Rela Institute of Orthopedics, Dr. Rela Institute & Medical Centre, Chennai, 600044, India.
Int Orthop. 2020 Apr;44(4):635-643. doi: 10.1007/s00264-019-04353-7. Epub 2019 Jun 14.
Femoral neck nonunion in young patients has always been a difficult problem to deal with for surgeons. Numerous surgical procedures to address either the biological or mechanical issues at the nonunion have been described and most of them have been associated with variable results. Isolated biological augmentation is often associated with poor results and some techniques like vascularized grafting may require not so commonly available expertise. Valgus osteotomy is aimed to correct the abnormal fracture biomechanics associated with femoral neck fractures. By altering the nature of force transmission across the nonunion, shear forces are converted into compressive forces that lead to rapid osseous union without the need for bone grafting. Though the principles are sound and were described a long time ago, the technical aspects have evolved over time. Various modifications have been described to overcome shortcomings such as limb length discrepancy, reduction of femoral offset, alteration in mechanical axis, and the overall proximal femur anatomy. In this review, we look back at the fundamental principles and recent literature on the results of valgus intertrochanteric osteotomy for femoral neck pseudoarthrosis. We also highlight the important need for accurate preoperative planning and surgical execution. Lastly, we elaborate on the technical improvisations that have happened over time in order to improve functional results and to minimize complications and poor outcome after a valgus osteotomy.
年轻患者的股骨颈骨不连一直是外科医生难以处理的问题。为了解决骨不连处的生物学或力学问题，已经描述了许多手术方法，其中大多数都与不同的结果相关联。单纯的生物学增强通常与较差的结果相关，而一些技术，如带血管的移植物，可能需要不太常见的专业知识。外翻截骨术旨在纠正与股骨颈骨折相关的异常骨折生物力学。通过改变穿过骨不连处的力传递性质，剪切力转化为压缩力，从而在不需要植骨的情况下迅速实现骨愈合。尽管这些原则是合理的，并且很久以前就已经描述过，但随着时间的推移，技术方面已经发生了演变。已经描述了各种改进方法来克服诸如肢体长度差异、股骨偏移减小、力学轴改变以及整个股骨近端解剖结构等缺点。在这篇综述中，我们回顾了外翻转子间截骨术治疗股骨颈假关节的基本原理和最新文献。我们还强调了准确的术前规划和手术执行的重要性。最后，我们详细介绍了随着时间的推移发生的技术改进，以改善功能结果，并最小化外翻截骨术后的并发症和不良后果。
