Morita Mitsuhiro, Yamada Harumoto, Hemmi Osamu, Fujikawa Kyosuke
Department of Orthopaedic Surgery, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Japan.
J Orthop Sci. 2004;9(1):99-102. doi: 10.1007/s00776-003-0742-7.
In acetabular dysplasia of the hip joint accompanied by a giant acetabular bone cyst, rotational acetabular osteotomy may cause serious complications, such as bone necrosis after surgery or fracture of the fragile acetabulum during the operation. In a patient with this condition, we performed a two-stage operation: first, autogenous bone grafting supplemented with hydroxyapatite filling, then rotational acetabular osteotomy (after new bone formation had been assured). Radiographs and CT scans showed favorable fusion of the grafted bone. Some 18 months after the second operation, arthrograms showed no inflow of contrast medium from the articular cavity into the bone cyst region, although this had been observed before treatment. Thus, an effective remodeling of bony congruency was indicated in the mobile acetabulum 5 years after the second operation. This two-stage operation appears to be useful for correcting acetabular dysplasia accompanied by a giant bone cyst and to carry a reduced risk of serious complications, such as deterioration of the articular surface of the acetabulum or necrosis of the translocated acetabulum.
在伴有巨大髋臼骨囊肿的髋关节髋臼发育不良中，髋臼旋转截骨术可能会导致严重并发症，如术后骨坏死或术中脆弱髋臼骨折。对于患有这种病症的患者，我们进行了两阶段手术：首先，自体骨移植并辅以羟基磷灰石填充，然后进行髋臼旋转截骨术（在确保新骨形成之后）。X线片和CT扫描显示移植骨融合良好。第二次手术后约18个月，关节造影显示对比剂未从关节腔流入骨囊肿区域，而在治疗前曾观察到有对比剂流入。因此，第二次手术后5年，活动髋臼显示出有效的骨性一致性重塑。这种两阶段手术似乎有助于矫正伴有巨大骨囊肿的髋臼发育不良，并降低严重并发症的风险，如髋臼关节面恶化或移位髋臼坏死。
