自研取骨器在带血管蒂腓骨瓣治疗股骨头坏死中的应用

目的探讨自研取骨器在带血管蒂腓骨瓣移植（FVFG）治疗股骨头无菌性坏死（ONFH）中的临床应用效果。方法回顾性分析2011年10月至2018年11月中国人民解放军火箭军特色医学中心收治的股骨头无菌性坏死患者18例（20髋），根据国际骨循环协会（ARCO）分期标准：Ⅱ期9髋，Ⅲ期9髋，Ⅳ期2髋。采用自主研发并申请专利的取骨器制备股骨颈骨隧道，取腓骨行FVFG治疗ONFH，术前及术后采用Harris评分进行评估。结果患者均获随访，随访时间21 ～ 62 个月，平均39 个月。患者18 例（20 髋）术前髋关节Harris 评分为（78.60±9.19）分。手术时间280 ～ 670 min，平均381 min。术中出血量200 ～ 800 mL，平均450 mL。术后1例出现窦道、组织坏死，多次清创后治愈，其余患者甲级愈合。术后复查X片显示腓骨瓣均达到骨性融合，位置良好，末次随访结果示股骨头坏死程度改善15 髋，无进展4 髋，进展1 髋，有效率95%，Harris 评分为（89.05±6.51）分，优良率90%，髋关节疼痛、关节活动度均有不同程度改善，与术前比较差异有统计学意义（t=4.19，P=0.000 5）。结论自研取骨器可精确设计股骨颈骨道、减少骨质浪费，可辅助FVFG有效治疗股骨头无菌性坏死。

英文摘要:

Objective To investigate the clinical advantage of autogenous bone harvester invented for the treatment of osteonecrosis of the femoral head (ONFH) with free vascularized fibular grafting (FVFG). Methods From October 2011 to November 2018, 18 patients (20 hips) with osteonecrosis of the femoral head were treated in PLA Rocket Force Characteristic Medical Center. According to the Association Research Circulation Osseous (ARCO) standard: 9 hips in stage Ⅱ, 9 hips in stage Ⅲ and 2 hips in stage Ⅳ. Autogenous bone harvester invented was used to prepare the bone canal for fibula on FVFG operation. The Harris score was used for evaluation before and after operation. Results The follow-up time ranged from 21 to 62 months, with an average of 39 months. The Harris score of 18 patients (20 hips) was (78.60±9.19) points before operation. The operation time was 280-670 min, with an average of 381 min. The intraoperative blood loss was 200-800 mL, with an average of 450 mL. All patients were healed except one case developed sinus and tissue necrosis which was cured after multiple debridement. X-ray examination showed that all the grafted fibular were in good position and achieved bone fusion. At the final follow-up, femoral head necrosis improved in 15 hips, no progress in 4 hips and progress in 1 hip, the efficient rate was 95%. Hip pain and joint range of motion at the final follow-up were improved with the Harris score of (89.05±6.51) points, the excellent and good rate was 90%. The difference was statistically significant(t=4.19, P=0.000 5) compared with the preoperative condition. Conclusion The autogenous bone harvester prepared the bone canal of femoral neck for fibular accurately and decreased the waste of bones. In general, it is helpful for FVFG in the treatment of ONFH.

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