Gillingham B L, Sanchez A A, Wenger D R
Division of Pediatric Orthopedics, Department of Orthopedics, Naval Medical Center, San Diego, CA 92134-1005, USA.
J Am Acad Orthop Surg. 1999 Sep-Oct;7(5):325-37. doi: 10.5435/00124635-199909000-00005.
Persistent acetabular dysplasia is a well-known cause of premature hip osteoarthritis. In the dysplastic hip, point loading occurs at the edge of the steep, shallow acetabulum. Pelvic osteotomies reduce this load by increasing the contact area, relaxing the capsule and muscles about the hip, improving the moment arm of the hip, and normalizing the forces of weight bearing. The orthopaedic surgeon can choose from among a variety of pelvic osteotomies (e.g., redirectional, reshaping, and salvage) for the purpose of restoring normal anatomy and biomechanical forces across the hip joint. Treatment of residual dysplasia is based on the patient's age and the presence or absence of congruent hip reduction. A Salter or Pemberton procedure is generally appropriate for a child between the ages of 2 and 10. A triple innominate osteotomy can be considered for the older child or adolescent in whom the triradiate cartilage remains open. After triradiate closure, the Ganz periacetabular osteotomy can be considered in addition to the triple innominate osteotomy.
持续性髋臼发育不良是导致髋关节过早发生骨关节炎的一个众所周知的原因。在发育不良的髋关节中，点载荷发生在陡峭、浅平的髋臼边缘。骨盆截骨术通过增加接触面积、放松髋关节周围的关节囊和肌肉、改善髋关节的力臂以及使负重力量正常化来减轻这种负荷。骨科医生可以从多种骨盆截骨术（例如，重新定向、重塑和挽救性截骨术）中进行选择，以恢复髋关节的正常解剖结构和生物力学力量。残余发育不良的治疗基于患者的年龄以及髋关节复位是否一致。Salter或Pemberton手术通常适用于2至10岁的儿童。对于三骨骺软骨仍开放的较大儿童或青少年，可以考虑三联髋臼截骨术。在三骨骺闭合后，除了三联髋臼截骨术外，还可以考虑Ganz髋臼周围截骨术。
