Ikemura Satoshi, Yamamoto Takuaki, Jingushi Seiya, Nakashima Yasuharu, Mawatari Taro, Iwamoto Yukihide
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan.
J Orthop Sci. 2007 May;12(3):260-4. doi: 10.1007/s00776-007-1123-4. Epub 2007 May 31.
We originally used two or three large cancellous screws for a transtrochanteric rotational osteotomy for osteonecrosis. Since January 2002, a screw and plate system (K-MAX Adjustable Angle Hip Screw) has been used to obtain more rigid fixation at the site of osteotomies. We investigated the clinical and radiological results of a transtrochanteric anterior rotational osteotomy.
Between January 2000 and December 2001, a transtrochanteric anterior rotational osteotomy with large cancellous screws was performed in 25 hips of 22 patients, and between January 2002 and March 2005, the K-MAX Adjustable Angle Hip Screw was used in 44 hips of 40 patients for treatment of osteonecrosis of the femoral head. Japanese Orthopaedic Association (JOA) score, postoperative management, and radiographic appearances were investigated.
The mean preoperative JOA score was 60.8 +/- 12.1 points in the large cancellous screw group and 61.5 +/- 14.4 points in the K-MAX Adjustable Angle Hip Screw group. This improved to 86.1 +/- 13.3 points in the large cancellous screw group and 88.7 +/- 6.6 points in the K-MAX Adjustable Angle Hip Screw group at the final follow-up. Intentional varus angulations were obtained in 15 of 25 hips in the large cancellous screw group and in 36 of 44 hips in the K-MAX Adjustable Angle Hip Screw group. Altogether, 23 of 25 (92.0%) cases with large cancellous screws started partial weight-bearing 7 weeks after the operation, and 43 of 44 (97.7%) cases with the K-MAX Adjustable Angle Hip Screw started 5 weeks after the operation.
The K-MAX Adjustable Angle Hip Screw produced clinical results similar to those with the large cancellous screws. In addition, partial weight-bearing could be started 2 weeks earlier after a transtrochanteric anterior rotational osteotomy with the K-MAX Adjustable Angle Hip Screw.
我们最初在转子间旋转截骨术治疗股骨头坏死时使用两枚或三枚大的松质骨螺钉。自2002年1月起，开始使用一种螺钉钢板系统（K-MAX可调角度髋螺钉）以在截骨部位获得更坚固的固定。我们对转子间前旋转截骨术的临床和影像学结果进行了研究。
在2000年1月至2001年12月期间，对22例患者的25髋实施了采用大的松质骨螺钉的转子间前旋转截骨术，在2002年1月至2005年3月期间，对40例患者的44髋使用K-MAX可调角度髋螺钉治疗股骨头坏死。对日本骨科协会（JOA）评分、术后管理及影像学表现进行了研究。
大的松质骨螺钉组术前JOA评分平均为60.8±12.1分，K-MAX可调角度髋螺钉组为61.5±14.4分。在末次随访时，大的松质骨螺钉组提高到86.1±13.3分，K-MAX可调角度髋螺钉组提高到88.7±6.6分。大的松质骨螺钉组25髋中有15髋获得了预期的内翻成角，K-MAX可调角度髋螺钉组44髋中有36髋获得了预期的内翻成角。大的松质骨螺钉组25例中有23例（92.0%）在术后7周开始部分负重，K-MAX可调角度髋螺钉组44例中有43例（97.7%）在术后5周开始部分负重。
K-MAX可调角度髋螺钉产生的临床结果与大的松质骨螺钉相似。此外，采用K-MAX可调角度髋螺钉进行转子间前旋转截骨术后可提前2周开始部分负重。
