Atsumi Takashi, Kajiwara Toshihisa, Hiranuma Yasunari, Tamaoki Satoshi, Asakura Yasuhiro
Department of Orthopaedic Surgery, Fujigaoka Hospital, Showa University School of Medicine, 1-30 Fujigaoka Aobaku, Yokohama 227-8501, Japan.
J Bone Joint Surg Am. 2006 Nov;88 Suppl 3:42-7. doi: 10.2106/JBJS.F.00767.
In young patients with nontraumatic femoral head osteonecrosis with extensive and collapsed lesions, joint preservation is a goal if total joint arthroplasty is to be avoided. We evaluated the effectiveness of a posterior rotational osteotomy in this patient population.
We reviewed thirty-five hips in twenty-eight young patients with nontraumatic femoral head osteonecrosis treated by posterior femoral neck rotational osteotomy. All femoral heads were collapsed, and seven hips showed joint-space narrowing. Lateral radiographs of the femoral head revealed that 15% of the mean posterior portion and 17% of the mean anterior portion of the femoral head consisted of radiographically apparent living bone. The mean age of the patients (ten women and eighteen men) was twenty-eight years. The mean follow-up period was eight years.
Less than six months after surgery, the radiographically apparent area of living bone of the femoral head below the acetabular roof was shown to be 59% on the standard anteroposterior radiograph and 54% on the 45 degrees -flexion radiograph. In thirty-three hips (94%), further collapse of the femoral head was prevented and an adequate amount of living bone was demonstrated on the loaded lateral portion of the femoral head on the final follow-up radiographs. Progressive joint-space narrowing was seen in four hips.
In young patients with osteonecrosis and extensively collapsed lesions of the femoral head, posterior femoral neck rotational osteotomy appears to be effective in delaying the progression of degeneration if an adequate area of living bone can be placed under the loaded lateral portion of the acetabulum.
Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.
在患有广泛且塌陷性病变的非创伤性股骨头坏死的年轻患者中，如果要避免全关节置换，保留关节是一个目标。我们评估了在这类患者群体中进行股骨转子后倾截骨术的有效性。
我们回顾了28例接受股骨颈后倾截骨术治疗的非创伤性股骨头坏死年轻患者的35个髋关节。所有股骨头均已塌陷，7个髋关节出现关节间隙变窄。股骨头的外侧X线片显示，股骨头平均后部的15%和平均前部的17%为X线片上可见的存活骨。患者（10名女性和18名男性）的平均年龄为28岁。平均随访期为8年。
术后不到6个月，在标准前后位X线片上，髋臼顶下方股骨头的X线片上可见的存活骨面积显示为59%，在45度屈曲位X线片上为54%。在33个髋关节（94%）中，股骨头进一步塌陷得到预防，在最终随访X线片上，股骨头负重外侧部分显示有足够量的存活骨。4个髋关节出现进行性关节间隙变窄。
在患有股骨头坏死且病变广泛塌陷的年轻患者中，如果能在髋臼负重外侧部分下方放置足够面积的存活骨，股骨颈后倾截骨术似乎能有效延缓退变进展。
治疗水平IV。有关证据水平的完整描述，请参阅jbjs.org上的作者须知。
