Free graft of vascularized iliac bone flap based on deep iliac circumflex vessels for the treatment of osteonecrosis of the femoral head

中华显微外科杂志 Pub Date : 2019-08-25 DOI:10.3760/CMA.J.ISSN.1001-2036.2019.04.001

Ju-yu Tang, Wei Du, Panfeng Wu, Zheng-bing Zhou, Fang Yu, X. Pang, Lei Zeng, Ding Pan, Yongbing Xiao, Rui Liu, Li-ming Qing, Ou Qifeng, Xing Zhang

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Abstract

Objective To investigate the feasibility and clinical efficacy of free graft of vascularized iliac bone flap based on deep iliac circumflex vessels for the treatment of osteonecrosis of femoral head (ONFH). Methods Twelve cases of ONFH (13 hips) received free graft of vascularized iliac bone flap based on deep iliac circumflex vessels from April, 2016 to July, 2017. The average Harris score was (74.7±6.9) in the second stage and (68.6±9.2) in the third stage. After debriding the necrosis bone of the femoral head, the contralateral vascularized iliac bone flap had been harvested, and then implanted into the femoral head. The deep iliac circumflex artery and its accompanying vein were anastomosed with the transverse branch (or ascending branch) of the lateral circumflex femoral artery and concomitant vein respectively. The herringbone brace was used for hip fixation for 3 weeks after operation. X-ray examination(1, 3, 6, 9 and 12 months after operation, respectively) and Harris hip score (6 and 12 months after operation, respectively) were performed to evaluate the recovery results of the femoral head. Scores were recorded and analyzed by paired t-test. The difference was considered to statistically significant if P<0.05. Results The patients were followed-up for 15 (12-20) months. The iliac bone flap of 12 patients (13 hips) healed well. There was no necrosis and collapse in 12 hips, except 1 femoral head collapsed slightly because of weight loading too early. The average Harris score was (91.6±4.5) of the second stage and (84.8±6.1) of the third stage. Compared with scores before the operation, the difference was statistically significant (P<0.05). Conclusion Free vascularized iliac bone grafting based on deep iliac circumflex vessels is an ideal treatment for ONFH head in middle and advanced stage. Key words: Osteonecrosis of the femoral head; Iliac bone flap; Deep iliac circumflex vessels; Transplantation; Harris hip score

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旋髂深血管带血管髂骨瓣游离移植治疗股骨头坏死

目的探讨旋髂深血管带血管髂骨瓣游离移植治疗股骨头坏死的可行性和临床疗效。方法自2016年4月至2017年7月，对12例（13髋）ONFH患者采用旋髂深血管带血管髂骨瓣游离移植。Harris评分第二阶段为（74.7±6.9），第三阶段为（68.6±9.2）。股骨头坏死骨切除后，取对侧带血管的髂骨瓣，植入股骨头。旋髂深动脉及其伴行静脉分别与旋股外侧动脉和伴行静脉的横支（或升支）吻合。术后应用人字形支架髋关节固定3周。分别在术后1、3、6、9和12个月进行X线检查和Harris髋关节评分（分别在术前6和12个月中），以评估股骨头的恢复结果。通过配对t检验记录和分析得分。如果P＜0.05，则认为差异具有统计学意义。结果随访15个月（12～20个月）。12例（13髋）患者髂骨瓣愈合良好。除1例股骨头因负荷过重过早而轻微塌陷外，其余12例髋关节无坏死塌陷。Harris评分第二阶段为（91.6±4.5），第三阶段为（84.8±6.1）。结论旋髂深血管游离带血管髂骨移植术是治疗中晚期股骨头缺血性坏死的理想方法。关键词：股骨头坏死；髂骨瓣；旋髂深血管；移植；Harris髋关节评分

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来源期刊

中华显微外科杂志

CiteScore

0.50

自引率

0.00%

发文量

6448

期刊介绍： Chinese Journal of Microsurgery was established in 1978, the predecessor of which is Microsurgery. Chinese Journal of Microsurgery is now indexed by WPRIM, CNKI, Wanfang Data, CSCD, etc. The impact factor of the journal is 1.731 in 2017, ranking the third among all journal of comprehensive surgery. The journal covers clinical and basic studies in field of microsurgery. Articles with clinical interest and implications will be given preference.