Otaka Keiji, Osawa Yusuke, Takegami Yasuhiko, Seki Taisuke, Imagama Shiro
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, 453-8511, Japan.
Arthroplasty. 2023 Sep 5;5(1):46. doi: 10.1186/s42836-023-00202-6.
Although favorable results have been reported with total hip arthroplasty, joint-preserving treatment should be the first choice for subchondral fracture of the femoral head (SFF) in young patients. This study reviewed four young male patients with SFF who underwent intertrochanteric curved varus osteotomy (CVO). The patients had a mean age of 32.3 years (range: 18-49 years). Conservative treatment was initially attempted in all cases, but failed to alleviate the pain, leading to surgical intervention at an average time of 6 months (range: 4-10 months) after symptom onset. As the fracture sites were located medial to the lateral edge of the acetabulum in all cases, CVO was performed to achieve a postoperative intact ratio of ≥ 34% in the weight-bearing region of the femoral head. The average follow-up period after surgery lasted 4.3 years (range: 2-7 years). Clinical and radiographic assessments were performed pre- and postoperatively. At the latest follow-up, the mean Harris hip score improved from 67.3 preoperatively to 99.5 postoperatively. The average preoperative intact ratio of the weight-bearing region of the femoral head was 12.3%, which increased to 44.3% postoperatively. No progression to femoral head collapse or joint space narrowing was observed on the plain radiographs. CVO is a simple, less-invasive, and beneficial approach for treating SFF in young patients whose fractures occur medial to the lateral edge of the acetabulum.
尽管全髋关节置换术已报告有良好效果，但对于年轻患者的股骨头软骨下骨折（SFF），保留关节的治疗应是首选。本研究回顾了4例接受转子间弧形内翻截骨术（CVO）的年轻男性SFF患者。患者平均年龄为32.3岁（范围：18 - 49岁）。所有病例最初均尝试保守治疗，但未能缓解疼痛，导致在症状出现后平均6个月（范围：4 - 10个月）进行手术干预。由于所有病例的骨折部位均位于髋臼外侧边缘的内侧，因此进行CVO以在股骨头负重区实现术后完整率≥34%。术后平均随访期为4.3年（范围：2 - 7年）。术前和术后均进行了临床和影像学评估。在最近的随访中，Harris髋关节平均评分从术前的67.3提高到术后的99.5。股骨头负重区术前平均完整率为12.3%，术后增至44.3%。在X线平片上未观察到股骨头塌陷或关节间隙变窄的进展。对于骨折发生在髋臼外侧边缘内侧的年轻SFF患者，CVO是一种简单、侵入性较小且有益的治疗方法。
