Kitoh Hiroshi, Kaneko Hiroshi, Ishiguro Naoki
Department of Orthopaedic Surgery, Nagoya University School of Medicine, Nagoya, Aichi, Japan.
J Pediatr Orthop. 2009 Dec;29(8):879-84. doi: 10.1097/BPO.0b013e3181c1e314.
Salter innominate osteotomy (SIO) is widely used to improve the coverage of the femoral head in dysplastic acetabulum, but the geometric change after osteotomy and its effect on the outcome have not been well elucidated.
Pelvic radiographs of the 90 hips in 86 patients who underwent SIO for the treatment of acetabular dysplasia were reviewed and the movement of the distal fragment and the shift of the femoral head after SIO were analyzed. On the basis of the anteroposterior radiographs of the pelvis in a supine position taken at 5 weeks after operation, various parameters including an open-wedged angle at the osteotomy site (lateral rotation angle, LRA), lateral displacement of the distal fragment (distance d), and the ratio of the bilateral obturator foramen heights (the ratio of obturator heights, ROH), were measured. Improvement in the center-edge angle (CEA) and acetabular index (AI) after SIO was correlated with the LRA, distance d, and ROH. Horizontal and vertical distances from the pubic symphysis to the center of the femoral head were also measured from preoperative and postoperative pelvic radiographs and changes in the position of the femoral head were calculated. For the patients who were followed until skeletal maturity, final radiographic results were also assessed according to the Severin classification.
The average improvement of the CEA and AI after SIO was 19.6 and 13.3 degrees, respectively. The average value of the LRA, distance d, and ROH were 30.2 degrees, 4.07 mm, and 73.0%, respectively. The LRA and distance d positively and the ROH negatively correlated with the improvement of the CEA and AI. The center of the femoral head moved an average of 7.06 mm caudally and 3.11 mm medially after SIO. Thirty-six hips (40%) in 36 patients were available for follow-up until skeletal maturity. The radiographic outcome was good (Severin I or II) in 33 hips and poor (Severin III) in 3 hips. Preoperative CEA was relatively smaller in a poor group. Greater improvement of the CEA during postoperative follow-up was observed in a good group.
Favorable coverage of the femoral head was obtained after SIO by shifting the center of the femoral head caudally and medially as well as rotating the distal fragment anterolaterally. SIO is a very effective procedure in improvement of the dysplastic acetabulum for the hips with round and spherical femoral head.
Therapeutic studies, level III (retrospective study).
Salter 髋臼截骨术（SIO）被广泛用于改善发育性髋臼中股骨头的覆盖情况，但截骨术后的几何变化及其对治疗结果的影响尚未得到充分阐明。
回顾了 86 例因髋臼发育不良接受 SIO 治疗的患者的 90 个髋关节的骨盆 X 光片，分析了 SIO 后远端骨折块的移动和股骨头的移位情况。根据术后 5 周仰卧位骨盆前后位 X 光片，测量了包括截骨部位的开口楔形角（外侧旋转角，LRA）、远端骨折块的外侧移位（距离 d）以及双侧闭孔高度比（闭孔高度比，ROH）等各种参数。SIO 后中心边缘角（CEA）和髋臼指数（AI）的改善与 LRA、距离 d 和 ROH 相关。还从术前和术后骨盆 X 光片中测量了耻骨联合到股骨头中心的水平和垂直距离，并计算了股骨头位置的变化。对于随访至骨骼成熟的患者，还根据 Severin 分类评估了最终的影像学结果。
SIO 后 CEA 和 AI 的平均改善分别为 19.6 度和 13.3 度。LRA、距离 d 和 ROH 的平均值分别为 30.2 度、4.07 毫米和 73.0%。LRA 和距离 d 与 CEA 和 AI 的改善呈正相关，ROH 与 CEA 和 AI 的改善呈负相关。SIO 后股骨头中心平均向尾侧移动 7.06 毫米，向内侧移动 3.11 毫米。36 例患者中的 36 个髋关节（40%）随访至骨骼成熟。影像学结果良好（Severin I 或 II）的有 33 个髋关节，较差（Severin III）的有 3 个髋关节。较差组术前 CEA 相对较小。在良好组中，术后随访期间 CEA 的改善更大。
通过将股骨头中心向尾侧和内侧移位以及将远端骨折块向外侧旋转，SIO 后获得了股骨头的良好覆盖。对于股骨头呈圆形和球形的髋关节，SIO 是改善发育性髋臼的一种非常有效的手术方法。
治疗性研究，III 级（回顾性研究）。
