Technical summary and modified instruments of free vascularized fibular grafting for osteonecrosis of femoral head_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DONGShuai ,  CAIXiyu , ZHUZhengwei

Department of Orthopaedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China;

Corresponding?author：

CAIXiyu, Email: caixirain@163.com

Keywords：

Free vascularized fibular grafting; osteonecrosis of femoral head; surgical instruments

DOI：

10.7507/1002-1892.201608131

Video：

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Objective To summarize retrospectively the clinical technology of repairing osteonecrosis of femoral head (ONFH) by free vascularized fibular grafting (FVFG), and the value of modified instruments in operation. Methods Between March 2011 and January 2013, 35 patients with ONFH (47 hips) who underwent FVFG with modified instruments. There were 24 males (32 hips) and 11 females (15 hips), aged 34 years on average (range, 22-43 years). The unilateral hip was involved in 23 cases and the bilateral hips in 12 cases. The disease duration ranged from 5 to 9 months (mean, 7 months). Based on etiology, 25 hips were classified as alcohol ONFH, 12 hips as corticosteroids ONFH, 3 hips as trauma ONFH, and 7 hips as idiopathic ONFH. According to the Association Research Circulation Osseous(ARCO) stage, 3 hips were rated as stage I, 39 hips as stage II, and 5 hips as stage III on the X-ray films. The preoperative Harris score was 58.2±6.1. Results The time to get fibula was 15-35 minutes (mean, 25 minutes). The operation time was 90-200 minutes (mean, 130 minutes), and the blood loss during operation was 150-500 mL (mean, 270 mL). All the patients achieved primary healing of incision, without complication of infection or deep vein thrombosis. All 35 patients were followed up 12-42 months, with an average of 28 months. The Harris score at final follow-up was 87.3±5.7, showing significant difference when compared with preoperative score (t=102.038,P=0.000). Radiographic results at final follow-up showed good position of fibula; and necrosis was improved in 9 hips, had no changes in 36 hips, and aggravated in 2 hips. Conclusion FVFG for ONFH can improve hip function effectively, and modified instruments can improve operation efficiency.

Citation： DONGShuai, CAIXiyu, ZHUZhengwei. Technical summary and modified instruments of free vascularized fibular grafting for osteonecrosis of femoral head. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(2): 129-133. doi: 10.7507/1002-1892.201608131 Copy

1.	Garrigues GE, Aldridge JM 3rd, Friend JK, et al. Free Vascularized Fibular Grafting for treatment of osteonecrosis of the femoral head secondary to hip dislocation. Microsurgery, 2009, 29(5): 342-345.
2.	童德迪, 陳山林, 榮艷波, 等. 術中三維計算機導航輔助吻合血管的腓骨移植治療股骨頭缺血壞死的臨床研究. 中華顯微外科雜志, 2014, 37(4): 328-333.
3.	劉曉琳, 盛加根, 張長青, 等. 單側供體吻合血管游離腓骨移植治療雙側股骨頭缺血性壞死. 中國修復重建外科雜志, 2011, 25(6): 641-645.
4.	Yoo MC, Kim KI, Hahn CS, et al. Long-term followup of vascularized fibular grafting for femoral head necrosis. Clin Orthop Relat Res, 2008, 466(5): 1133-1140.
5.	田雷, 王坤正, 黨曉謙, 等. 吻合血管游離腓骨移植治療股骨頭壞死的中期及遠期療效評估. 中華關節外科雜志(電子版), 2012, 6(6): 879-887.
6.	Gao YS, Chen SB, Jin DX, et al. Modified surgical techniques of free vascularized fibular grafting for treatment of the osteonecrosis of femoral head: results from a series of 407 cases. Microsurgery, 2013, 33(8): 646-651.
7.	馬元琛, 廖俊星, 林楨, 等. 鉭棒與髓芯減壓植骨治療早中期股骨頭壞死的療效比較. 廣東醫學, 2014, 35(13): 2101-2103.
8.	趙德偉, 謝輝, 王本杰, 等. 帶血管蒂髂骨瓣轉移聯合多孔鉭金屬棒植入治療股骨頭缺血性壞死. 中華顯微外科雜志, 2014, 37(1): 29-34.
9.	康凱, 邵林, 韓劍鋒, 等. 應用骨髓間充質干細胞治療股骨頭壞死的研究進展. 山西醫科大學學報, 2016, 47(2): 187-191.
10.	楊健, 袁冰, 韋卓, 等. 吻合血管游離腓骨移植治療股骨頭壞死近期臨床療效分析. 生物骨科材料與臨床研究, 2016, 13(2): 59-62.
11.	Woodhouse AG, Drake ML, Lee GC, et al. Free vascularized fibular grafts for femoral head osteonecrosis: alternative technique utilizing a buttress plate for graft fixation. J Surg Orthop Adv, 2015, 24(2): 144-146.
12.	呂玉明, 程立明, 裴國獻, 等. 改良游離腓骨移植結合含BMP異體骨治療股骨頭壞死. 實用醫學雜志, 2011, 27(11): 1985-1987.
13.	趙德偉. 帶血管蒂骨瓣移植治療股骨頭壞死的經驗與技巧. 中華顯微外科雜志, 2009, 32(4): 265-266.
14.	陳勝寶, 張長青, 金東旭, 等. 影響吻合血管腓骨移植治療股骨頭壞死療效的相關因素分析. 中華顯微外科雜志, 2009, 32(4): 267-270.
15.	徐佩君, 盛加根, 徐鎮, 等. 不斷股直肌起點髖前側入路行吻合血管游離腓骨治療股骨頭壞死的解剖學研究. 中華關節外科雜志(電子版), 2014, 8(5): 574-577.
16.	費騰, 陳增淦, 張璟, 等. 改良吻合血管腓骨移植治療股骨頭缺血性壞死. 中華顯微外科雜志, 2015, 38(3): 222-225.
17.	Eward WC, Rineer CA, Urbaniak JR, et al.The vascularized fibular graft in precollapse osteonecrosis: is long-term hip preservation possible? Clin Orthop Relat Res, 2012, 470(10): 2819-2826.
18.	顏廷衛, 孫雪生, 王朝亮. 吻合血管腓骨移植聯合DBM及自體多能干細胞混合性植入治療ARCOⅡ~Ⅲ期非創傷性股骨頭壞死. 中國矯形外科雜志, 2014, 22(21): 1958-1962.

1. Garrigues GE, Aldridge JM 3rd, Friend JK, et al. Free Vascularized Fibular Grafting for treatment of osteonecrosis of the femoral head secondary to hip dislocation. Microsurgery, 2009, 29(5): 342-345.
2. 童德迪, 陳山林, 榮艷波, 等. 術中三維計算機導航輔助吻合血管的腓骨移植治療股骨頭缺血壞死的臨床研究. 中華顯微外科雜志, 2014, 37(4): 328-333.
3. 劉曉琳, 盛加根, 張長青, 等. 單側供體吻合血管游離腓骨移植治療雙側股骨頭缺血性壞死. 中國修復重建外科雜志, 2011, 25(6): 641-645.
4. Yoo MC, Kim KI, Hahn CS, et al. Long-term followup of vascularized fibular grafting for femoral head necrosis. Clin Orthop Relat Res, 2008, 466(5): 1133-1140.
5. 田雷, 王坤正, 黨曉謙, 等. 吻合血管游離腓骨移植治療股骨頭壞死的中期及遠期療效評估. 中華關節外科雜志(電子版), 2012, 6(6): 879-887.
6. Gao YS, Chen SB, Jin DX, et al. Modified surgical techniques of free vascularized fibular grafting for treatment of the osteonecrosis of femoral head: results from a series of 407 cases. Microsurgery, 2013, 33(8): 646-651.
7. 馬元琛, 廖俊星, 林楨, 等. 鉭棒與髓芯減壓植骨治療早中期股骨頭壞死的療效比較. 廣東醫學, 2014, 35(13): 2101-2103.
8. 趙德偉, 謝輝, 王本杰, 等. 帶血管蒂髂骨瓣轉移聯合多孔鉭金屬棒植入治療股骨頭缺血性壞死. 中華顯微外科雜志, 2014, 37(1): 29-34.
9. 康凱, 邵林, 韓劍鋒, 等. 應用骨髓間充質干細胞治療股骨頭壞死的研究進展. 山西醫科大學學報, 2016, 47(2): 187-191.
10. 楊健, 袁冰, 韋卓, 等. 吻合血管游離腓骨移植治療股骨頭壞死近期臨床療效分析. 生物骨科材料與臨床研究, 2016, 13(2): 59-62.
11. Woodhouse AG, Drake ML, Lee GC, et al. Free vascularized fibular grafts for femoral head osteonecrosis: alternative technique utilizing a buttress plate for graft fixation. J Surg Orthop Adv, 2015, 24(2): 144-146.
12. 呂玉明, 程立明, 裴國獻, 等. 改良游離腓骨移植結合含BMP異體骨治療股骨頭壞死. 實用醫學雜志, 2011, 27(11): 1985-1987.
13. 趙德偉. 帶血管蒂骨瓣移植治療股骨頭壞死的經驗與技巧. 中華顯微外科雜志, 2009, 32(4): 265-266.
14. 陳勝寶, 張長青, 金東旭, 等. 影響吻合血管腓骨移植治療股骨頭壞死療效的相關因素分析. 中華顯微外科雜志, 2009, 32(4): 267-270.
15. 徐佩君, 盛加根, 徐鎮, 等. 不斷股直肌起點髖前側入路行吻合血管游離腓骨治療股骨頭壞死的解剖學研究. 中華關節外科雜志(電子版), 2014, 8(5): 574-577.
16. 費騰, 陳增淦, 張璟, 等. 改良吻合血管腓骨移植治療股骨頭缺血性壞死. 中華顯微外科雜志, 2015, 38(3): 222-225.
17. Eward WC, Rineer CA, Urbaniak JR, et al.The vascularized fibular graft in precollapse osteonecrosis: is long-term hip preservation possible? Clin Orthop Relat Res, 2012, 470(10): 2819-2826.
18. 顏廷衛, 孫雪生, 王朝亮. 吻合血管腓骨移植聯合DBM及自體多能干細胞混合性植入治療ARCOⅡ~Ⅲ期非創傷性股骨頭壞死. 中國矯形外科雜志, 2014, 22(21): 1958-1962.

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Technical summary and modified instruments of free vascularized fibular grafting for osteonecrosis of femoral head

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