,根据Ficat分期改变进行影像学评价。对患者术前10天内、术后6个月和12个月进行三维步态测量,观察患者的步态改善情况。
结果：30例患者术后随访22-35个月无一例改行人工全髋关节置换,Harris髋关节功能评分从术前平均63.6分提高至术后平均87.7分,术后复查X线片28例较术前无明显差异,2例轻度塌陷,较术前塌陷<2mm,未见骨性关节炎形成。三维步态分析显示,患者术后较术前步长、步调、步频均有增加,髋关节活动范围也有明显增加。随着时间的推移患者的步态越来越得到改善,12个月时基本达到最大值。
结论针对青壮年不同程度的中期股骨头缺血性坏死,采用带血管蒂髂骨瓣转移术,是该阶段保留股骨头的有效治疗方法。
Objective To research on the methods and the therapeutic effect of the implantation of pedicled iliac bone graft with ascending branch of lateral femoral circumflex artery with the intermediate stage osteonecrosis of the femoral head.
Methods We assembled 30 patients data (male 17, female 13) and analyzed the operating effects who were operated for the intermediate stage osteonecrosis of the femoral head with the way of the implantation of pedicled iliac bone graft with ascending branch of lateral femoral circumflex artery, from June 2007 to June 2008, they had a mean age 34.7 years (range,20-45 years). All patients were followed up for a mean of 29.5 months (range,22-35 months). All the patients'Body Mass Index was less than 30. The hips were 11 Ficat Stage II,19 Stage III. In etiological factor, 13 patients were caused by hormone,10 patients by alcohol,2 patients by trauma and 5 unknown cause. The clinical effects were assessed by Harris scoring, The radiological effect was assessed according to variation of Ficat stage respectively.Three-dimensional gait analysis was done on all the patients preoperative and at the 6th,12th month postoperative, and then we observed the changing of gait.
Results Nobody of thirty cases underwent total hip replacement postoperatively in following-up 22-35 months. Preoperative and post-operative Harris score were 63.6 and 87.7. The radiological process was the same in preoperation and postoperation except two patients. No bone arthritis appeared. Compared to preoperation, the gait analysis show that not only the gait velocity, stride length and cadence in patients were higher but also the rang of motion of hip Increased walking in postoperation, and it is the best effect on 12 months.
Conclusion The efficacy was satisfactory by using the implantation of pedicled iliac bone graft with ascending branch of lateral femoral circumflex artery in treatment of intermediate stage osteonecrosis of the femoral head for younger.
方法：收集2007年6月—2008年6月间在我院行带旋股外侧血管升支髂骨瓣治疗中期股骨头缺血性坏死的30例患者资料,对其进行手术效果分析。平均随访时间29.5个月(22个月-35个月)。其中男性17例,女性13例；年龄20～45岁,平均年龄34.7岁,所有患者体重指数(Body Mass Index,BMI)小于30,Ficat分期Ⅱ期11髋,Ⅲ期19髋,按病因分类激素性13例,酒精性10例,创伤性2例,无明确诱因5例,用Harris髋关节功能评分标准进行临床评价,根据Ficat分期改变进行影像学评价。对患者术前10天内、术后6个月和12个月进行三维步态测量,观察患者的步态改善情况。
结果：30例患者术后随访22-35个月无一例改行人工全髋关节置换,Harris髋关节功能评分从术前平均63.6分提高至术后平均87.7分,术后复查X线片28例较术前无明显差异,2例轻度塌陷,较术前塌陷<2mm,未见骨性关节炎形成。三维步态分析显示,患者术后较术前步长、步调、步频均有增加,髋关节活动范围也有明显增加。随着时间的推移患者的步态越来越得到改善,12个月时基本达到最大值。
结论针对青壮年不同程度的中期股骨头缺血性坏死,采用带血管蒂髂骨瓣转移术,是该阶段保留股骨头的有效治疗方法。
Objective To research on the methods and the therapeutic effect of the implantation of pedicled iliac bone graft with ascending branch of lateral femoral circumflex artery with the intermediate stage osteonecrosis of the femoral head.
Methods We assembled 30 patients data (male 17, female 13) and analyzed the operating effects who were operated for the intermediate stage osteonecrosis of the femoral head with the way of the implantation of pedicled iliac bone graft with ascending branch of lateral femoral circumflex artery, from June 2007 to June 2008, they had a mean age 34.7 years (range,20-45 years). All patients were followed up for a mean of 29.5 months (range,22-35 months). All the patients'Body Mass Index was less than 30. The hips were 11 Ficat Stage II,19 Stage III. In etiological factor, 13 patients were caused by hormone,10 patients by alcohol,2 patients by trauma and 5 unknown cause. The clinical effects were assessed by Harris scoring, The radiological effect was assessed according to variation of Ficat stage respectively.Three-dimensional gait analysis was done on all the patients preoperative and at the 6th,12th month postoperative, and then we observed the changing of gait.
Results Nobody of thirty cases underwent total hip replacement postoperatively in following-up 22-35 months. Preoperative and post-operative Harris score were 63.6 and 87.7. The radiological process was the same in preoperation and postoperation except two patients. No bone arthritis appeared. Compared to preoperation, the gait analysis show that not only the gait velocity, stride length and cadence in patients were higher but also the rang of motion of hip Increased walking in postoperation, and it is the best effect on 12 months.
Conclusion The efficacy was satisfactory by using the implantation of pedicled iliac bone graft with ascending branch of lateral femoral circumflex artery in treatment of intermediate stage osteonecrosis of the femoral head for younger.
引文
1. Mont MA. Hungerford DS. J Bone Joint Surg (Am),1995,77(3):459-474.
2. Ficat RP.Idiopathic bonenecrosis of the femoral head:Early diagnosis and treatment [J]. JBone Joint Surg(Br) 1985,67(1):3-9
3. Arlet J, Ficat P. Biopsy Drilling as a means of early diagnosis. Idiopthic Ischemic Necrosis of Femoral Head in Adult.In:Zinn WMed, Baltimore:University Park Press,1971,74-80.
4. Sugioka Yet al. Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head [J]. Clin Orthop,1992,277: 111.
5. Schneider W.Aigner N,Pinggem o et.al.Intertrochanterie osteotomy for avascular necrosis of the head of the femur:Survival probability of two different methods[J]. J Bone Joint Surg Br,2002,84(6):817-824.
6. Yasunaga Y,Hisatome T.Ikuta Y,et.al. A histological study of the necrotic area after transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head [J].J Bone Joint Surg(Br),2002,83-167.
7.何伟,袁浩,李雄,等.多条血管束植入治疗成人股骨头坏死的远期疗效观察[J].骨关节损伤杂志,2000,15(4)：261-262.
8.范丽娟,苏奇,佘焕群.多组血管束植入股骨头修整与再造治疗中晚期股骨头缺血性坏死[J].骨与关节损伤杂志,2003,18(9)：596-597.
9.赵德伟,王卫明,王本杰,等.保留股骨头手术治疗股骨头缺血性坏死1005例临床分析.中华外科杂志,2005,43(16)：1054.23.
10.赵德伟徐传达崔旭.股骨头不同区域囊变对力学承载的影响J.中华骨科杂志2005,25(4)232.
11. Judet H, Gilbert A. Long-term results of free vascularized fibular grafting for femoral head necrosis. Clin Orthop,2001, (386):114-119
1. Fuchs B, Knothe U, Hertel R, et al. Femoral osteotomy and iliac graft vascularization for femoral head osteonecrosis. Clin Orthop,2003,4(12):84-93.
2. 王岩,朱盛修,袁浩等.成人股骨头缺血性坏死疗效评价草案[J],骨与关节损伤杂志,1994.9(2)：142.
3. 赵德伟主编骨坏死人民卫生出版社,2004.
4. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fracture:Treatment by mold arthroplasty. J Bone Joint Surg,1969,51 A:737-755.
5. 赵德伟：王卫明；王本杰.保留股骨头手术治疗股骨头缺血性坏死1005例临床分析,中华外科杂志,2005,16：1054-57.
6. 赵德伟,主编.股骨头缺血性坏死的修复与再造 [M]第1版北京：人民卫生出版社,2005：57
7. 曾可明,雀金军.非创伤性骨坏死的病因及发病机理国外研究概况,广西医学,1998,20(6).
8. 刘万林,郭文通.激素性股骨头缺血性坏死发病机理及研究进展.中国矫形外科杂志,2000,7：169-173.
9. 程少丹李武军杨豪激素性股骨头坏死发病机制研究进展.中医正骨2002,14(7).
10. Glickstein MF, Burk DI, Schiebler ML, et al. Avascular necrosis versus other diseases of the hip:Sensitivity of. MRI Radiology,1988,169 (1):213-216.
11.赵培荣庄奇新乔瑞华杨世勋张长青股骨头缺血坏死骨髓水肿的MRI研究实用放射学杂志20067.
12. Ficat P, Arlet J. Ischemia and necrosis of bone. Baltimore:Williams& Wilkins, 1980,95.
13. ARCO (Association Research Circulation Organization). Committee on terminology and classification. ARCO News,1992,4:41.
14. Mont MA. Hungefford DS. Current concepts review:non-traumatic avasculai necrosis of the femoral head. J Bone Joint Surg 1995:77A 459-74
15.赵德伟王卫明陈要武带旋股外侧血管升支髂嵴支和髂前下棘支双骨膜瓣的应用解剖中国临床解剖学杂志2003 21(3)211-213
16.李军伟翁习生邱贵兴股骨头缺血性坏死的外科治疗进展中华骨科杂志2002 22(7)437-439.
17. Eisenschenk A, Lautenbach M. Schwetlick G,et al. Treatment of femoral head necrosis with vascularized iliac crest transplants. Clin Orthop,2001, 386:100-105.
18. Jay R, Lieberman MD, Core decompression for osteonecrosis of the hip, Clin Orthop,2004,(418):29-33.
19.王卫明 赵德伟 髓芯减压自体骨髓细胞结合重组合异种骨移植 中国骨与关节损伤杂志 2005 20(2)100-101
20. Urbaniak JR, Harvey EJ:Revascularization of the femoral head in osteonecrasis. J Am Acad Orthop Surg.6:44-54,1998.
21. Yoo MG, Chung DW, Han CS:Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head. Clin Orthop.277:128-138,1992.
22..Eisenschenk A, Lautenbach M, Schwetlick G, et al. Treatment of femoral head necrosis with vascularized iliac crest transplants. Clin Orthop,2001, 386:100-105.
2. Ficat RP.Idiopathic bonenecrosis of the femoral head:Early diagnosis and treatment [J]. JBone Joint Surg(Br) 1985,67(1):3-9
3. Arlet J, Ficat P. Biopsy Drilling as a means of early diagnosis. Idiopthic Ischemic Necrosis of Femoral Head in Adult.In:Zinn WMed, Baltimore:University Park Press,1971,74-80.
4. Sugioka Yet al. Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head [J]. Clin Orthop,1992,277: 111.
5. Schneider W.Aigner N,Pinggem o et.al.Intertrochanterie osteotomy for avascular necrosis of the head of the femur:Survival probability of two different methods[J]. J Bone Joint Surg Br,2002,84(6):817-824.
6. Yasunaga Y,Hisatome T.Ikuta Y,et.al. A histological study of the necrotic area after transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head [J].J Bone Joint Surg(Br),2002,83-167.
7.何伟,袁浩,李雄,等.多条血管束植入治疗成人股骨头坏死的远期疗效观察[J].骨关节损伤杂志,2000,15(4)：261-262.
8.范丽娟,苏奇,佘焕群.多组血管束植入股骨头修整与再造治疗中晚期股骨头缺血性坏死[J].骨与关节损伤杂志,2003,18(9)：596-597.
9.赵德伟,王卫明,王本杰,等.保留股骨头手术治疗股骨头缺血性坏死1005例临床分析.中华外科杂志,2005,43(16)：1054.23.
10.赵德伟徐传达崔旭.股骨头不同区域囊变对力学承载的影响J.中华骨科杂志2005,25(4)232.
11. Judet H, Gilbert A. Long-term results of free vascularized fibular grafting for femoral head necrosis. Clin Orthop,2001, (386):114-119
1. Fuchs B, Knothe U, Hertel R, et al. Femoral osteotomy and iliac graft vascularization for femoral head osteonecrosis. Clin Orthop,2003,4(12):84-93.
2. 王岩,朱盛修,袁浩等.成人股骨头缺血性坏死疗效评价草案[J],骨与关节损伤杂志,1994.9(2)：142.
3. 赵德伟主编骨坏死人民卫生出版社,2004.
4. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fracture:Treatment by mold arthroplasty. J Bone Joint Surg,1969,51 A:737-755.
5. 赵德伟：王卫明；王本杰.保留股骨头手术治疗股骨头缺血性坏死1005例临床分析,中华外科杂志,2005,16：1054-57.
6. 赵德伟,主编.股骨头缺血性坏死的修复与再造 [M]第1版北京：人民卫生出版社,2005：57
7. 曾可明,雀金军.非创伤性骨坏死的病因及发病机理国外研究概况,广西医学,1998,20(6).
8. 刘万林,郭文通.激素性股骨头缺血性坏死发病机理及研究进展.中国矫形外科杂志,2000,7：169-173.
9. 程少丹李武军杨豪激素性股骨头坏死发病机制研究进展.中医正骨2002,14(7).
10. Glickstein MF, Burk DI, Schiebler ML, et al. Avascular necrosis versus other diseases of the hip:Sensitivity of. MRI Radiology,1988,169 (1):213-216.
11.赵培荣庄奇新乔瑞华杨世勋张长青股骨头缺血坏死骨髓水肿的MRI研究实用放射学杂志20067.
12. Ficat P, Arlet J. Ischemia and necrosis of bone. Baltimore:Williams& Wilkins, 1980,95.
13. ARCO (Association Research Circulation Organization). Committee on terminology and classification. ARCO News,1992,4:41.
14. Mont MA. Hungefford DS. Current concepts review:non-traumatic avasculai necrosis of the femoral head. J Bone Joint Surg 1995:77A 459-74
15.赵德伟王卫明陈要武带旋股外侧血管升支髂嵴支和髂前下棘支双骨膜瓣的应用解剖中国临床解剖学杂志2003 21(3)211-213
16.李军伟翁习生邱贵兴股骨头缺血性坏死的外科治疗进展中华骨科杂志2002 22(7)437-439.
17. Eisenschenk A, Lautenbach M. Schwetlick G,et al. Treatment of femoral head necrosis with vascularized iliac crest transplants. Clin Orthop,2001, 386:100-105.
18. Jay R, Lieberman MD, Core decompression for osteonecrosis of the hip, Clin Orthop,2004,(418):29-33.
19.王卫明 赵德伟 髓芯减压自体骨髓细胞结合重组合异种骨移植 中国骨与关节损伤杂志 2005 20(2)100-101
20. Urbaniak JR, Harvey EJ:Revascularization of the femoral head in osteonecrasis. J Am Acad Orthop Surg.6:44-54,1998.
21. Yoo MG, Chung DW, Han CS:Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head. Clin Orthop.277:128-138,1992.
22..Eisenschenk A, Lautenbach M, Schwetlick G, et al. Treatment of femoral head necrosis with vascularized iliac crest transplants. Clin Orthop,2001, 386:100-105.