Objective: To assess the long-term effectiveness of the transplantation of iliac bone flap pedicled with deep iliac circumflex vessels for treating avascular necrosis of femoral head (ANFH) at Ficat stage II and III.
Methods: Thirty-two cases (43 hips) of ANFH underwent iliac bone flap transplantation pedicled with deep iliac circumflex vessels between October 2000 and February 2006, and the clinical data were retrospectively reviewed. Of 32 cases, 27 were male (38 hips), and 5 were female (5 hips), aged 21-52 years (mean, 36.6 years); there were 8 cases (11 hips) of hormone ANFH, 18 cases (23 hips) of alcoholic ANFH, and 6 cases (9 hips) of idiopathic ANFH. The disease duration ranged from 2-52 months (mean, 8.2 months). According to Ficat staging criteria, 26 hips were classified as stage II and 17 hips as stage III. The preoperative Harris hip score (HSS) was 68.2±8.4. The HHS scores and X-ray photograph were compared between at pre- and post-operation to assess the outcomes clinically and radiologically.
Results: All incisions healed by first intention. Two cases had numbness of the lateral femoral skin. Four patients (6 hips) failed to be followed up, and the other 28 cases were followed up 98-187 months (mean, 129.3 months). Five patients (6 hips) showed aggravation or no relief with progression to stage IV at 8-69 months, who received total hip arthroplasty. The 10-year survival rate was 83.78% (31/37). The HHS score was significantly increased to 86.7±9.0 at last follow-up (t=-48.313, P=0.000). The hip function was excellent in 9 hips, good in 13 hips, and fair in 9 hips, and the success rate was 75.68%. Radiographic examination showed signs of bone remodeling at 6-8 weeks. After bone healing, the femoral head density gradually became uniform. Until last follow-up, ANFH progressed from Ficat stage II to III in 5 hips, from Ficat stage II to IV in 3 hips, and from Ficat stage III to IV in 3 hips; complete hip shape, continuous Shenton line, and normal joint space were observed in the other 26 hips, and the radiographic success rate was 70.27% (26/37).
Conclusions: The pedicled iliac bone flap transplantation for ANFH at Ficat stage II and III can provide good osteogenesis and vascular reconstruction of the femoral head. The long-term follow-up effectiveness is satisfactory.
目的: 探讨带旋髂深血管蒂髂骨瓣植入治疗FicatⅡ、Ⅲ期股骨头缺血性坏死（avascular necrosis of femoral head，ANFH）的远期疗效。.
方法: 回顾分析2000年10月-2006年2月，采用带旋髂深血管蒂髂骨瓣植入术治疗并获随访的FicatⅡ、Ⅲ期ANFH 32例（43髋）。其中男27例（38髋），女5例（5髋）；年龄21～52岁，平均36.6岁。病因：激素性8例（11髋），酒精性18例（23髋），特发性6例（9髋）。病程2～52个月，平均8.2个月。依照骨坏死Ficat分期标准：Ⅱ期26髋，Ⅲ期17髋。术前患髋Harris功能评分（Harris hip score，HHS）为（68.2±8.4）分。依据手术前后HHS评分变化和X线片改变进行临床疗效评价和影像学评价。.
结果: 术后切口均Ⅰ期愈合。除2例发生大腿前外侧皮肤麻木外，无其他手术相关并发症发生。4例（6髋）失访，其余患者获随访，随访时间98～187个月，平均129.3个月。5例（6髋）术后症状无缓解或加重，8～69个月时进展至Ⅳ期，行人工全髋关节置换术；余23例（31髋）未行进一步髋部手术；股骨头10年生存率83.78%（31/37）。末次随访时，23例（31髋）HHS评分为（86.7±9.0）分，与术前比较差异有统计学意义（t=-48.313，P=0.000）；获优9髋、良13髋、可9髋；治疗成功率75.68%（28/37）。影像学检查示6～8周植骨区开始骨重建迹象，成骨后股骨头密度逐渐变均匀。至末次随访时5髋Ficat Ⅱ期进展至Ⅲ期，3髋Ficat Ⅱ期进展至Ⅳ期，3髋Ficat Ⅲ期进展至Ⅳ期；余26髋外形完整，Shenton线基本连续，关节间隙亦未见明显狭窄，影像学成功率为70.27%（26/37）。.
结论: 带旋髂深血管蒂髂骨瓣植入治疗FicatⅡ、Ⅲ期ANFH ，能够实现良好的成骨和血管重建作用，远期疗效满意。.
Keywords: Avascular necrosis of femoral head; Long-term effectiveness; Vascular pedicled periosteal flap.