Eidelman Mark, Keshet Doron, Nelson Scott, Bor Noam
Pediatric Orthopedics Unit.
Rambam Health Care Center, Haifa.
J Pediatr Orthop. 2019 Apr;39(4):181-186. doi: 10.1097/BPO.0000000000000906.
Femoral neck lengthening and transfer of the greater trochanter were introduced by Morscher as treatment for patients with coxa breva and overgrowth of the greater trochanter. In this study we evaluated intermediate and long-term results of this operation.
We reviewed clinical and radiographic results of 18 patients (20 hips) who were treated by Morscher osteotomy. Ten patients had Perthes disease, 4 had developmental dysplasia of the hip, and 4 had avascular necrosis of the hip. The median age at surgery was 16 years [interquartile range (IQR): 14 to 17.5]. The median follow-up period was 7 years (IQR: 4.5 to 10). All patients were evaluated clinically by means of Harris Hip Score (HHS) before and after surgery.
Preoperative clinical examination revealed that all patients had a limp and a positive Trendelenburg test. Median HHS was 72.5 (IQR: 69 to 83). Postoperatively, the Trendelenburg test was negative in 14 hips and positive in 6 hips. Postoperative median HHS was 94.5 (IQR: 89 to 96). Radiographic examination showed progression of osteoarthritis in 3 patients. One operation failed and was converted to total arthroplasty (total hip replacement) after 4 years. Two hips required total hip replacement 10 years after the operation. Leg length discrepancy was reduced in 17/20 hips. Overall patient satisfaction level was good-excellent in 12 patients, fair in 4, and bad in 2 patients. Postoperative complications included blade migration (1 patient (and wire breakage (2 patients).
Morscher osteotomy can be effective for the treatment of patients with short femoral neck and overgrowth of the greater trochanter with a positive Trendelenburg test and mild leg length discrepancy. A congruent nonarthritic hip joint is a prerequisite for the success of the operation.
Level IV.
股骨颈延长及大转子转移术由莫舍尔引入，用于治疗髋短缩和大转子过度生长的患者。在本研究中，我们评估了该手术的中期和长期结果。
我们回顾了18例（20髋）接受莫舍尔截骨术治疗患者的临床和影像学结果。10例患者患有佩特兹病，4例患有发育性髋关节发育不良，4例患有股骨头缺血性坏死。手术时的中位年龄为16岁[四分位间距（IQR）：14至17.5岁]。中位随访期为7年（IQR：4.5至10年）。所有患者在手术前后均通过Harris髋关节评分（HHS）进行临床评估。
术前临床检查显示所有患者均有跛行及Trendelenburg试验阳性。HHS中位数为72.5（IQR：69至83）。术后，14髋Trendelenburg试验阴性，6髋阳性。术后HHS中位数为94.5（IQR：89至96）。影像学检查显示3例患者骨关节炎进展。1例手术失败，4年后改行全关节置换术（全髋关节置换）。2髋在术后10年需要行全髋关节置换。20髋中有17髋的下肢长度差异减小。总体患者满意度为12例患者为优，4例为良，2例为差。术后并发症包括刀片移位（1例患者）和钢丝断裂（2例患者）。
莫舍尔截骨术对于治疗股骨颈短缩和大转子过度生长、Trendelenburg试验阳性及轻度下肢长度差异的患者可能有效。一个匹配的非关节炎髋关节是手术成功的前提条件。
IV级。
