Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
Int Orthop. 2020 Apr;44(4):761-769. doi: 10.1007/s00264-020-04480-6. Epub 2020 Jan 23.
The most appropriate procedure and at what type and stage of osteonecrosis of the femoral head (ONFH) these procedures had been argued. We attempted to clarify the trend in surgical operations with respect to the age of patients, type classification, and stage of ONFH over a period of 15 years by using the multi-center sentinel monitoring system in Japan.
We evaluated the hips of 3844 patients using this system in three phases of every five years from 2003 to 2017. We classified the surgical procedures as osteotomy (OT), hemiarthroplasty (Hemi), and total hip arthroplasty (THA). We assessed the trend in age, type classification, and stage of ONFH over three time periods; "early," and the "late." We calculated the proportion of surgeries for ONFH in each period. We used the Cochran-Armitage test to evaluate trends in proportion of two levels of characteristics across three time periods.
The proportion of younger patients significantly decreased. The proportion of OT and Hemi decreased over time, while the proportion of THA increased. The proportion of patients with types C1 and C2 who underwent OT and Hemi decreased over time. In contrast, that of THA increased. The proportion of patients who underwent OT and Hemi significantly decreased; the proportion of patients who underwent THA significantly increased over time at all stages.
In Japan, the younger patients underwent surgery for ONFH decreased. The patients who underwent OT and Hemi for ONFH decreased, while that of THA increased over time.
针对股骨头坏死（ONFH）的何种类型和阶段，哪种手术方法最为适宜，一直存在争议。我们试图通过日本多中心监测系统，在 15 年间，就患者年龄、分型和 ONFH 分期的变化，明确手术操作的趋势。
自 2003 年至 2017 年，我们通过该系统，每 5 年分 3 期，对 3844 例患者的髋关节进行了评估。我们将手术方法分为截骨术（OT）、半髋关节置换术（Hemi）和全髋关节置换术（THA）。我们评估了 ONFH 在 3 个时期（“早期”和“晚期”）的年龄、分型和分期的变化趋势。我们计算了每个时期的 ONFH 手术比例。我们使用 Cochran-Armitage 检验评估了三个时期两个特征水平的比例变化趋势。
年轻患者的比例显著下降。OT 和 Hemi 的比例随时间推移而下降，而 THA 的比例则增加。接受 OT 和 Hemi 的 C1 和 C2 型患者的比例随时间推移而下降，而接受 THA 的患者的比例则增加。OT 和 Hemi 的患者比例显著下降，THA 的患者比例随时间推移在所有分期均显著增加。
在日本，接受 ONFH 手术的年轻患者比例下降。接受 ONFH OT 和 Hemi 治疗的患者比例下降，而接受 THA 的患者比例随时间推移而增加。
