Department of Orthpaedics, St. Olav's University Hospital, Norwegian University of Science and Technology, Trondheim, Norway.
Acta Orthop. 2011 Feb;82(1):64-8. doi: 10.3109/17453674.2010.548030. Epub 2010 Dec 29.
Total necrosis of the femoral head after infection in children during their first months of life gives a dislocated hip with severe leg shortening. A new femoral head can be achieved with subtrochanteric osteotomy and transposition of the apophysis of the greater trochanter into the acetabulum. Previous reports have dealt with short-term results (up to 12 years). Here I present some results of this procedure 15-24 years after operation.
4 children aged 1-6 years with complete necrosis of the femoral head were operated on with transposition of the greater trochanter. Secondary shelf plasty was performed later in 1 child, distal femoral epiphysiodesis in another, and femoral bone lengthening in 1 child. The mean follow-up period was 19 (15-24) years.
A new femoral head developed in all hips. 2 of them had a spherical head with a good acetabular cover, and without any osteoarthritis except for slight reduction of cartilage height. These hips were painless, with a mobility that allowed good walking function after 16 and 24 years, respectively. In the other 2 patients, in which there was a severe acetabular dysplasia at the primary operation, the new femoral head was somewhat flattened; painful osteoarthritis led to hip replacement 15 and 21 years after trochanter arthroplasty. Even these patients had a relatively good walking function until the last couple of years before hip replacement. Maximum leg length discrepancy was 7 cm.
Trochanter arthroplasty with subtrochanteric osteotomy in total femoral head necrosis after septic arthritis in children may give satisfactory long-term results provided adequate acetabular cover is obtained. Although the method cannot provide a normal hip, it can contribute to less length discrepancy, less pain, improved gait, and more favorable conditions for later hip replacement.
在儿童生命的头几个月，感染后导致股骨头全部坏死会导致髋关节脱位和严重的下肢缩短。通过股骨转子下截骨和大转子骨骺向髋臼内移位，可以获得新的股骨头。先前的报告涉及短期结果（最长 12 年）。在此，我介绍了该手术 15-24 年后的一些结果。
4 例 1-6 岁患有股骨头全部坏死的儿童接受了大转子移位手术。1 例患儿随后进行了二次臼顶成形术，另 1 例进行了股骨远端骺板切除术，1 例进行了股骨延长术。平均随访时间为 19 年（15-24 年）。
所有髋关节均形成了新的股骨头。其中 2 例股骨头呈球形，髋臼覆盖良好，无任何骨关节炎，仅轻度软骨高度降低。这些髋关节无疼痛，活动度良好，分别在 16 年和 24 年后能够正常行走。在另外 2 例患者中，初次手术时髋臼发育不良严重，新的股骨头有些扁平；严重的髋臼关节炎导致在转子成形术后 15 年和 21 年进行了髋关节置换。即使在接受转子成形术 15 年和 21 年后，这些患者仍有相对较好的行走功能，直到髋关节置换前的最近几年。最大下肢长度差异为 7 厘米。
在儿童感染性关节炎后全股骨头坏死行转子下截骨转子成形术可获得满意的长期结果，前提是获得足够的髋臼覆盖。虽然该方法不能提供正常的髋关节，但可以减少长度差异、减轻疼痛、改善步态，并为以后的髋关节置换创造更有利的条件。
