若年者の特発性大腿骨頭壊死症に対する大腿骨頭回転骨切り術の治療成績

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  • Clinical Results of Transtrochanteric Rotational Osteotomy for Idiopathic Osteonecrosis of the Femoral Head
  • ジャクネンシャ ノ トクハツセイ ダイタイコットウ エシショウ ニ タイスル ダイタイコットウ カイテン ホネキリ ジュツ ノ チリョウ セイセキ

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Objective: Because idiopathic osteonecrosis of the femoral head (ION) frequently develops in young adults, joint-preserving surgery is important. We retrospectively reviewed the clinical and radiographic results in patients who underwent transtrochanteric rotational osteotomy of the femoral head over a 5-year period in our institution.<br>Methods: We were able to follow up 32 consecutive patients (25 male patients and 7 female patients. 38 hips) for a mean of 13.5 years. The average age was 37.7 years at the time of surgery. Using the Japanese Organizing Committee classification, the ION stage was 2 in 1 joint, 3A in 24 joints, and 3B in 13 joints. The necrotic type was C-1 in 6 joints and C-2 in 32 joints, according to the Japanese Organizing Committee classification. Patients were evaluated using the Japanese Orthopaedic Association Score (JOA score) and radiographic analysis.<br>Results: The mean JOA score improved from 54.7 to 86.6 points (P < 0.0001) at the time of the final follow-up evaluation. Radiographically, the osteonecrosis in 26 hips (68%) had no progressive collapse, but 12 hips (32%) showed osteoarthritic changes and collapse. Six patients (eight hips) underwent total hip arthroplasty (THA). The postoperative intact area ratio (%) was significantly different between those with no progressive collapse (74.5%) and those with progressive collapse (45.4%) (P < 0.05). The cumulative survival rate was 75.6% at 13 years, with conversion to THA as the end point. Conclusion: In patients with extensive lesions, adequate rotation and intentional varus position is important to prevent the collapse of the transposed necrotic area.

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