International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA.
Department of Orthopedics, Alexandria University, Alexandria, Egypt.
J Pediatr Orthop B. 2024 Jul 1;33(4):348-357. doi: 10.1097/BPB.0000000000001109. Epub 2023 Jul 19.
Femoral head reduction osteotomy (FHRO) was described to treat misshapen femoral head that is causing intraarticular hip pain. The published literature showed discrepancies in patient selection, surgical techniques, and decision to perform concurrent acetabular osteotomy. Very few studies used Standardized Outcome Measures (SOMs). This study aims to describe the technique of FHRO and report the results of our series of 22 patients using SOMs and compare them to former peer-reviewed articles. Twenty-two hips in 22 patients with hip pain caused by mishshapen femoral were treated with FHRO with or without triple pelvic osteotomy (TPO). Patients with poor hip range of motion and significant hip joint arthritis were excluded. The mean patient age was 15.8 (range, 9.2-23.9). Clinical results were reported using the HHS. Radiographical results were reported by comparing Lateral Center Edge Angle (LCEA), extrusion index, Tonnis angle, head size percent, sphericity index, and distance from tip of trochanter to center of femoral head. The mean follow-up was 3.2 years. Only 5 patients received TPO. The HHS showed statistical improvement from 62.0 to 81.6 (The median interquartile range 63.5-88.5). Five patients had HHS less than 70 at the latest follow up. All radiographic parameters except the Tonnis angle, showed statistically significant improvement. FHRO with or without pelvic osteotomy is a good salvage procedure for patients presenting with misshapen femoral head with intraarticular hip pain, who still have good preoperative ROM with no signs of hip arthritis. Level of evidence: IV.
股骨颈头缩小截骨术（FHRO）被用于治疗导致髋关节腔内疼痛的畸形股骨头。已发表的文献显示，在患者选择、手术技术以及是否同时进行髋臼截骨术方面存在差异。很少有研究使用标准化结局测量（SOMs）。本研究旨在描述 FHRO 的技术，并报告我们使用 SOMs 对 22 例患者系列的结果，并与以前的同行评议文章进行比较。22 例髋关节疼痛患者，由于股骨头畸形导致髋关节疼痛，采用 FHRO 治疗，其中 5 例同时行三骨盆截骨术（TPO）。排除髋关节活动范围差和髋关节关节炎明显的患者。患者平均年龄为 15.8 岁（范围为 9.2-23.9 岁）。临床结果采用 HHS 进行报告。通过比较侧位中心边缘角（LCEA）、挤出指数、Tonnis 角、头大小百分比、球形指数和从大转子尖端到股骨头中心的距离，报告放射学结果。平均随访时间为 3.2 年。只有 5 例患者接受 TPO。HHS 从 62.0 提高到 81.6（中位数四分位距 63.5-88.5），差异有统计学意义。5 例患者在末次随访时 HHS 小于 70。除 Tonnis 角外，所有放射学参数均显示出统计学上的显著改善。FHRO 联合或不联合骨盆截骨术是一种治疗髋关节腔内疼痛的畸形股骨头的良好挽救性手术方法，对于术前髋关节活动度良好且无髋关节关节炎迹象的患者是一种良好的治疗方法。证据水平：IV。
