髂骨与转子间联合截骨术治疗Perthe’s病

目的探讨Slter骨盆截骨与转子间内翻联合截骨术治疗Pcrthe’s病的疗效和影响因素。方法对9例有股骨头骨骺塌陷和包容不良合并半脱位的5～13岁(平均7.4岁)患儿,同时完成Salter骨盆截骨和转子间内翻联合截骨术,利用转子间取出的楔形骨块行髂骨截骨间隙内嵌入植骨,6例双截骨端用双克氏针交叉固定,3例髂骨截骨端双克氏针交叉固定,转子间截骨端用90°小钢板固定。结果术后随访4～8年,全部顺利完成骨愈合,X线形态测量包容良好,头基本恢复圆形,临床Harri’s评分平均术前78分改善到术后随访时的98分,取得良好的治疗效果。结论Slter骨盆截骨与转子间内翻联合截骨对Perthe’s病的扁平化后遗症和继发性髋臼指数增高的防止效果满意,对年龄小、病程短、髋关节形态明显异常者矫治效果更好。     

股骨转子间截骨联合术式治疗晚期髋关节发育不良

目的探讨股骨转子间截骨联合术式治疗晚期髋关节发育不良的临床效果。方法采用股骨转子间截骨、髋臼成形或加盖及带血管蒂髂骨瓣转移治疗晚期髋关节发育不良31例(42髋)。结果随访1．2～12年,平均4．3年,全部患者术后髋关节疼痛消失或明显减轻,髋关节功能明显改善。结论股骨转子间截骨联合术是一种治疗晚期髋关节发育不良的有效方法,可以避免或延缓全髋关节置换术。     

Salter骨盆截骨治疗Perthes病

儿童股骨头缺血性坏死(Legg-Calve-Perthes病,简称Perthes病)是儿童比较常见的髋关节疾病,由于病因尚不清楚,治疗方法各家不一.我科自1992年8月至1999年10月,采用Salter骨盆截骨术,配合胫骨结节牵引和CPM机治疗Perthes病12例,经随诊观察,疗效较满意.     

转子间截骨治疗儿童股骨头坏死的疗效观察

目的观察转子间截骨在治疗儿童股骨头缺血性坏死中的效果。方法对12例股骨头缺血性坏死患者,采用股骨转子间内翻截骨,使截骨后颈干角为110°。结果随访2-6年,优9例,良2例,差1例。结论股骨转子间内翻截骨治疗儿童股骨头缺血性坏死,手术方法简单,不需长期石膏固定,疗效可靠,是治疗Perthes病的最佳选择。     

Salter髂骨截骨联合股骨头圆韧带重建术治疗小儿发育性髋关节脱位

目的探讨Salter髂骨截骨联合股骨头圆韧带重建术治疗儿童发育性髋关节脱位的疗效。方法采用Salter髂骨截骨联合股骨头圆韧带重建术治疗39例(44髋)发育性髋关节脱位患儿。结果患儿均获随访,时间6～24个月。按照吉士俊等疗效评定标准进行评定:优35髋,良6髋,可3髋,优良率达93.2%。结论Salter髂骨截骨联合股骨头圆韧带重建术治疗学龄前儿童发育性髋关节脱位效果良好。     

转子间外翻截骨治疗股骨头坏死塌陷

目的探讨转子间外翻截骨治疗股骨头缺血坏死塌陷的临床疗效。方法对96例(96髋)股骨头缺血坏死塌陷患者(Ⅰb型45例和Ⅱ型51例)行转子间外翻25°～30°截骨,解剖钢板固定。术后水平皮肤牵引3周,后持拐行走。结果96例均获随访,时间3～23年,术后3～4个月截骨愈合。按王岩评价法评价:优89髋(92.71%),良6髋(6.25%),可1髋(1.04%),优良率98.96%。结论转子间外翻截骨治疗股骨头坏死塌陷,疗效满意。     

转子间内翻内移截骨术治疗Perthes病的远期效果

目的观察转子间内翻内移截骨术治疗Perthes病的远期疗效。方法对38例Perthes病患儿施行了转子间内翻内移截骨术,手术时年龄4～13岁,平均8岁10个月;Ⅱ期19例,Ⅲ期14例,Ⅳ期5例。平均随访7年(3～15年),根据临床表现和X线征象评定疗效,分析其远期效果。结果根据自拟的评定标准,优15例,良17例,可3例,差3例,总优良率84.2%;Ⅱ期患儿优良率94.7%,Ⅲ期85.7%,Ⅳ期40.0%。结论转子间内翻内移截骨术治疗Perthes病具有术式简单、损伤小、疗效良好等优点,值得推广应用。     

Neck-shaft angle remodelling after derotation varus osteotomy for severe Perthes disease

Sixteen patients with a severe form of Perthes disease who underwent containment derotation varus osteotomy (DVO) of the proximal femur were studied retrospectively for the neck-shaft angle (NSA) remodelling. Analysis of results after a mean follow-up of 7 years (minimum of 5 years and maximum of 8.7 years) showed mean preoperative, immediate postoperative and the latest follow-up neck-shaft angles (NSA) as 135 degrees, 110 degrees (none had varus less than 90 degrees) and 125 degrees, respectively. A statistically significant relationship between NSA remodelling and the immediate post-op NSA (P = 0.0035) was established. Patients with smaller postoperative NSA showed better remodelling compared with those who had higher degrees of NSA immediately after the surgery. No significant relationship was found between the degree of NSA remodelling and the patient's age at diagnosis, age at surgery, severity of Perthes or the Stulberg grading at maturity. The authors conclude that up to 90 degrees or more varization after DVO for Perthes disease can remodel with time, and the remodelling process is independent of the patient's age at diagnosis, age at surgery, or severity of Perthes or Stulberg grading at maturity.     

Curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head

We reviewed the outcome of curved intertrochanteric varus osteotomy in the treatment of osteonecrosis of the femoral head in 20 hips. A mean varus angulation of 31 degrees was obtained by the osteotomy. The ratio of intact area on the weight-bearing portion increased from 19% to 61%. The mean elevation and lateral displacement of the greater trochanter were 1.2 cm and 0.5 cm, respectively. These changes in the position of the greater trochanter were very small when compared with those after conventional varus wedge osteotomy. Nonunion or delayed union was not observed. Quantitative analyses showed aggressive bone remodelling in the medial intertrochanteric region. Eighteen hips survived without collapse after a mean follow-up of 48 months. We conclude that curved varus osteotomy can be used to preserve the hip joint in patients with osteonecrosis of the femoral head.     

Boomerang proximal tibial osteotomy for the treatment of severe varus gonarthrosis

Purpose

The purpose of the study was to review the results of modified infratubercle displacement osteotomy in patients with severe varus gonarthrosis and to determine the factors influencing outcomes.

Methods

A total of 177 knees in 133 patients with severe varus gonarthrosis were treated with infratubercle boomerang-shaped osteotomy, stabilised with dual plates. The mean age of the patients was 63.8 years (range 43–80 years), and the mean follow-up period was 61.4 months (range 24 –139 months). The factors associated with clinical and survival outcomes were analysed including age, gender, body mass index (BMI), preoperative and post-operative femorotibial angle and femorotibial angle at one year after surgery.

Results

Using the Knee Society clinical rating system 149 knees or 84.2 % were rated as having good to excellent results and 21 knees or 15.8 % as having fair to poor results. Overall, the mean preoperative knee score of 33.6 points had improved significantly to 80.7 points at the final follow-up (p < 0.001). Using Kaplan-Meier survivorship analysis the five-year survival was 97.1 % with conversion to arthroplasty or second osteotomy as the end point and 89.2 % with a knee score of under 70 points as the end point. The anatomical femorotibial angle at one year after osteotomy had the most significant positive effect on the clinical (p < 0.001) and survival outcomes for all end points (p = 0.002 for conversion to arthroplasty or second osteotomy and p < 0.001 for knee score less than 70 points).

Conclusions

The boomerang osteotomy can create adequate valgus alignment in severe varus gonarthrosis. The one-year post-operative knee alignment of 11° valgus provided the most satisfactory results and that between six and 15° valgus the longest survival time.     

Curved osteotomy technique for intertrochanteric varus surgery--an experimental and computer-assisted surgery

PURPOSE: In conventional intertrochanteric varus osteotomy, shortening of the leg and insufficiency of the abductor muscles occur frequently. To avoid these disadvantages, a curved osteotomy is presented. METHOD: 189 intertrochanteric barrel vault and wedge osteotomies were compared. By means of digitized preoperative radiographs the varus osteotomies were planned with a computer program optimising postoperative leg length, bone contact area at the osteotomy site, femoral offset, and abductor muscle length. RESULTS: The average leg shortening was 3.9 mm (range: 0-5 mm) for barrel vault osteotomy and 13.6 mm (range: 8-22.2 mm) for the wedge technique. After correction the mean contact area at the osteotomy sites was 1731.6 mm2 (range: 1087.8-2341.8 mm2) in the barrel vault technique compared with 783.7 mm2 (range: 563.7-1249.6 mm2) in the wedge procedure (p < 0.001, t-test). Adequate femoral offset was achieved in both types of osteotomy. In all curved osteotomies the length of the abductor muscles remained nearly constant in contrast to the wedge procedure. Additional comparative experimental barrel vault osteotomies in 22 human autopsy femora with a high-speed dissecting tool and round jigs revealed a precise application of the preoperative planning. CONCLUSION: The intertrochanteric curved osteotomy provides minimum leg shortening and increased bone contact area. It can prevent an insufficiency of the abductor muscles, because shortening is minimized.     

Long-term results of intertrochanteric varus osteotomy for dysplastic osteoarthritis of the hip

The beneficial role of intertrochanteric varus or valgus osteotomy in the treatment of hip osteoarthrosis has been recognised since the 1920s. Even today, it has an important role to delay the need for hip replacement in younger patients. The purpose of this study was to evaluate the long-term results of intertrochanteric varus osteotomy for dysplastic osteoarthritis of the hip. Between 1980 and 1995, 52 hips with dysplastic osteoarthritis underwent an intertrochanteric varus osteotomy. All patients could be followed up after 17.8 years. Radiographic assessment included centre-edge (CE) angle of Wiberg and collodiaphyseal (CCD) angle. Dysplastic hip dislocation was classified according to Crowe. Osteoarthritis was graded according to Tönnis. Preoperative osteoarthritis was Tonnis grade 1 in 19 hips, grade 2 in 28 and grade 3 in five. Complications were also documented. Clinical evaluation included score according to Merle d’Aubigné, Harris Hip Score and range of motion. Six of 52 patients underwent total hip replacement (THR) within five years after intertrochanteric osteotomy. In these cases, preoperative osteoarthritis was grade 3 in four cases and grade 2 in one case according to Tönnis. Twenty-five of 52 patients underwent THR after an interval of five to ten years after intertrochanteric osteotomy. In these cases, preoperative osteoarthritis was grade 3 in one case and grade 2 in 24 cases according to Tönnis. Sixteen of 52 patients underwent THR after an interval of ten to 15 years after intertrochanteric osteotomy. In these cases, preoperative osteoarthritis was grade 2 in four cases and grade 1 in 12 cases according to Tönnis. In five patients the hip was functioning well after a period longer than 15 years. In all these cases osteoarthritis was grade 1 according to Tönnis. In 40.4% of patients, THR was delayed longer than ten years. The osteotomy performed well at a mean time of 9.7 years after the procedure (range 3–21). Intertrochanteric varus osteotomy for dysplastic osteoarthritis of the hip should be considered in early or mild osteoarthritic changes of the hip. Good prognosis with delay of THR of more than ten years can be expected to exceed 40%, even when indications are less than optimum.     

Dwyer osteotomy for treatment of calcaneal varus

Treatment of varus deformity of the rearfoot is satisfactorily corrected with a lateral closing wedge osteotomy of the calcaneus. Whether the condition being treated is club foot, pes cavus deformity, or calcaneal varus alone, statistics show the varus component is consistently resolved with this osteotomy approach. A case report of calcaneal varus is presented, including a postoperative complication with resolution.     

Osteonecrosis of the femoral head. Simple varus intertrochanteric osteotomy

We present the long-term results of simple varus intertrochanteric osteotomy for osteonecrosis of the femoral head. We followed 26 hips in 20 patients, with a mean age at the time of surgery of 36 years, for a mean of 12.5 years. The mean varus angulation was 23 degrees. The outcome in 19 of the hips (73%) was good or excellent; seven (27%) had a fair or poor result, with four needing some form of prosthetic arthroplasty. Simple varus intertrochanteric osteotomy is indicated, even if the extent of the capital infarct comprises more than 50% of the diameter of maximum radial distance from the circumference, provided that after operation the medial necrotic lesion measures less than two-thirds of the weight-bearing area, and the superolateral bone is normal.