Applied anatomic study on vascularized fibula graft with unilateral fibula as the donor for bilateral femoral head necrosis

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 oxide-gelatin.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 SteinbergⅡ,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 cm.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.