Objective: To observe the effectiveness of digital subtraction angiography (DSA) assisted musculoskeletal flap transplantation in the treatment of osteonecrosis of the femoral head (ONFH).
Methods: The clinical data of 15 patients with 15 hips of ONFH admitted between January 2016 and December 2019 were retrospectively analyzed. All patients were male, aged 20-45 years, with an average age of 31.6 years. There were hormone type in 9 cases and alcohol type in 6 cases. The disease duration ranged from 15 days to 3 years, with an average of 8 months. The Association Research Circulation Osseous (ARCO) staging: 4 hips in stage Ⅱ, 11 hips in stage Ⅲ. The preoperative visual analogue scale (VAS) score was 6.2±0.2, and the Harris score of the hip joint was 57.3±1.3. Preoperative DSA examination of the femoral head was performed to determine the location of vascular lesions of the femoral head. According to the results of the angiography, the surgical selection of the musculoskeletal flap was guided. For the patients with both superior and inferior retinaculum vessels developed, simple core decompression was performed. For the patients with superior retinaculum vessels developed but inferior retinaculum vessels not developed, anterolateral tensor fasciae flap was used. For the patients whose superior retinaculum did not develop and the inferior retinaculum developed, posterolateral quadratus femoris flap was used. The fibular flap with anastomotic vessels was used in the patients whose superior and inferior retinaculum vessels were not developed.
Results: All 15 cases of 15 hips were followed up 6-24 months, with an average of 14 months. During the follow-up, the patient's ONFH did not worsen, the femoral head did not collapse, the joint space was normal, and the hip joint fextion and extension function was acceptable. At last follow-up, the VAS score was 1.9±0.2, and the hip Harris score was 92.1±0.8, both of which were significantly improved when compared with preoperative ones ( t=14.85, P=0.00; t=23.22, P=0.00).
Conclusion: For patients with ONFH who need musculoskeletal flap transplantation, preoperative DSA of femoral head can determine the location of vascular lesions of femoral head, so as to guide the selection of musculoskeletal flap transplantation, which is of great significance for hip-conserving surgery.
目的: 观察数字减影血管造影（digital subtraction angiography，DSA）技术辅助肌骨瓣移植治疗股骨头坏死（osteonecrosis of the femoral head，ONFH）的临床疗效。.
方法: 回顾分析 2016 年 1 月—2019 年 12 月收治的 15 例 15 髋 ONFH 患者临床资料。患者均为男性，年龄 20～45 岁，平均 31.6 岁。病因：激素型 9 例，酒精型 6 例。病程 15 d～3 年，平均 8 个月。国际骨循环协会（ARCO）分期：Ⅱ期 4 髋，Ⅲ期 11 髋。术前疼痛视觉模拟评分（VAS）为（6.2±0.2）分，髋关节 Harris 评分为（57.3±1.3）分。术前行股骨头 DSA 检查确定股骨头血管病变部位，根据造影结果指导肌骨瓣移植术式的选择。对于股骨头上、下支持带血管均显影者行单纯髓芯减压术，对上支持带血管显影而下支持带血管未显影者采用前外侧入路的阔筋膜张肌骨瓣移植，对上支持带血管不显影而下支持带血管显影者采用经后外侧入路的股方肌骨瓣移植，对上、下支持带血管均未显影者行吻合血管的腓骨瓣移植。.
结果: 15 例 15 髋均获随访，随访时间 6～24 个月，平均 14 个月。随访期间患者 ONFH 未进一步加重，股骨头无塌陷，关节间隙正常，髋关节屈伸功能可。末次随访时，VAS 评分为（1.9±0.2）分，髋关节 Harris 评分为（92.1±0.8）分，均较术前显著改善，差异有统计学意义（ t=14.85， P=0.00； t=23.22， P=0.00）。.
结论: 对于需行肌骨瓣移植的 ONFH 患者，术前行股骨头 DSA 可明确股骨头血管病变部位，以此指导肌骨瓣移植术式的选择，对保髋手术具有重要意义。.
Keywords: Osteonecrosis of the femoral head; digital subtraction angiography; musculoskeletal flap transplantation.