Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
J Am Acad Orthop Surg. 2011 May;19(5):275-86. doi: 10.5435/00124635-201105000-00005.
Surgical management of the problematic hip in adolescent and young adult patients can be challenging. In many of these patients, hip arthrosis and pain occur secondary to hip dysplasia associated with chronic instability, whether the result of prior treatment or chronic unmanaged acetabular dysplasia. Surgical techniques such as the Bernese periacetabular osteotomy are performed to correct acetabular deficiency, restore hip joint stability, and eliminate pain. Patients with previous Legg-Calvé-Perthes disease or slipped capital femoral epiphysis frequently note onset of symptomatic hip arthrosis and pain in adolescence or young adulthood. Pain occurs secondary to pathologic impingement of the deformed proximal femur against the anterolateral acetabulum (ie, femoroacetabular impingement). The recent successful innovation of the transtrochanteric surgical hip dislocation approach provides complete access to the hip and offers the potential for comprehensive correction of both the often severe proximal femoral deformity and associated labral chondral disease secondary to Legg-Calvé-Perthes disease and slipped capital femoral epiphysis. Restoration of more normal proximal femoral morphology results in marked improvement in functional outcome. Effective orthopaedic management requires an understanding of the mechanisms of hip disease as well as surgical expertise.
青少年和年轻成人患者中存在问题的髋关节的手术治疗可能具有挑战性。在这些患者中，许多髋关节骨关节炎和疼痛是由于与慢性不稳定相关的髋关节发育不良引起的，无论是先前治疗的结果还是慢性未治疗的髋臼发育不良。诸如 Bernese 髋臼周围截骨术等手术技术用于纠正髋臼缺陷，恢复髋关节稳定性并消除疼痛。患有先前的 Legg-Calvé-Perthes 病或股骨颈骨骺滑脱的患者常在青少年或年轻成人时出现髋关节骨关节炎和疼痛的症状。疼痛是由于变形的股骨近端在前外侧髋臼处发生病理性撞击（即，股骨髋臼撞击症）引起的。最近，经转子间截骨术髋关节脱位入路的成功创新为髋关节提供了完整的通路，并为常见的严重股骨近端畸形以及与 Legg-Calvé-Perthes 病和股骨颈骨骺滑脱相关的盂唇软骨病提供了全面矫正的潜力。恢复更正常的股骨近端形态结构可显著改善功能结果。有效的矫形管理需要了解髋关节疾病的机制以及手术专业知识。
