Troelsen Anders, Elmengaard Brian, Søballe Kjeld
Orthopaedic Research Unit, Aarhus University Hospital, Denmark.
Acta Orthop. 2008 Dec;79(6):777-84. doi: 10.1080/17453670810016849.
Periacetabular osteotomy is the treatment of choice in young adults with hip dysplasia. Patient morbidity and surgical outcome may depend on the choice of surgical approach. We compared the outcome of a new minimally invasive approach to that of the frequently used "classic" ilioinguinal approach.
We retrospectively evaluated our experience with the ilioinguinal and minimally invasive approaches, which were used in successive time periods at our institution between December 1998 and February 2007 (n=263). Intraoperative and early postoperative outcome factors together with analysis of hip joint survival were compared in well-defined study groups.
In the minimally invasive and ilioinguinal groups respectively, the median (interquartile range) intraoperative blood loss was 250 (200-350) mL and 500 (350-700) mL (p<0.001), the mean (95% CI) hemoglobin reduction was 2.0 (1.9-2.1) mmol/L and 2.5 (2.4-2.7) mmol/L (p<0.001), transfusion was required following 4% and 18% of the procedures (p<0.001), and the median (interquartile range) duration of surgery was 70 (60-75) min and 100 (80-120) min (p<0.001). Median (interquartile range) postoperative center-edge and acetabular index angles were 33 (30-36) and 2 (0-6), respectively, in the minimally invasive group and 31 (25-35) and 9 (1-14) in the ilioinguinal group. There were no cases of moderate or severe complications in the minimally invasive group and 3 cases of arterial thrombosis in the ilioinguinal group (3%). At follow-up of 5 years, the hip joint survival rates were 97% in the minimally invasive group and 93% in the ilioinguinal group.
Given the accumulated experience of the surgeon, the outcome of the minimally invasive approach compares favorably with that of the ilioinguinal approach, and the results support continued use of the minimally invasive approach for periacetabular osteotomy. Using this approach, we did not encounter any complications and acetabular reorientation was not compromized.
髋臼周围截骨术是年轻成人髋关节发育不良的首选治疗方法。患者的发病率和手术效果可能取决于手术入路的选择。我们比较了一种新的微创入路与常用的“经典”髂腹股沟入路的手术效果。
我们回顾性评估了1998年12月至2007年2月在我们机构先后采用髂腹股沟入路和微创入路的经验（n = 263）。在明确界定的研究组中比较了术中及术后早期的结果因素以及髋关节生存率分析。
微创组和髂腹股沟组术中失血量中位数（四分位间距）分别为250（200 - 350）mL和500（350 - 700）mL（p < 0.001），血红蛋白平均降低值（95%可信区间）分别为2.0（1.9 - 2.1）mmol/L和2.5（2.4 - 2.7）mmol/L（p < 0.001），4%和18%的手术需要输血（p < 0.001），手术时间中位数（四分位间距）分别为70（60 - 75）分钟和100（80 - 120）分钟（p < 0.001）。微创组术后中心边缘角和髋臼指数角中位数（四分位间距）分别为33（30 - 36）和2（0 - 6），髂腹股沟组分别为31（25 - 35）和9（1 - 14）。微创组无中度或重度并发症病例，髂腹股沟组有3例动脉血栓形成（3%）。在5年随访时，微创组髋关节生存率为97%，髂腹股沟组为93%。
鉴于外科医生积累的经验，微创入路的手术效果优于髂腹股沟入路，结果支持继续使用微创入路进行髋臼周围截骨术。采用这种入路，我们未遇到任何并发症，髋臼重新定位也未受影响。
