Morita D, Hasegawa Y, Okura T, Osawa Y, Ishiguro N
Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya City 466-8550, Japan.
Bone Joint J. 2017 Feb;99-B(2):175-183. doi: 10.1302/0301-620X.99B2.BJJ-2016-0417.R2.
Transtrochanteric rotational osteotomy (TRO) is performed for young patients with non-traumatic osteonecrosis of the femoral head (ONFH) to preserve the hip. We aimed to investigate the long-term outcomes and the risk factors for failure 15 years after this procedure.
This study included 95 patients (111 hips) with a mean age of 40 years (21 to 64) who underwent TRO for ONFH. The mean follow-up was 18.2 years (3 to 26). Kaplan-Meier survivorship analyses were performed with conversion to total hip arthroplasty (THA) and radiological failure due to secondary collapse of the femoral head or osteoarthritic changes as the endpoint. Multivariate analyses were performed to assess risk factors for each outcome.
Survival rates at 15 years with conversion to THA and radiological failure as the endpoint were 59% (95% confidence interval (CI) 49 to 67) and 30% (95% CI 22 to 39), respectively. Necrotic type C2 ONFH (lesions extending laterally to the acetabular edge) (hazards ratio (HR) 3.9) and age > 40 years (HR 2.5) were risk factors for conversion to THA. Stage > 3a ONFH (HR 2.0) and age > 40 years (HR 1.9) were risk factors for radiological failure.
The 15 year outcomes after TRO for ONFH are unfavorable because osteoarthritic changes occur after five years post-operatively. Cite this article: Bone Joint J 2017;99-B:175-83.
对于非创伤性股骨头坏死（ONFH）的年轻患者，施行转子间旋转截骨术（TRO）以保留髋关节。我们旨在研究该手术后15年的长期疗效及失败的危险因素。
本研究纳入了95例（111髋）平均年龄40岁（21至64岁）因ONFH接受TRO的患者。平均随访时间为18.2年（3至26年）。采用Kaplan-Meier生存分析，以转换为全髋关节置换术（THA）以及因股骨头继发塌陷或骨关节炎改变导致的影像学失败作为终点。进行多因素分析以评估各结局的危险因素。
以转换为THA和影像学失败为终点的15年生存率分别为59%（95%置信区间（CI）49至67）和30%（95%CI 22至39）。坏死C2型ONFH（病变外侧延伸至髋臼边缘）（风险比（HR）3.9）和年龄>40岁（HR 2.5）是转换为THA的危险因素。ONFH分期>3a期（HR 2.0）和年龄>40岁（HR 1.9）是影像学失败的危险因素。
ONFH行TRO术后15年的疗效不佳，因为术后五年会出现骨关节炎改变。引用本文：《骨与关节杂志》2017年；99-B：175 - 83。
