用于治疗骨坏死的杉冈经转子旋转截骨术的结果：股方肌缺损在骨坏死进展中的发生率及作用
Results of the Sugioka transtrochanteric rotational osteotomy for osteonecrosis: Frequency and role of a defect of the quadratus femoris muscle in osteonecrosis progression.
作者信息
Yamamoto T, Motomura G, Karasuyama K, Nakashima Y, Doi T, Iwamoto Y
机构信息
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan.
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan.
出版信息
Orthop Traumatol Surg Res. 2016 May;102(3):387-90. doi: 10.1016/j.otsr.2016.01.017. Epub 2016 Mar 9.
BACKGROUND
During transtrochanteric rotational osteotomy (RO), it is important to preserve the posterior column artery (PCA), which is generally located in the adipose tissue underneath the quadratus femoris muscle (QF). If there is a defect in the QF, the risk of injuring the PCA, subsequently resulting in total necrosis of the femoral head, may increase. Therefore, we investigated: (1) the frequency of defects of the QF at the time of RO, and (2) clinical outcome of RO based upon a defect of the QF.
HYPOTHESIS
The presence of defects of the QF at the time of RO could be detected pre-operatively by magnetic resonance imaging.
METHODS
RO was performed in 124 hips between 2001 and 2010. In all, 95 of the hips were in male patients and 29 in female patients. The mean age was 45.4 years (range: 11-61 years) at the time of surgery and MRI was performed before RO in all cases. We retrospectively evaluated the progression of a collapse through 3 years after RO.
RESULTS
MRI showed a defect in the QF in four hips (3.2%) (2 males, 2 females), all of which were confirmed intra-operatively. Among the four patients, one (25%) underwent total hip arthroplasty because of varus deformity of the osteotomy site due to total necrosis of the femoral head 1 year after RO. The 120 hips with a normal QF showed no evidence of total necrosis or progression of necrosis of the femoral head, indicating that the presence of defects of the QF may increase the risk of poor survivorship of this procedure.
CONCLUSIONS
Defects of the QF have been reported to occur in 1-2% of all patients, whereas in our study the incidence in ON was approximately 3%. In ON patients with QF defects, pre-operative MRI evaluation of the QF appears to be important when planning RO, followed by a carefully performed surgical procedure.
LEVEL OF EVIDENCE
IV; retrospective case series without control group.
背景
在经转子旋转截骨术（RO）过程中，保留后柱动脉（PCA）很重要，该动脉通常位于股方肌（QF）下方的脂肪组织中。如果QF存在缺损，损伤PCA的风险可能会增加，进而导致股骨头完全坏死。因此，我们进行了以下研究：（1）RO时QF缺损的发生率；（2）基于QF缺损的RO临床结果。
假设
RO时QF缺损的情况可通过术前磁共振成像检测到。
方法
2001年至2010年期间对124例髋关节进行了RO。其中，男性患者95例，女性患者29例。手术时的平均年龄为45.4岁（范围：11 - 61岁），所有病例在RO前均进行了MRI检查。我们回顾性评估了RO后3年塌陷的进展情况。
结果
MRI显示4例髋关节（3.2%）（2例男性，2例女性）存在QF缺损，所有这些在术中均得到证实。在这4例患者中，1例（25%）因RO后1年股骨头完全坏死导致截骨部位内翻畸形而接受了全髋关节置换术。120例QF正常的髋关节未显示股骨头完全坏死或坏死进展的迹象，表明QF缺损可能会增加该手术预后不良的风险。
结论
据报道，所有患者中QF缺损的发生率为1% - 2%，而在我们的研究中，ON患者中的发生率约为3%。对于存在QF缺损的ON患者，在计划RO时，术前对QF进行MRI评估似乎很重要，随后需谨慎进行手术操作。
证据水平
IV；无对照组的回顾性病例系列。
Zotero 插件