大腿骨転子部骨切り術の一つの工夫

抄録

A new technique (intertrochanteric curved osteotomy) has been designed as varus osteotomy to prevent the elevation of the greater trochanter (Trendelenburg limp), shortening the leg and lateral displacement of the femoral shaft which was induced by the usual technique.
Through a lateral longitudinal approach the proximal femurr is exposed from a point just inferior to the level of the lesser trochanter proximally to the top of the greater trochanter. Then curved osteotomy is performed through the medial portion of the attachment of the gluteus medius and minimus muscle on the greater trochanter to the lesser trochanter in the lateral part of crista intertrochanterica making a slight detachment of the vastus lateralis, medialis and gluteus minimus muscle origin from the frontal osteotomy line. The center of the circumferential osteotomy line should be the center of the rotation of the joint.
Next pull the proximal fragment proximally into abduction under the extension of distal fragment distally until the desired varus position is reached. The fragments are fixed by several screws of the appropriate length.
This technique is able to make torsional correction, to displace to proximal fragment to anterior or posterior direction on the transverse plane or insert a small bone piece in the anterior or posterior gap of osteotomy line.
This procedure has been performed successfully on 16 patients. Follow up study and discussion has shown that this new technique is by far more successful than the usual technique.