摘要目的 探讨吻合旋髂深血管的游离髂骨瓣移植治疗股骨头坏死(ONFH)的可行性及临床效果.方法 2016年4月至2017年7月,收治ONFH患者12例(13 髋),患髋 Harris 评分:Arco 分期二期患者平均(74.7±6.9)分,三期患者平均(68.6±9.2)分.坏死病灶清除后,设计对侧髂骨瓣游离移植,将旋髂深动、静脉分别与旋股外侧动脉横支(或升支)及其伴行静脉吻合.术后"人"形支具固定髋部3周,分别于术后1、3、6、9、12个月行X线片检查了解髂骨瓣愈合及股骨头恢复情况.术后6、12 个月行Harris 评分了解髋关节功能恢复情况,并进行统计学分析,P＜0.05为差异有统计学意义.结果 本组术后随访平均15(12~20)个月,所有患者移植髂骨瓣均愈合良好,除1髋因负重过早出现轻度塌陷,其余12髋股骨头未见继发坏死与塌陷;Arco分期二期患者术后Harris评分平均为(91.6±4.5)分,三期平均为(84.8±6.1)分,与术前相比,差异均有统计学意义(P＜0.05).结论 吻合旋髂深血管的髂骨瓣移植可能是一种治疗中、晚期股骨头缺血性坏死的可靠方法.

abstractsTo 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 ves-sels 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 con-comitant vein respectively. The herringbone brace was used for hip fixation for 3 weeks after operation. X-ray exami-nation (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 fol-lowed-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.