Ayabe Yusuke, Motomura Goro, Ikemura Satoshi, Yamaguchi Ryosuke, Utsunomiya Takeshi, Yamamoto Noriko, Tanaka Hidenao, Hamai Satoshi, Kawahara Shinya, Nakashima Yasuharu
Investigation Performed at Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Investigation Performed at Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
J Orthop Sci. 2025 Mar;30(2):313-319. doi: 10.1016/j.jos.2024.03.010. Epub 2024 Apr 2.
This study assessed the hip survival rate and patient-reported outcome measures (PROMs) of transtrochanteric curved varus osteotomy (CVO) for osteonecrosis of the femoral head (ONFH) compared with those of conservative management.
The CVO group comprised 32 consecutive patients (39 hips) who underwent CVO for ONFH between 2000 and 2011. The conservative group consisted of 36 consecutive patients (37 hips) who were managed conservatively for at least 1 year after collapse and who had ONFH classified by the Japanese Investigation Committee of Health and Welfare as type B or C1, for which CVO is indicated. Kaplan-Meier analysis of hip survival used any ONFH-related therapeutic surgery as the endpoint. PROMs were evaluated for all patients with surviving hips and radiographs available at the latest follow-up.
The 10-year hip survival rate in the CVO group was 86.7%, which was significantly higher than the 51.0% 5-year survival rate in the conservative group (p < 0.0001). The Oxford Hip Score and UCLA Activity Score were significantly better in the CVO group without joint space narrowing than in the conservative group, with no significant differences between the CVO group with joint space narrowing and the conservative group.
CVO could preserve hip joints more effectively than conservative follow-up after collapse, although the presence of joint space narrowing could reduce satisfaction levels even in patients with long-term hip survival.
本研究评估了经转子间弧形内翻截骨术（CVO）治疗股骨头坏死（ONFH）的髋关节生存率和患者报告结局指标（PROMs），并与保守治疗进行比较。
CVO组包括2000年至2011年间连续32例接受CVO治疗ONFH的患者（39髋）。保守组由36例连续患者（37髋）组成，这些患者在塌陷后接受了至少1年的保守治疗，且其ONFH被日本厚生省调查委员会分类为B型或C1型，适合CVO治疗。髋关节生存的Kaplan-Meier分析以任何与ONFH相关的治疗性手术作为终点。对所有存活髋关节且在最新随访时有X线片的患者评估PROMs。
CVO组10年髋关节生存率为86.7%，显著高于保守组5年生存率51.0%（p<0.0001）。CVO组中无关节间隙变窄的患者牛津髋关节评分和加州大学洛杉矶分校活动评分显著优于保守组，CVO组有关节间隙变窄的患者与保守组之间无显著差异。
CVO比塌陷后的保守随访能更有效地保留髋关节，尽管即使在长期髋关节存活的患者中，关节间隙变窄也可能降低满意度。
