【摘要】：目的總結(jié)吻合血管游離腓骨移植(free vascularized fibular grafting,FVFG)治療股骨頭缺血性壞死(osteonecrosis of femoral head,ONFH)的臨床技術(shù),以及改進的手術(shù)器械在術(shù)中應(yīng)用價值。方法2011年3月—2013年1月,采用改進的手術(shù)器械行FVFG治療ONFH患者35例(47髖)。男24例(32髖),女11例(15髖);年齡22~43歲,平均34歲。單髖23例,雙髖12例。病程5~9個月,平均7個月。ONFH類型:酒精性25髖,激素性12髖,創(chuàng)傷性3髖,特發(fā)性7髖。術(shù)前行X線片檢查,根據(jù)國際骨循環(huán)協(xié)會(ARCO)分期標準:Ⅰ期3髖,Ⅱ期39髖,Ⅲ期5髖。術(shù)前髖關(guān)節(jié)Harris評分為(58.2±6.1)分。結(jié)果術(shù)中切取腓骨時間為15~35 min,平均25 min;手術(shù)時間90~200 min,平均130 min。術(shù)中出血量為150~500 m L,平均270 m L。術(shù)后切口均Ⅰ期愈合,無感染、下肢深靜脈血栓形成等并發(fā)癥發(fā)生。患者均獲隨訪,隨訪時間12~42個月,平均28個月。末次隨訪時Harris評分為(87.3±5.7)分,較術(shù)前顯著提高,比較差異有統(tǒng)計學(xué)意義(t=102.038,P=0.000)。X線片復(fù)查示,腓骨瓣位置良好,末次隨訪時股骨頭壞死改善9髖,無進展36髖,進展2髖。結(jié)論采用FVFG治療ONFH能有效改善患者髖關(guān)節(jié)功能,術(shù)中應(yīng)用改進的手術(shù)器械能提高手術(shù)效率。
[Abstract]:Objective to summarize the clinical technique of vascularized fibula transplantation (free vascularized fibular grafting,FVFG) in the treatment of avascular necrosis of the femoral head (osteonecrosis of femoral head,ONFH) and the value of the improved surgical instruments in the operation. Methods from March 2011 to January 2013, 35 patients (47 hips) with ONFH were treated with FVFG. There were 24 males (32 hips) and 11 females (15 hips), aged 2243 years (mean 34 years). There were 23 cases with single hip and 12 cases with double hip. The course of disease ranged from 5 to 9 months (mean 7 months). ONFH type: alcoholic 25 hips, steroid 12 hips, traumatic 3 hips, idiopathic 7 hips. X-ray examination was performed before operation. According to the (ARCO) staging criteria of the International Bone Circulation Association, there were 3 hips in stage 鈪，

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