Baqué François, Brown Antony, Matta Joel
Hip and Pelvis Institute, Saint John's Health Center, Santa Monica, California 90404, USA.
Orthopedics. 2009 Jun;32(6):399. doi: 10.3928/01477447-20090511-04.
Patients with hip dysplasia often endure multiple surgical interventions, first in attempts to preserve their biologic hips and later for total hip arthroplasty (THA). Each different surgical approach traumatizes the musculoligamentous complex of the hip. These cumulative insults can significantly affect THA success. We retrospectively reviewed 8 patients who underwent THA after previous periacetabular osteotomy via the same anterior approach. Acetabular bone stock required no augmentation for implant coverage. No complication occurred during surgery. All patients increased their functional score at last follow-up. No dislocation or implant loosening occurred. Leg-length restoration was excellent. Periacetabular osteotomy is a proven conservative procedure in dysplastic hips that can be realized through a Smith-Petersen incision. Restoration of the acetabular anatomy is achieved with limited muscle detachment. Good results have been achieved with periacetabular osteotomy; however, some patients develop increasing pain from progression of osteoarthritis and require a THA to allow relief of symptoms. The anterior-approach THA is a well-established procedure using the same Smith-Petersen interval as periacetabular osteotomy. Using this approach for both procedures optimizes the patient's immediate and ultimate functional recovery and hip stability. Instead of compromising subsequent THA, periacetabular osteotomy may improve THA results in dysplastic hips.
髋关节发育不良患者常常需要接受多次手术干预，首先是尝试保留其具有生物活性的髋关节，之后则是进行全髋关节置换术（THA）。每种不同的手术入路都会损伤髋关节的肌肉韧带复合体。这些累积的损伤会显著影响全髋关节置换术的成功率。我们回顾性分析了8例曾通过相同前路行髋臼周围截骨术，之后又接受全髋关节置换术的患者。髋臼骨量无需增加即可覆盖植入物。手术过程中未发生并发症。所有患者在末次随访时功能评分均有所提高。未发生脱位或植入物松动。肢体长度恢复良好。髋臼周围截骨术是一种已被证实的用于发育不良髋关节的保守手术，可通过史密斯-彼得森切口实现。通过有限的肌肉分离实现髋臼解剖结构的恢复。髋臼周围截骨术已取得良好效果；然而，一些患者因骨关节炎进展而疼痛加剧，需要进行全髋关节置换术以缓解症状。前路全髋关节置换术是一种成熟的手术，使用与髋臼周围截骨术相同的史密斯-彼得森间隙。两种手术均采用这种入路可优化患者的近期和最终功能恢复以及髋关节稳定性。髋臼周围截骨术非但不会影响后续的全髋关节置换术，反而可能改善发育不良髋关节的全髋关节置换术效果。
