Kim K-I, Cho Y-J, Ramteke A A, Yoo M-C
Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, Korea.
J Bone Joint Surg Br. 2011 Jun;93(6):732-7. doi: 10.1302/0301-620X.93B6.25809.
Reconstructive acetabular osteotomy is a well established and effective procedure in the treatment of acetabular dysplasia. However, the dysplasia is frequently accompanied by intra-articular pathology such as labral tears. We intended to determine whether a concomitant hip arthroscopy with peri-acetabular rotational osteotomy could identify and treat intra-articular pathology associated with dysplasia and thereby produce a favourable outcome. We prospectively evaluated 43 consecutive hips treated by combined arthroscopy and acetabular osteotomy. Intra-operative arthroscopic examination revealed labral lesions in 38 hips. At a mean follow-up of 74 months (60 to 97) the mean Harris hip score improved from 72.4 to 94.0 (p < 0.001), as did all the radiological parameters (p < 0.001). Complications included penetration of the joint by the osteotome in one patient, a fracture of the posterior column in another and deep-vein thrombosis in one further patient. This combined surgical treatment gave good results in the medium term. We suggest that arthroscopy of the hip can be performed in conjunction with peri-acetabular osteotomy to provide good results in patients with symptomatic dysplasia of the hip, and the arthroscopic treatment of intra-articular pathology may alter the progression of osteoarthritis.
髋臼重建截骨术是治疗髋臼发育不良一种成熟且有效的手术方法。然而，发育不良常伴有诸如盂唇撕裂等关节内病变。我们旨在确定髋臼周围旋转截骨术同期行髋关节镜检查能否识别并治疗与发育不良相关的关节内病变，从而产生良好疗效。我们对连续43例接受关节镜检查与髋臼截骨术联合治疗的髋关节进行了前瞻性评估。术中关节镜检查发现38例髋关节存在盂唇病变。平均随访74个月（60至97个月）时，Harris髋关节平均评分从72.4提高至94.0（p<0.001），所有放射学参数也有改善（p<0.001）。并发症包括1例患者截骨刀穿破关节、另1例患者后柱骨折以及还有1例患者发生深静脉血栓形成。这种联合手术治疗在中期取得了良好效果。我们建议髋关节镜检查可与髋臼周围截骨术联合进行，为有症状的髋关节发育不良患者带来良好疗效，并且关节内病变的关节镜治疗可能改变骨关节炎的进程。
