中华显微外科杂志
中華顯微外科雜誌
중화현미외과잡지
Chinese Journal of Microsurgery
2014年
4期
328-333
,共6页
股骨头缺血性坏死%计算机导航%三维%腓骨移植%旋股外侧动脉
股骨頭缺血性壞死%計算機導航%三維%腓骨移植%鏇股外側動脈
고골두결혈성배사%계산궤도항%삼유%비골이식%선고외측동맥
Avascular necrosis of femoral head%Computer navigation%Three-dimensional (3-D)%Fibula grafting%Lateral circumflex femoral artery
目的 探讨应用术中即时三维计算机导航辅助吻合血管的腓骨移植,同时采用一种新的供区血管治疗股骨头缺血坏死的临床应用价值,并总结早期的临床结果. 方法 2010年10月至2013年4月,应用术中即时三维计算机导航辅助吻合血管游离腓骨移植的方法治疗股骨头缺血坏死14例(18髋),采用Steinberg分期:Ⅱ期8髋,Ⅲ期6髋,Ⅳ期4髋.手术在即时三维计算机导航引导下完成.术中在股骨大转子下方选取最佳入点,钻孔并逐渐扩大骨隧道直达股骨头病变区,用注册过的磨钻精确、彻底磨除坏死的囊变病灶及硬化骨.整个磨除过程均在导航计算机显示屏实时监控下完成,并在导航引导下经骨隧道植入游离腓骨,用一枚空心钉将腓骨尾端固定于股骨近端,吻合旋股外侧动、静脉降支与腓动、静脉.术中/后常规拍片,了解病灶清除、植骨及腓骨固定位置等情况. 结果 全部14例(18髋)均在术中即时三维导航下顺利完成手术,旋股外侧动、静脉降支与腓动、静脉吻合通畅,动脉搏动良好,术后7d行放射性核素全身骨扫描检查,检查结果均提示游离腓骨成活.术后X线检查提示坏死病灶及周围硬化骨清除彻底,游离腓骨植入位置良好.采用Harris评分评估临床疗效,X线评估影像学疗效.术后随访8～29个月,平均23.6个月,1年以上随访13例17髋,术前Harris评分(57.5±14.5)分,平均59分,术后最后一次随访Harris评分(87.5±2.5)分,平均88.6分,按Harris评分标准,优6髋,良11髋.术后末次随访患髋X线检查与术前对比,有15髋股骨头坏死有不同程度改善,2髋无明显变化,全部患髋股骨头关节面均未出现进一步塌陷. 结论 术中即时三维计算机导航辅助吻合血管的腓骨移植治疗股骨头缺血坏死,为微创手段进行关节囊外手术提供有力保障,不仅可以精确、彻底清除坏死灶,而且可以将游离腓骨精准植入至关节软骨下骨下方,同时采用旋股外侧动、静脉降支为供区血管,不破坏股骨头血供,为保留关节手术提供了一种新的术式,具有良好的临床应用价值.
目的 探討應用術中即時三維計算機導航輔助吻閤血管的腓骨移植,同時採用一種新的供區血管治療股骨頭缺血壞死的臨床應用價值,併總結早期的臨床結果. 方法 2010年10月至2013年4月,應用術中即時三維計算機導航輔助吻閤血管遊離腓骨移植的方法治療股骨頭缺血壞死14例(18髖),採用Steinberg分期:Ⅱ期8髖,Ⅲ期6髖,Ⅳ期4髖.手術在即時三維計算機導航引導下完成.術中在股骨大轉子下方選取最佳入點,鑽孔併逐漸擴大骨隧道直達股骨頭病變區,用註冊過的磨鑽精確、徹底磨除壞死的囊變病竈及硬化骨.整箇磨除過程均在導航計算機顯示屏實時鑑控下完成,併在導航引導下經骨隧道植入遊離腓骨,用一枚空心釘將腓骨尾耑固定于股骨近耑,吻閤鏇股外側動、靜脈降支與腓動、靜脈.術中/後常規拍片,瞭解病竈清除、植骨及腓骨固定位置等情況. 結果 全部14例(18髖)均在術中即時三維導航下順利完成手術,鏇股外側動、靜脈降支與腓動、靜脈吻閤通暢,動脈搏動良好,術後7d行放射性覈素全身骨掃描檢查,檢查結果均提示遊離腓骨成活.術後X線檢查提示壞死病竈及週圍硬化骨清除徹底,遊離腓骨植入位置良好.採用Harris評分評估臨床療效,X線評估影像學療效.術後隨訪8～29箇月,平均23.6箇月,1年以上隨訪13例17髖,術前Harris評分(57.5±14.5)分,平均59分,術後最後一次隨訪Harris評分(87.5±2.5)分,平均88.6分,按Harris評分標準,優6髖,良11髖.術後末次隨訪患髖X線檢查與術前對比,有15髖股骨頭壞死有不同程度改善,2髖無明顯變化,全部患髖股骨頭關節麵均未齣現進一步塌陷. 結論 術中即時三維計算機導航輔助吻閤血管的腓骨移植治療股骨頭缺血壞死,為微創手段進行關節囊外手術提供有力保障,不僅可以精確、徹底清除壞死竈,而且可以將遊離腓骨精準植入至關節軟骨下骨下方,同時採用鏇股外側動、靜脈降支為供區血管,不破壞股骨頭血供,為保留關節手術提供瞭一種新的術式,具有良好的臨床應用價值.
목적 탐토응용술중즉시삼유계산궤도항보조문합혈관적비골이식,동시채용일충신적공구혈관치료고골두결혈배사적림상응용개치,병총결조기적림상결과. 방법 2010년10월지2013년4월,응용술중즉시삼유계산궤도항보조문합혈관유리비골이식적방법치료고골두결혈배사14례(18관),채용Steinberg분기:Ⅱ기8관,Ⅲ기6관,Ⅳ기4관.수술재즉시삼유계산궤도항인도하완성.술중재고골대전자하방선취최가입점,찬공병축점확대골수도직체고골두병변구,용주책과적마찬정학、철저마제배사적낭변병조급경화골.정개마제과정균재도항계산궤현시병실시감공하완성,병재도항인도하경골수도식입유리비골,용일매공심정장비골미단고정우고골근단,문합선고외측동、정맥강지여비동、정맥.술중/후상규박편,료해병조청제、식골급비골고정위치등정황. 결과 전부14례(18관)균재술중즉시삼유도항하순리완성수술,선고외측동、정맥강지여비동、정맥문합통창,동맥박동량호,술후7d행방사성핵소전신골소묘검사,검사결과균제시유리비골성활.술후X선검사제시배사병조급주위경화골청제철저,유리비골식입위치량호.채용Harris평분평고림상료효,X선평고영상학료효.술후수방8～29개월,평균23.6개월,1년이상수방13례17관,술전Harris평분(57.5±14.5)분,평균59분,술후최후일차수방Harris평분(87.5±2.5)분,평균88.6분,안Harris평분표준,우6관,량11관.술후말차수방환관X선검사여술전대비,유15관고골두배사유불동정도개선,2관무명현변화,전부환관고골두관절면균미출현진일보탑함. 결론 술중즉시삼유계산궤도항보조문합혈관적비골이식치료고골두결혈배사,위미창수단진행관절낭외수술제공유력보장,불부가이정학、철저청제배사조,이차가이장유리비골정준식입지관절연골하골하방,동시채용선고외측동、정맥강지위공구혈관,불파배고골두혈공,위보류관절수술제공료일충신적술식,구유량호적림상응용개치.
Objective To evaluate the feasibility,technique and preliminary clinical results of the intraoperative three-dimensional (3-D) computer navigation system assisted free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head.Methods From October 2010 to April 2013,14 patients (18 hips) with osteonecrosis of the femoral head were treated by free vascularized fibular graft transfer,assisted by intraoperative3-D computer navigation system.Of 18 hips,8 were classified as stage Ⅱ ;6 as stage Ⅲ,4 as stage Ⅳ according to Steinberg system.The entire procedures were visualized and guided by the 3-D navigation system,including location of optimal entry point,exploration of the field,excision of the necrotic bone tissues,and the fibular grafting transfer with vessel anastomosis.The follow-up records included the results of X-ray,the Harris score of the hip,and the complications.Results Operations of all 14 patients (18 hips) were smooth and successful with patent vessel and umcompromised grafts evidenced by ECT scan at day 7 postoperatively.Postoperative X-ray confirmed the complete eradication of necrotic focuses with surrounding calcified bone and the accurate positioning of fibular grafts.The mean follow-up period was 23.6 months (8-29 months).Harris scores significantly improved from 57.5 ± 14.5 before operations to 87.5 ±2.5 after,with 6 hips' scores classified as "Excellent",and 11 as "Good".X-ray obtained more than 1 year after operation suggested improvement was achieved in 15 hips.Conclusion Intraoperative 3-D computer navigation system has multiple merits in assisting free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head,including clear anatomic structure,better accuracy,less damage,and reliable functional recovery,which imply it is a highly applicable approach.
