特発性大腿骨頭壊死症--大腿骨頭回転骨切り術の長期治療成績と摘出骨頭の病理組織学的検討

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Long-term clinical results after transtrochanteric anterior rotational osteotomy for idiopathic osteonecrosis of the femoral head and histopathological study of the removed femoral head were evaluated in patients who eventually underwent arthroplasty. From 1987 to 1996, transtrochanteric rotational osteotomy was used to treat 35 hips in 26 patients with osteonecrosis of the femoral head. Every hip case had anterior rotational osteotomy and follow-up periods ranged from ten to 18 years. When the end point of the study was defined as postoperative progress to collapse of the femoral head, the 10-year survival rate was 84% and that of the 15-year was 76%. When the end point was defined as an advanced stage after operation, the 10-year survival rate was 68% and the 15-year, 35%. This operation that indicates the ratio of the intact area of the posterior part of the femoral head to the total articular surface on the lateral view of the hip roentgenogram patients should be more than 33%, and for postoperative patients, the transposed intact area should occupy more than 36% of the accetabular weight-bearing area after osteotomy and the intentional varus position. In addition, excellent results were obtained in patients within the limits of the above indications. The risk factors for postoperative progressive collapse include advanced types, 66% or less, and 40% or less of the intact area of the posterior part on the lateral view of the hip roentgenogram. Even though favorable medium-term results had excellent success, in some patients an advanced stage was observed in the long-term results of more than 10 years, resulting in arthroplasty. In the removed femoral head in 8cases eventually undergoing arthroplasty, repair of the osteonecrotic area was histopathologically evaluated. Large sections and 1/4 section specimens were stained with hematoxylin-eosin. The osteonecrotic area, a band-like sclerotic area, and an intact area were identified on the large section specimens, leading to measurement of the following: (1) the maximum thickness of appositional bone formation, (2) the mean thickness of the creeping substitu-tion, (3) coverage of the necrosis trabecula, and (4) the area of all bone trabecula. The osteonecrosis was repaired when the appositional bone was formed from the band-like sclerotic area to the area around the necrotic bone, resulting in proximal expansion throughout the entire necrotic area. Pathological features of the osteonecrotic area without weight-bearing stress were almost identical to MRI findings. The final pathological findings in the repair of osteonecrosis constitutes not replacement with intact tissues, but filled with thickened trabeculae following the disappearance of necrotic tissues and fibrosis.
学校法人昭和大学・昭和医学会の論文

著者

豊島洋一
昭和大学医学部整形外科学教室

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