Watanabe Minoru, Kagaya Satoshi, Kuzushima Daichi, Kachi Itaru, Ishikawa Tsubasa, Kanzaki Kouji
Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama, 227-8501, Japan.
BMC Musculoskelet Disord. 2025 Mar 11;26(1):235. doi: 10.1186/s12891-025-08463-9.
Transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH) is considered technically demanding, with varying results among institutions. This is due to the complex soft tissue exposure and determination of the osteotomy line. We report a case in which the osteotomy line was assessed using the Stryker OrthoMap three-dimensional (3D) computed tomography (CT)-based navigation system and determined as preoperatively planned.
The patient was a 24-year-old male with alcohol-related ONFH. Japanese Investigation Committee Classification Type C2/C2 Stage 3b/3b was confirmed through magnetic resonance imaging, and TRO was performed bilaterally on the same day using the Stryker OrthoMap 3D CT-based navigation system. The patient was hospitalized for 55 days, and full loading was allowed at 6 months postoperatively. Eight months after surgery, the patient could return to work at his previous job in the restaurant industry relatively quickly. One and a half years postoperatively, the functional score improved from a preoperative visual analog scale of 90 to 12 mm at and the Japanese Hip Society Hip Evaluation Questionnaire improved from 31 points preoperatively to 59 points.
This is the first report of a bilateral TRO for bilateral ONFH performed on the same day using CT-based navigation. For osteonecrosis, which is often bilateral, accurate determination of the osteotomy line as planned preoperatively using CT-based navigation contributes to shorter operative time, less intraoperative blood loss, and allows for bilateral same-day surgery. This may improve situations in which patients are hesitant to undergo bone-preserving surgery because of the long period of time required to return to work, thereby facilitating their early reintegration into society.
转子间旋转截骨术（TRO）治疗股骨头坏死（ONFH）在技术上要求较高，不同机构的治疗效果各异。这是由于软组织暴露复杂以及截骨线的确定存在差异。我们报告了一例使用史赛克OrthoMap三维（3D）计算机断层扫描（CT）导航系统评估截骨线并按术前规划确定截骨线的病例。
患者为一名24岁男性，患有酒精性ONFH。通过磁共振成像确诊为日本调查委员会分类C2/C2期3b/3b型，同日使用史赛克OrthoMap基于3D CT的导航系统双侧进行TRO。患者住院55天，术后6个月允许完全负重。术后8个月，患者能够相对较快地回到之前在餐饮行业的工作岗位。术后一年半，功能评分从术前视觉模拟量表的90分提高到12毫米，日本髋关节协会髋关节评估问卷得分从术前的31分提高到59分。
这是首例同日使用基于CT的导航系统对双侧ONFH进行双侧TRO的报告。对于常为双侧性的股骨头坏死，使用基于CT的导航系统按术前规划准确确定截骨线有助于缩短手术时间、减少术中出血，并允许双侧同日手术。这可能改善因恢复工作所需时间长而对保骨手术犹豫不决的患者的情况，从而促进他们早日重新融入社会。
