Intertrochanteric, Subtrochantric Femoral Osteotomies For Posttraumatic, Congenital And Nontraumatic (Acquired) Conditions

摘要

The goal of osteotomy for osteonecrosis8,9,10,11,12,13,14 of the femoral head is to rotate the diseased are a way from the weight-bearing zone there by transferring forces to a less involved or normal region. Since most lesions are anterolateral, a flexion - valgus intertrochanteric osteotomy is usually the osteotomy of choice. It is important to separate etiology from pathogenesis. However, the single most important an factor in the treatment of osteonecrosis is establishing an early diagnosis. Osteotomy for Osteonecrosis The goal of osteotomy for osteonecrosis8,9,10,11,12,13,14 of the femoral head is to rotate the diseased are a way from the weight-bearing zone there by transferring forces to a less involved or normal region. Since most lesions are anterolateral, a flexion – valgus intertrochanteric osteotomy is usually the osteotomy of choice. It is important to separate etiology from pathogenesis. However, the single most important an factor in the treatment of osteonecrosis is establishing an early diagnosis. Intertrochantertic osteotomy is indicated for selected patients with Ficat stage II or III osteonecrosis as well as some patients with a stage IV lesion. The necrotic angle as described by kerbouletal considered a lesion to be large when the summed angle was>200° and small when it was<130°. Wagner 9,10,11,12,13,14,15,16,17,18 has Reported favorable results with an intertrochanteric osteotomy that couples a medical and anterior by based wedge removal resulting in both varus and flexion of the distal fragment. A discussion of osteotomies for osteonecrosis con not be complete without mentioning the sugioka11,12,13,14,15 trans trochanteric rotational osteotomy which was initially reported in Japan in 1973. (Fig 7A and 7B)