【摘要】 目的　评价吻合血管游离腓骨移植治疗股骨头坏死的临床疗效。　方法　 1981年以来采用吻合血管游离腓骨移植方法治疗股骨头坏死 6 2 0例 ,其中 Ficat 期 138例 ,Ficat 期 32 2例 ,Ficat 期 119例 ,Ficat 期 41例。手术切除股骨头周边增生变形的骨赘和炎性反应的滑膜组织。将股骨颈前外侧凿成与腓骨外径相应的骨槽 ,在‘C’臂 X光机监视下沿骨槽深达股骨头软骨下区 ,凿刮骨坏死囊变组织 ,取大转子或髂骨松质骨填塞 ,然后将游离腓骨插入股骨头骨洞内 ,嵌入股骨颈骨槽内 ,腓骨动静脉与旋股外动静脉进行显微吻合。　结果　 376例获得 1～ 19年的随访 ,根据综合评价其优良率为86 .7%。　结论　该手术可在直视下彻底清除坏死囊变组织和减压 ,同时植入新鲜松质骨 ,为坏死区再血管化清除障碍。植入的游离腓骨可增加股骨头部的血供和支撑作用 ,防止股骨头进一步塌陷。此术式可用于 Ficat 、 、 期的病例更多还原

【Abstract】 Objective To evaluate the effect of the treatment of osteonecrosis of femoral head with the free vascularized fibula grafting Methods Since 1981,620 cases of osteonecrosis of femoral head were treated with the free vascularized grafting According to Ficat staging,138 cases as Ficat Ⅰ stage,322 cases Ficat Ⅱ,119 cases Ficat Ⅲ and 41 cases Ficat Ⅳ The main operation procedures consisted of capsulotomy,resection of the proliferative osteophytes and the inflammed synovial tissue A bone slot was produced over the anterolateral aspect of femoral head with a similar diameter of the grafted fibula and then a tunnel was produced reaching deep into the subchondral area of the femoral head Intraoperation monitoring was done with the “C” armed X ray machine Cancellous bone chips were procured from the great trochanter or the iliac crest that were used to fill up the cystic area of the femoral head Then,the fibula was implanted into tunnel and microvascular anastomosis was done between the fibular vessel and lateral circumflex femoral vessel Results All cases were followed up 1～19 (mean 6) years Clinical good and excellent results were seen in 86 7% of these cases Conclusion This operation procedure could totally remove the necrotic tissue and reduce the intra osseous pressure At the same time,vascularization of the necrotic area was enhanced following the implantation of the free fibula that also played a role for the prevention of the collapse of the femoral head This operation can be used for the treatment of Ficat Ⅰ,Ⅱ and Ⅲ cases更多还原