Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy.
Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131 Salerno, Italy.
Br Med Bull. 2021 Mar 25;137(1):98-111. doi: 10.1093/bmb/ldaa044.
In osteonecrosis of the femoral head (ONFH), blood supply is insufficient for the metabolic requirements of the bone. The initial management is conservative, and, in case of failure, surgery is indicated. Osteotomies aim to change the spatial position of the necrotic portion of the femoral head. This systematic review evaluates the effectiveness and safety of osteotomies for ONFH.
The systematic review, organized, conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, was performed on PubMed and Google Scholar. We analysed outcomes in term of Harris Hip Score, leg shortening, secondary collapse and blood loss. We also verified the percentage of patients who required total hip replacement (THR) after osteotomy for ONFH.
A total of 16 articles were selected, including 775 patients and 852 osteotomies [curved varus osteotomy in 369 (43.3%) patients; transtrochanteric rotational osteotomy in 435 (51.05%) patients; half wedge osteotomy in 48 (5.6%) patients]. There was an overall THR conversion rate of 31.5% (268 hips on 852 osteotomies).
There were no prospective randomized trials, and the outcome measures employed were often heterogeneous.
Approximately one-third of the osteotomies performed in cases of ONFH are converted to THR over a period of ~7 years. In older patients, primary THR should be considered, especially as the conversion to THR after osteotomy is technically demanding.
Randomized clinical studies should be conducted in order to define the parameters of the patient that can direct towards the most suitable osteotomic technique.
在股骨头坏死（ONFH）中，血液供应不足以满足骨骼的代谢需求。初始治疗是保守的，若治疗失败，则需要手术。截骨术旨在改变股骨头坏死部分的空间位置。本系统评价评估了截骨术治疗股骨头坏死的有效性和安全性。
该系统评价是按照系统评价和荟萃分析的首选报告项目的指导组织、进行和报告的，检索了 PubMed 和 Google Scholar。我们分析了 Harris 髋关节评分、下肢缩短、二次塌陷和失血量等结果。我们还验证了接受股骨头坏死截骨术的患者中需要全髋关节置换（THR）的百分比。
共选择了 16 篇文章，包括 775 名患者和 852 例截骨术[369 例（43.3%）患者行弧形内翻截骨术；435 例（51.05%）患者行转子间旋转截骨术；48 例（5.6%）患者行半楔形截骨术]。852 例截骨术中，总体 THR 转化率为 31.5%（268 髋）。
没有前瞻性随机试验，且使用的结局测量指标往往存在异质性。
在股骨头坏死患者中，大约有三分之一的截骨术在大约 7 年内会转为 THR。对于老年患者，应考虑初次 THR，尤其是因为截骨术后转为 THR 在技术上具有挑战性。
应开展随机临床试验，以确定能指导选择最合适截骨术技术的患者参数。
