转子间旋转截骨术后骨坏死的修复过程。
The repair process of osteonecrosis after a transtrochanteric rotational osteotomy.
机构信息
Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
出版信息
Clin Orthop Relat Res. 2010 Dec;468(12):3186-91. doi: 10.1007/s11999-010-1384-7.
BACKGROUND
Many studies have reported the factors influencing the progression of collapse and development of osteoarthritis after a transtrochanteric rotational osteotomy. It is not well understood how the healing process of the osteonecrotic area occurs after this procedure.
QUESTIONS/PURPOSES: We evaluated (1) the osteonecrotic area after a successful transtrochanteric rotational osteotomy radiographically; and (2) determined whether specific perioperative clinical and radiographic factors related to the difference(s) in the healing process after a transtrochanteric rotational osteotomy.
METHODS
We retrospectively reviewed 64 patients (70 hips) among 402 patients (507 hips) who had a transtrochanteric rotational osteotomy between 1981 and 1996 and showed no evidence of progression of collapse or joint space narrowing at 10 years after the osteotomy. Forty-eight hips (45 patients) were males and 22 (19 patients) were females, with a mean age of 37 years (range, 12-57 years) at the time of surgery. An anterior rotational osteotomy was performed for 57 hips and a posterior rotational osteotomy was performed for 13 hips. We recorded various perioperative factors potentially influencing repair and assessed the radiographs at last followup for various features indicating repair.
RESULTS
Ten years after the transtrochanteric rotational osteotomy, the osteonecrotic area in 50 hips (71%) had osteosclerotic changes radiographically (Group I), while 20 hips (29%) had normal bony architecture without sclerotic changes (Group II). We observed no difference between Groups I and II with regard to the age, gender, use of corticosteroids, etiology, and radiographic stage.
CONCLUSIONS
Although the reason for this difference in the healing patterns remains unknown, this study indicates the majority of the hips showed osteosclerosis after a transtrochanteric rotational osteotomy, while approximately 30% of the hips showed a normal bony architecture.
背景
许多研究报告了影响转子间旋转截骨术后塌陷进展和骨关节炎发展的因素。对于该手术后坏死区域的愈合过程是如何发生的，目前还不是很清楚。
问题/目的：我们评估了（1）转子间旋转截骨术后成功的情况下，从影像学上观察坏死区域；以及（2）确定与转子间旋转截骨术后愈合过程差异相关的特定围手术期临床和影像学因素。
方法
我们回顾性分析了 1981 年至 1996 年间进行转子间旋转截骨术的 402 例患者（507 髋）中的 64 例患者（70 髋），这些患者在截骨术后 10 年时均未出现塌陷或关节间隙变窄的进展迹象。48 髋（45 例患者）为男性，22 髋（19 例患者）为女性，手术时的平均年龄为 37 岁（范围 12-57 岁）。57 髋行前路旋转截骨术，13 髋行后路旋转截骨术。我们记录了各种可能影响修复的围手术期因素，并在最后一次随访时评估了各种提示修复的影像学表现。
结果
转子间旋转截骨术后 10 年，50 髋（71%）的坏死区域在影像学上出现硬化改变（I 组），而 20 髋（29%）的骨结构正常，无硬化改变（II 组）。I 组和 II 组在年龄、性别、使用皮质类固醇、病因和影像学分期方面无差异。
结论
尽管这种愈合模式差异的原因尚不清楚，但本研究表明，大多数髋部在转子间旋转截骨术后出现硬化，而约 30%的髋部出现正常骨结构。
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