Department of Orthopaedic Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
J Bone Joint Surg Am. 2010 Jan;92(1):31-41. doi: 10.2106/JBJS.H.01556.
Periacetabular osteotomy has been established as an effective treatment for early or mild osteoarthritis caused by developmental dysplasia of the hip. However, the optimal method of surgical reconstruction for older patients remains controversial. The purpose of this retrospective study was to evaluate the clinical and radiographic results of a curved periacetabular osteotomy for the treatment of developmental dysplasia of the hip in patients fifty years of age or older.
We evaluated forty-six consecutive hips in forty-two patients fifty years of age or older (the older group) who had developmental dysplasia of the hip and had undergone a curved periacetabular osteotomy between 1995 and 2006 with a minimum two-year follow-up period. The mean age was 54.6 years. We compared the clinical and radiographic results of this cohort with those of fifty hips in forty-four patients who were less than fifty years old (the younger group) and were managed with the same osteotomy. The mean age was 32.3 years. The patients were matched according to sex and Tönnis grade. Radiographic measurements included the center-edge angle, acetabular roof obliquity, acetabular head index, anterior center-edge angle, and head lateralization index.
The mean Harris hip score improved from 69.6 points preoperatively to 90.9 points postoperatively in the older group and from 71.1 points preoperatively to 91.8 points postoperatively in the younger group. There were no significant differences in any of the radiographic measurements between the two groups preoperatively or postoperatively. The Tönnis grades improved in two hips and progressed in three hips in the older group and improved in three hips and progressed in three hips in the younger group.
Satisfactory results can be obtained clinically and radiographically after curved periacetabular osteotomy in patients fifty years of age or older with Tönnis grade-1 or 2 osteoarthritis of the hip secondary to developmental dysplasia.
髋臼周围截骨术已被确立为治疗由髋关节发育不良引起的早期或轻度骨关节炎的有效方法。然而，对于年龄较大的患者，最佳的手术重建方法仍存在争议。本回顾性研究的目的是评估髋臼周围截骨术治疗髋关节发育不良的临床和影像学结果，研究对象为年龄在 50 岁或以上的患者。
我们评估了 42 名患者的 46 个髋关节（年龄较大组），这些患者的年龄均在 50 岁或以上，患有髋关节发育不良，并于 1995 年至 2006 年间接受了髋臼周围截骨术治疗，随访时间至少为 2 年。患者的平均年龄为 54.6 岁。我们将该队列的临床和影像学结果与 44 名年龄小于 50 岁（年龄较小组）的患者的结果进行比较，这些患者也接受了相同的截骨术治疗。患者的平均年龄为 32.3 岁。我们根据性别和 Tönnis 分级对患者进行了匹配。影像学测量包括中心边缘角、髋臼顶倾斜角、髋臼头指数、前中心边缘角和股骨头外侧化指数。
年龄较大组的 Harris 髋关节评分从术前的 69.6 分提高到术后的 90.9 分，年龄较小组的 Harris 髋关节评分从术前的 71.1 分提高到术后的 91.8 分。两组患者术前和术后的影像学测量值均无显著差异。年龄较大组中有 2 髋的 Tönnis 分级改善，3 髋进展，年龄较小组中有 3 髋的 Tönnis 分级改善，3 髋进展。
对于 Tönnis 分级为 1 级或 2 级、由髋关节发育不良引起的骨关节炎的 50 岁或以上患者，行髋臼周围截骨术后可获得满意的临床和影像学结果。
