Objective To anatomy study the feasibility of treatment of bilateral femoral head necrosis by vascularized fibula graft with unilateral fibula as the donor. Methods Five amputated extremities were chosen to perform peroneal artery perfusion with lead oxidegelatin. Firstly, the amount and distribution of the peroneal artery branches supplying fibula were determined.Secondly, the distance between origination of the peroneal artery and the fibula head, the internal diameter of origination of the peroneal artery/vein, the internal diameter of each branches, and the distance between adjacent branches, were measured with a caliper respectively. The distribution and scope of the fibula blood supply was determined. In terms of clinical application, 1 case with bilateral femoral head necrosis, whose bilateral hips were both classified as Steinberg Ⅱ, Harris score was 70 on the right and 74 on the left, was chosen under the treatment of vascularized fibula graft with unilateral fibula as the donor. The case was followed up and the therapeutic effectiveness was evaluated. Results Anatomical studies have shown that branches of the peroneal artery supplying the fibula included the arcuate arteries, the amount of which were 6-9, average diameter was 1.55 mm, average interval was 3.2 cm, the average distance between the first arcuate artery and the fibula head was 9.5 cm, average length of arcuate arteries blood supply was 25 cr One fibula nutrient artery originated from the peroneal artery, the origination spot to the fibula head was 14.8 cm and the average diameter was 1.67 mm. In terms of clinical application, the case was followed up by 9 months, motion of either hip was good, Harris score was 94 on the right and 98 on the left, X rays showed that bone absorption did not appear on either fibula graft, fusion between new bone and fibula graft was good, and non complications were found.Conclusion Unilateral fibula as the donor can provide sufficient vascularized fibula and ensure the blood supply, with adequate safety and feasibility.%目的 解剖学研究单侧供体吻合血管腓骨移植治疗双侧股骨头坏死的可行性.方法 采用截肢后小腿标本5例,分别予以明胶氧化铅腓动脉灌注.标本处理完成后先明确供应腓骨的腓动脉分支的数量及分布,再通过游标卡尺分别测量腓动脉起始处与腓骨小头距离、起始处腓动静脉口径、各支腓骨营养动脉口径及走行至腓骨时的间距,明确营养血管分布规律及血管覆盖腓骨范围.临床应用中采用单侧供体吻合血管腓骨移植术治疗双侧股骨头坏死患者(双髋关节Steinberg分期均为Ⅱ期,Harris评分右侧70分、左侧74分)1例,并随访作疗效评价.结果 解剖学研究显示供应腓骨的腓动脉分支包括弓状动脉6～9支,外径平均1.55 mm,间隔平均3.2 cm,其中第1弓状动脉距离腓骨小头平均距离为9.5 cm,覆盖腓骨范围平均25 cm;距腓骨小头平均14.8 cm处发出1支腓骨滋养动脉,外径平均为1.67 mm.手术病例临床随访9个月,患者髋关节活动良好,Harris评分为右94分、左98分,X线显示双侧游离腓骨均未出现骨质吸收,新生骨与游离腓骨融合良好.供区与受区均未出现并发症.结论 单侧供体可以提供足够长度的游离腓骨,并可以保证充分血供,具有充分的安全性和可行性.
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