Zhang Nian-fei, Li Zi-rong, Yang Lian-fa, Lin Peng, Shi Zhen-cai, Li Zhong-shi, Sun Wei
Osteonecrosis and Joint-Preserving and Reconstraction Center, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China.
Zhonghua Wai Ke Za Zhi. 2004 Dec 22;42(24):1477-80.
To explore the indications, operative technique and clinical results of the transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH).
Nineteen patients (23 hips) with ONFH underwent TRO from October 1992 to May 2001 were reviewed. There were 14 males and 5 females. The age was ranging from 22 to 43 years old with an average age of 33.4 years old. The etiology were as followed: alcoholism 10 cases (12 hips); steroid 6 cases (7 hips); trauma 2 cases (2 hips); caisson disease 1 case (2 hips). Ficat stage: II 8 cases 8 hips; III 11 cases 15 hips. Harris hip score 46 to 74 with mean score 56 preoperatively. In order to determine the location and extent of osteonecrosis, A-P view and accurate lateral view (the film should be placed parallel to the femoral neck with the hip in precisely 90 degrees and flexion 45 degrees of abduction and neutral rotation) were taken in both hips preoperatively. The surgical technique described by Sugioka were used in all patients.
Seventeen patients (19 hips) were followed up ranging from 18 to 11 years with mean 54 months. The Harris hip score was from 55 to 94 with mean 80.5. Fourteen hips score more than 80 and good to excellent rate was 73.2%. Harris score were less than 79 in 5 cases and 4 hips of these 5 hips were revised by total hip arthroplasty. The rotation angle was from 55 degrees to 80 degrees with mean 60 degrees .
The circumflex femoral medial artery injury was found in 1 hip; subtrochanteric fracture was found in 2 hips and 1 osteotomy site nonunion occurred.
TRO can be used to treat ONFH. The indications include: (1) younger patients (less than 45 years old). (2) Ficat stage II and III with more than one third intact articular surface of the femoral head. The better results could be obtained using posterior rotation and lager rotational angle. The Sugioka osteotomy should be used carefully because of its complicated surgical technique.
探讨经转子旋转截骨术（TRO）治疗股骨头坏死（ONFH）的适应证、手术技术及临床效果。
回顾1992年10月至2001年5月行TRO治疗的19例（23髋）ONFH患者。男性14例，女性5例。年龄22～43岁，平均33.4岁。病因如下：酒精性10例（12髋）；类固醇性6例（7髋）；创伤性2例（2髋）；减压病1例（2髋）。Ficat分期：Ⅱ期8例8髋；Ⅲ期11例15髋。术前Harris髋关节评分46～74分，平均56分。为确定坏死的部位和范围，术前对双侧髋关节均拍摄前后位片及精确侧位片（胶片应与股骨颈平行，髋关节呈精确90°、外展45°且中立旋转位）。所有患者均采用Sugioka描述的手术技术。
17例（19髋）患者获得随访，随访时间18～11年，平均54个月。Harris髋关节评分55～94分，平均80.5分。14髋评分超过80分，优良率为73.2%。5例Harris评分低于79分，其中4髋行全髋关节置换翻修术。旋转角度55°～80°，平均60°。
1髋发现旋股内侧动脉损伤；2髋发生转子下骨折，1例截骨部位不愈合。
TRO可用于治疗ONFH。其适应证包括：（1）较年轻患者（年龄小于45岁）。（2）FicatⅡ期和Ⅲ期，股骨头关节面完整超过三分之一。采用后外侧旋转及较大旋转角度可获得更好的效果。由于Sugioka截骨术手术技术复杂，应谨慎使用。
