Atsumi Takashi, Yoshikawa Yasushi, Nishi Masanori, Usui Yuki, Nakanishi Ryosuke, Kudo Yoshifumi
Showa Medical University, Tokyo, Japan.
Sassa General Hospital, Tokyo, Japan.
Arch Orthop Trauma Surg. 2025 Jun 28;145(1):356. doi: 10.1007/s00402-025-05909-6.
We evaluated the effectiveness of rotational open wedge osteotomy (ROWO) for patients ≧ 8 years Legg-Calvé-Perthes disease (LCPD) with extensive lesions. The main concept of ROWO is repositioning the posterolateral viable segment below the acetabular roof through dual open wedge osteotomy.
We reviewed 30 hips in 30 patients with LCPD and extensive lesions treated by ROWO, with a mean follow-up of 9.3 years (range: 5-21 years). The mean age was 8.3 years (range: 7-11.7 years). All hips had small viable bones in the posterolateral epiphysis preoperatively. Ten hips were classified as lateral pillar B/C, and 20 as Group C. Twenty-nine hips were Catterall Group 3, and one as Group 4. The fragmentation stage was most frequently observed at the time of operation. After osteotomy, the mean anterior rotational angle was 36°, with a mean varus of 18°. The repair process, femoral head morphology, acetabular coverage, and the angle between the femoral neck and diaphysis were assessed radiographically.
The repair rate in the viable area below the acetabular roof improved from 0.2% preoperatively to 83% at 6 months, 98% at 1 year, and 99% at the final follow-up on AP radiographs. Regarding morphology, spherical congruency was observed in 26 of 30 hips at the final follow-up (Stulberg classification: Class I: 7, Class II: 19). Class III was noted in four hips within the lateral pillar C group. No hips were classified as Class IV or V. The acetabular head index improved from a preoperative mean of 69 to 84 at the final follow-up. The lateral neck-shaft angle improved from 33° preoperatively to 32° at the final follow-up.
This procedure is effective in accelerating repair and promoting femoral head sphericity in older LCPD patients with extensive lesions by repositioning the viable epiphysis below the acetabular roof.
我们评估了旋转开放楔形截骨术（ROWO）对8岁及以上患有广泛病变的Legg-Calvé-Perthes病（LCPD）患者的有效性。ROWO的主要概念是通过双开放楔形截骨术将髋臼顶下方的后外侧存活节段重新定位。
我们回顾了30例接受ROWO治疗的LCPD且有广泛病变患者的30个髋关节，平均随访9.3年（范围：5 - 21年）。平均年龄为8.3岁（范围：7 - 11.7岁）。所有髋关节术前在后外侧骨骺均有小的存活骨。10个髋关节被分类为外侧柱B/C型，20个为C组。29个髋关节为Catterall 3组，1个为4组。手术时最常观察到碎裂期。截骨术后，平均前旋角度为36°，平均内翻为18°。通过X线片评估修复过程、股骨头形态、髋臼覆盖情况以及股骨颈与骨干之间的角度。
髋臼顶下方存活区域的修复率在前后位X线片上从术前的0.2%提高到6个月时的83%、1年时的98%以及最终随访时的99%。在形态方面，最终随访时30个髋关节中有26个观察到球形匹配（Stulberg分类：I级：7个，II级：19个）。外侧柱C组中有4个髋关节为III级。没有髋关节被分类为IV级或V级。髋臼头指数从术前平均69提高到最终随访时的84。外侧颈干角从术前的33°提高到最终随访时的32°。
该手术通过将存活的骨骺重新定位到髋臼顶下方，对于加速年龄较大、患有广泛病变的LCPD患者的修复并促进股骨头球形化是有效的。
