Migaud Henri, Chantelot Christophe, Giraud François, Fontaine Christian, Duquennoy Antoine
Orthopaedic Department, University Hospital of Lille, 59037 Lille, France.
Clin Orthop Relat Res. 2004 Jan(418):81-6. doi: 10.1097/00003086-200401000-00014.
The current authors retrospectively assessed 56 hip shelf arthroplasties (48 patients) with a mean followup of 17 years (range, 15-30 years) and 89 Chiari osteotomies (82 patients) with a mean followup of 13 years (range, 6-25 years) done in adults with painful hip dysplasia. Preoperative joint space narrowing was observed in 32 of 56 shelf arthroplasties and in 67 of 89 Chiari osteotomies. Survival rates, using hip replacement as the end point, were 37% (20% to 54%) at 20 years for shelf arthroplasty and 68% (54% to 81%) at 18 years for Chiari osteotomy. The severity of preoperative arthrosis was the main factor that impaired the survivorship of shelf arthroplasty and Chiari osteotomy. With arthritic changes without joint space narrowing, the 18-year survival rates were 83% (69% to 97%) for shelf arthroplasty and 94% (89% to 99%) for Chiari osteotomy. Shelf arthroplasty is best indicated for moderate dysplasia (center edge angle >0 degrees) without severe arthrosis. Chiari osteotomy is best suited for severe dysplasia (center edge angle <0 degrees) especially without or with slight arthrosis. Chiari osteotomy also can be a salvage procedure when marked joint space narrowing is present but only if it is related to severe dysplasia (center edge angle <0 degrees).
本研究作者回顾性评估了56例髋臼加盖成形术（48例患者），平均随访17年（范围15 - 30年），以及89例Chiari截骨术（82例患者），平均随访13年（范围6 - 25年），这些手术均在患有疼痛性髋关节发育不良的成人中进行。56例髋臼加盖成形术中32例以及89例Chiari截骨术中67例术前存在关节间隙变窄。以髋关节置换作为终点，髋臼加盖成形术20年生存率为37%（20%至54%），Chiari截骨术18年生存率为68%（54%至81%）。术前关节病的严重程度是影响髋臼加盖成形术和Chiari截骨术生存率的主要因素。对于无关节间隙变窄的关节炎改变，髋臼加盖成形术18年生存率为83%（69%至97%），Chiari截骨术为94%（89%至99%）。髋臼加盖成形术最适用于中度发育不良（中心边缘角>0度）且无严重关节病的情况。Chiari截骨术最适合重度发育不良（中心边缘角<0度），尤其是无或伴有轻度关节病的情况。当存在明显关节间隙变窄但仅与重度发育不良（中心边缘角<0度）相关时，Chiari截骨术也可作为挽救手术。
