Sugano Nobuhiko, Koyama Tsuyoshi
Osaka University Graduate School of Medicine, Department of Orthopaedic Surgery.
Clin Calcium. 2007 Jun;17(6):917-22.
Transtrochanteric rotational osteotomy (TRO) is one of the joint-preserving surgical treatments for osteonecrosis of the femoral head (ONFH). It can prevent collapse of the femoral head as necrotic lesions in the weight-bearing portion can be moved sufficiently to less weight-bearing portion by anterior rotation, posterior rotation or varus angulation. Patient selection and preoperative planning are important to determine indications for TRO. It has been reported that successful TRO requires at least 34% of the weight-bearing area supported by the intact part of the femoral head. However, this ratio is difficult to preoperatively quantify according to the rotation angle using conventional two-dimensional MR images or X-rays. Therefore, we developed a method of simulating TRO using three-dimensional (3-D) models reconstructed from 3-D MR images and applied it to serial patients with types C1 and C2 osteonecrosis at stage 1 or 2. The simulation visualized positional changes of the necrotic lesion in the weight-bearing area and enabled quantitation of the postoperative intact ratio. Our surgical simulation is useful for evaluating the postoperative intact ratio and for determining indications for TRO as well as the optimal angle of femoral head rotation and varus angulation.
转子间旋转截骨术（TRO）是股骨头坏死（ONFH）的保关节手术治疗方法之一。通过前旋、后旋或内翻成角，可将负重部位的坏死病灶充分转移至负重较小的部位，从而预防股骨头塌陷。患者选择和术前规划对于确定TRO的适应症很重要。据报道，成功的TRO需要股骨头完整部分支撑至少34%的负重面积。然而，使用传统二维磁共振成像（MR）或X线片，很难根据旋转角度在术前对该比例进行量化。因此，我们开发了一种利用从三维MR图像重建的三维模型模拟TRO的方法，并将其应用于1或2期C1和C2型骨坏死的连续患者。该模拟可直观显示负重区域坏死病灶的位置变化，并能对术后完整比例进行量化。我们的手术模拟有助于评估术后完整比例、确定TRO的适应症以及股骨头旋转和内翻成角的最佳角度。
