Higuchi Ryo, Takashima Kazuma, Uemura Keisuke, Okada Seiji, Sugano Nobuhiko, Hamada Hidetoshi
Department of Orthopaedics, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan.
J Arthroplasty. 2025 Jun 4. doi: 10.1016/j.arth.2025.05.120.
This study evaluated postoperative radiological outcomes of transtrochanteric osteotomy using a computed tomography (CT)-based navigation system in patients who have osteonecrosis of the femoral head.
This study included 16 patients who had a mean age of 28 ± 10 years and a mean follow-up of nine ± 5 years. There were four, five, and seven patients who underwent transtrochanteric anterior rotational osteotomy, transtrochanteric posterior rotational osteotomy, and curved varus osteotomy with a CT-based navigation system to achieve an intact ratio of ≥ 34%, respectively. According to the Japanese Investigation Committee classification, 14 and two hips were stage 3A and 3B, whereas 12 and four hips were type C1 and C2, respectively. There were two types of cumulative survival rates evaluated: one based on progression to collapse and the other based on conversion to total hip arthroplasty (THA) as the end point. The intact ratio, tip-to-apex distance, femoral offset, leg length, and neck-shaft angle were calculated via radiography and compared between the THA and non-THA groups according to whether conversion to THA was required.
Collapse occurred in two cases, whereas four cases required THA. The cumulative survival rate among those who experienced collapse and required THA was 88 and 75%, respectively. The reasons for conversion to THA in the four cases were collapse (one case), deep infection (one case), and failures at the osteotomy site (two cases). All patients had a postoperative intact ratio of ≥ 34% (mean value, 49 ± 10%). No differences in the postoperative intact ratio were found between the groups. The tip-to-apex distance was greater in the THA group (39 ± 8 mm) than in the non-THA group (28 ± 10 mm; P = 0.04).
Transtrochanteric osteotomy using a CT-based navigation system achieved a postoperative intact ratio of ≥ 34%. Further investigation may be necessary to reduce osteotomy site complications.
本研究评估了使用基于计算机断层扫描（CT）的导航系统对股骨头坏死患者进行转子间截骨术后的放射学结果。
本研究纳入了16例患者，平均年龄为28±10岁，平均随访时间为9±5年。分别有4例、5例和7例患者使用基于CT的导航系统接受了转子间前旋截骨术、转子间后旋截骨术和弧形内翻截骨术，以实现完整率≥34%。根据日本调查委员会的分类，14髋和2髋分别为3A期和3B期，而12髋和4髋分别为C1型和C2型。评估了两种累积生存率：一种基于塌陷进展情况，另一种以转换为全髋关节置换术（THA）作为终点。通过X线片计算完整率、顶点到尖点距离、股骨偏移、腿长和颈干角，并根据是否需要转换为THA在THA组和非THA组之间进行比较。
2例发生塌陷，4例需要进行THA。发生塌陷和需要进行THA的患者累积生存率分别为88%和75%。4例转换为THA的原因分别为塌陷（1例）、深部感染（1例）和截骨部位失败（2例）。所有患者术后完整率均≥34%（平均值，49±10%）。两组之间术后完整率无差异。THA组的顶点到尖点距离（39±8mm）大于非THA组（28±10mm；P=0.04）。
使用基于CT的导航系统进行转子间截骨术可实现术后完整率≥34%。可能需要进一步研究以减少截骨部位并发症。
