Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Dongjak-gu, Seoul 155-756, South Korea.
J Bone Joint Surg Am. 2010 Feb;92(2):314-21. doi: 10.2106/JBJS.H.01020.
Advanced-stage osteonecrosis and a large area of necrotic bone are known risk factors for failure of transtrochanteric rotational osteotomy of the hip in patients with osteonecrosis. The purpose of this study was to determine whether there are other risk factors for failure of this osteotomy.
One hundred and five patients (113 hips) underwent an anterior transtrochanteric rotational osteotomy for the treatment of femoral head osteonecrosis and were followed for a mean of 51.3 months postoperatively. Radiographic failure was defined as secondary collapse or osteoarthritic change. Multivariate analysis was performed to assess factors associated with secondary collapse and osteophyte formation. The Kaplan-Meier product-limit method was used to estimate survival.
Secondary collapse occurred in twenty-seven hips (24%), and fourteen hips (12%) were converted to a total hip arthroplasty. At the time of the most recent follow-up, the hip scores according to the system of Merle d'Aubigné et al. ranged from 6 to 18 points (mean, 15.8 points). Multivariate analysis showed that the stage of the necrosis (III or greater) (hazard ratio = 3.28; 95% confidence interval = 1.49 to 7.24), age of the patient (forty years or older) (hazard ratio = 1.08; 95% confidence interval = 1.02 to 1.14), body mass index (> or = 24 kg/m(2)) (hazard ratio = 1.19; 95% confidence interval = 1.03 to 1.38), and extent of the necrosis (a combined necrotic angle of > or = 230 degrees ) (hazard ratio = 1.08; 95% confidence interval = 1.04 to 1.11) were associated with secondary collapse. Seven of the eighty-six hips without collapse showed progression to osteoarthritis. The survival rate at 110 months was 63.4% (95% confidence interval = 51.1% to 75.7%) with total hip arthroplasty or radiographic failure as the end point and 56.0% (95% confidence interval = 44.6% to 67.4%) with total hip arthroplasty, radiographic failure, or loss to follow-up as the end point.
Our study showed that age, body mass index, and the stage and extent of the osteonecrosis were determining factors for secondary collapse, unsatisfactory clinical results, and conversion to total hip arthroplasty. These factors should be considered when selecting patients for a transtrochanteric rotational osteotomy.
对于患有股骨头坏死的患者，晚期骨坏死和大面积骨坏死是经转子间旋转截骨术失败的已知危险因素。本研究旨在确定这种截骨术失败是否还有其他危险因素。
105 例（113 髋）患者接受前路转子间旋转截骨术治疗股骨头坏死，术后平均随访 51.3 个月。影像学失败定义为继发性塌陷或骨关节炎改变。采用多因素分析评估与继发性塌陷和骨赘形成相关的因素。采用 Kaplan-Meier 乘积限法估计生存率。
27 髋（24%）发生继发性塌陷，14 髋（12%）转为全髋关节置换术。在最近一次随访时，根据 Merle d'Aubigné 等人的系统，髋关节评分范围为 6 至 18 分（平均 15.8 分）。多因素分析显示，坏死分期（III 期或更高级别）（危险比=3.28；95%置信区间=1.49 至 7.24）、患者年龄（40 岁或以上）（危险比=1.08；95%置信区间=1.02 至 1.14）、体重指数（≥24kg/m²）（危险比=1.19；95%置信区间=1.03 至 1.38）和坏死范围（联合坏死角度>或=230 度）（危险比=1.08；95%置信区间=1.04 至 1.11）与继发性塌陷有关。86 髋无塌陷者中有 7 髋出现进展性骨关节炎。以全髋关节置换术或影像学失败为终点的 110 个月生存率为 63.4%（95%置信区间=51.1%至 75.7%），以全髋关节置换术、影像学失败或随访丢失为终点的生存率为 56.0%（95%置信区间=44.6%至 67.4%）。
我们的研究表明，年龄、体重指数以及骨坏死的分期和范围是继发性塌陷、临床结果不佳和转为全髋关节置换术的决定因素。在选择经转子间旋转截骨术的患者时应考虑这些因素。
