儿童和青少年股骨粗隆间向后旋转截骨术：用于治疗发育性髋关节发育不良后股骨头残余畸形：2001JBJS

儿童和青少年股骨粗隆间向后旋转截骨术：用于治疗发育性髋关节发育不良后股骨头残余畸形：2001年JBJS-Br

作者：A M Sokolovsky, O A Sokolovsky.

作者单位: Belarusian Research Institute of Traumatology and Orthopaedics, Minsk, Republic of Belarus.

译者：陶可（北京大学人民医院骨关节科）

摘要

我们描述了一种股骨头和颈部向后旋转的股骨粗隆间截骨方法。我们分析了44名6至18岁儿童和青少年在保守（35）和手术（10）治疗髋关节发育不良并发股骨头缺血性坏死后残留发育不良的45髋。10例患者采用了股骨截骨与多种骨盆手术相结合的方式。37髋（36名患者）平均进行了4年5个月（2至15年）的随访。髋关节功能优秀9髋，良好17髋，一般7髋，差4髋，优良率达70.27%。

Fig. 1 Diagrams of the technique of modified rotational osteotomy of the proximal femur. Figure 1a – General view. Figure 1b – Initial stage (e, cutting the greater trochanter and insertion of the blade plate; f, incomplete femoral osteotomy; g, production of a posterior wall with a chisel). Figure 1c – Intermediate stage. The proximal fragment is free and consists of the femoral head, neck and trochanteric region. Figure 1d – Final stage. The femoral position after posterior 90° rotation of the proximal femoral component and osteosynthesis.

图1 改良股骨近端旋转截骨技术示意图。图1a 大体视图。图1b 截骨第一步（e，切割大转子并插入骨撬板；f，不完全股骨截骨；g，用凿子制作后壁）。图1c 中间阶段。近端骨块是游离的，由股骨头、颈部和转子区域组成。图1d 最后一步。股骨近端假体向后旋转90°并进行骨块结合后的股骨位置。

Fig. 2 Case 25. Radiographs showing A) residual subluxation of the left hip with severe deformity of the femoral head (coxa plana) and relative overgrowth of the greater trochanter (Severin class IV), B) after 90° posterior rotational osteotomy with improvement in joint congruity and C) follow-up at ten months. The osteotomy is united and the hip graded as Severin class I.

图2 病例25. X线片显示A)左髋关节残余半脱位伴股骨头严重畸形（扁平髋）和大转子相对过度生长（Severin IV类），B) 90°向后旋转截骨后，髋臼与股骨头形合度改善和C) 术后10个月的随访。截骨处骨质已愈合，髋关节分级为Severin I级。

Posterior rotational intertrochanteric osteotomy of the femur in children and adolescents. Use in residual deformity of the femoral head after treatment for developmental dysplasia of the hip

Abstract

We describe a method of intertrochanteric osteotomy with posterior rotation of the femoral head and neck. We analysed 45 hips in 44 children and adolescents aged from six to 18 years with residual dysplasia after conservative (35) and operative (10) treatment of developmental dysplasia of the hip complicated by avascular necrosis of the femoral head. In ten, femoral osteotomy was combined with a variety of pelvic procedures. Thirty-seven hips (36 patients) were available for follow-up at a mean of 4 years 5 months (2 to 15 years). Excellent results were obtained in nine, good in 17, fair in seven and poor in four.

文献出处：A M Sokolovsky, O A Sokolovsky. Posterior rotational intertrochanteric osteotomy of the femur in children and adolescents. Use in residual deformity of the femoral head after treatment for developmental dysplasia of the hip. J Bone Joint Surg Br. 2001 Jul;83(5):721-5. doi: 10.1302/0301-620x.83b5.10868.