Ertilav Devran, Cavit Ali, Bilbaşar Hakan, Ürgüden Mustafa
Uludağ Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 16059 Nilufer, Bursa, Türkiye.
Jt Dis Relat Surg. 2020;31(2):353-359. doi: 10.5606/ehc.2020.74300. Epub 2020 Jun 18.
This study aims to describe a stepped osteotomy technique applied to the femoral head autograft to keep the graft volume at a sufficient level, provide primary stability, and direct cancellous-cancellous bone contact.
In this retrospective study, 24 hips of 20 patients (5 males, 15 females; mean age 53 years; range, 43 to 68 years) with dysplasia of the hip (DDH) who underwent total hip arthroplasty with femoral head stepped osteotomy technique were evaluated between April 2003 and June 2010. Patients' age, gender, operation side, and postoperative complications were recorded. Aseptic loosening of the acetabular cup and graft integration/resorption were evaluated radiographically. Radiological evaluations were performed according to the methods of DeLee and Charnley, and Mulroy and Harris. Functional status of the patients was determined according to the criteria of Merle d'Aubigné and Postel, and Harris hip score (HHS).
The mean follow-up period was 5.5 years (range, 3 to 12 years). None of the patients had any complications in the early postoperative period. In all patients, the percentage of acetabular component coverage by the graft was measured as 27% (range, 19 to 38%) on average. At the last follow-up, all patients were satisfied with the result and there was no sign of clinically loosening, osteointegration was complete, and there was no radiographic evidence of graft resorption or collapse of any hip. The overall Merle d'Aubigné scores and HHSs of the patients significantly improved at the final follow-up.
This stepped osteotomy technique increases the probability of osteointegration, reduces the need for early revision, and provides reliable stability with satisfactory clinical and radiological midterm results.
本研究旨在描述一种应用于股骨头自体移植的阶梯式截骨技术，以保持移植骨体积处于足够水平，提供初始稳定性，并实现松质骨与松质骨的直接接触。
在这项回顾性研究中，对2003年4月至2010年6月期间接受股骨头阶梯式截骨技术全髋关节置换术的20例患者（5例男性，15例女性；平均年龄53岁；范围43至68岁）的24个髋关节进行了评估。记录患者的年龄、性别、手术侧别及术后并发症。通过影像学评估髋臼杯的无菌性松动以及移植骨的整合/吸收情况。根据DeLee和Charnley以及Mulroy和Harris的方法进行影像学评估。根据Merle d'Aubigné和Postel的标准以及Harris髋关节评分（HHS）确定患者的功能状态。
平均随访期为5.5年（范围3至12年）。所有患者术后早期均无并发症。所有患者中，移植骨覆盖髋臼组件的平均百分比为27%（范围19%至38%）。在最后一次随访时，所有患者对结果均满意，无临床松动迹象，骨整合完全，且任何髋关节均无移植骨吸收或塌陷的影像学证据。患者的总体Merle d'Aubigné评分和HHS在最终随访时显著改善。
这种阶梯式截骨技术增加了骨整合的可能性，减少了早期翻修的需求，并提供了可靠的稳定性，中期临床和影像学结果令人满意。
