Children's Hospital Boston, Boston, MA 02115, USA.
J Bone Joint Surg Am. 2011 Oct 19;93(20):1924-33. doi: 10.2106/JBJS.J.01806.
The treatment of hip instability in patients with Down syndrome is challenging, and the literature provides little data to guide treatment. The purpose of the present study was to evaluate our results with complete redirectional acetabular osteotomy and to compare these results with our experience with other procedures.
We retrospectively evaluated all patients with Down syndrome who underwent surgery for the treatment of gross hip instability or symptomatic acetabular dysplasia with or without subluxation. Medical records were reviewed for symptoms and demographic information. On the basis of the primary procedure, the patients were separated into Group A (periacetabular or triple osteotomy) or Group B (varus femoral osteotomy with or without incomplete acetabuloplasty [e.g., Dega osteotomy or shelf acetabuloplasty]). Preoperative and latest postoperative radiographs were used to compare the extrusion index, the lateral center-edge angle, the Tönnis angle, and the continuity of the Shenton line. Preoperative computed tomography (CT) scans were measured for acetabular version.
We identified thirty-five hips (twenty-three patients), including twenty-five hips in Group A and ten in Group B. The mean age was 11.8 years, and the mean duration of follow-up was 5.3 years. Preoperatively, the acetabula were retroverted in both groups. Patients in Group A had worse initial hip pathology than those in Group B, as indicated by a higher mean extrusion index (50% compared with 33%; p = 0.06), a smaller center-edge angle (1° compared with 15°; p = 0.003), a larger Tönnis angle (21° compared with 10°; p = 0.001), and a smaller percentage of patients with an intact Shenton line (20% compared with 40%; p = 0.39). Most recent radiographs, however, showed superior results for Group A, including a lower mean extrusion index (10% compared with 29%; p < 0.0001), a larger center-edge angle (33° compared with 14°; p < 0.001), a smaller Tönnis angle (-1° compared with 10°; p < 0.001), and a larger percentage of patients with an intact Shenton line (88% compared with 70%; p = 0.32). Preoperatively, eighteen hips demonstrated gross instability: twelve were treated with either periacetabular osteotomy or triple innominate osteotomy, and all but one (92%) remained stable at the time of the latest follow-up. In contrast, six hips were treated with femoral osteotomy with or without incomplete acetabuloplasty, with only three (50%) remaining stable.
Complete redirectional acetabular osteotomies are successful for stabilizing the hip and for correcting acetabular dysplasia in patients with Down syndrome.
唐氏综合征患者髋关节不稳定的治疗具有挑战性，文献中几乎没有数据可用于指导治疗。本研究的目的是评估我们在完全定向髋臼截骨术方面的结果，并将这些结果与我们在其他手术方面的经验进行比较。
我们回顾性评估了所有因严重髋关节不稳定或有症状髋臼发育不良而行手术治疗的唐氏综合征患者，无论是否伴有半脱位。对病历进行了症状和人口统计学信息的回顾。根据主要手术方式，将患者分为 A 组（髋臼周围或三联截骨术）或 B 组（股骨内旋截骨术，伴或不伴不完全髋臼成形术[如，Dega 截骨术或髋臼架成形术]）。比较术前和末次随访时的 X 线片，评估外展指数、外侧中心边缘角、Tönnis 角和 Shenton 线连续性。术前 CT 扫描测量髋臼角度。
我们共纳入 35 髋（23 例患者），其中 A 组 25 髋，B 组 10 髋。平均年龄为 11.8 岁，平均随访时间为 5.3 年。两组患者髋臼均为后旋。与 B 组相比，A 组患者的初始髋关节病变更严重，表现为更高的平均外展指数（50%比 33%；p = 0.06）、更小的中心边缘角（1°比 15°；p = 0.003）、更大的 Tönnis 角（21°比 10°；p = 0.001），以及更小比例的患者 Shenton 线完整（20%比 40%；p = 0.39）。然而，大多数最近的 X 线片显示 A 组的结果更好，包括更低的平均外展指数（10%比 29%；p < 0.0001）、更大的中心边缘角（33°比 14°；p < 0.001）、更小的 Tönnis 角（-1°比 10°；p < 0.001），以及更大比例的患者 Shenton 线完整（88%比 70%；p = 0.32）。术前 18 髋有明显的不稳定：12 髋行髋臼周围截骨术或三联截骨术，所有患者（100%）在末次随访时仍稳定。相比之下，6 髋行股骨截骨术伴或不伴不完全髋臼成形术，仅 3 髋（50%）稳定。
完全定向髋臼截骨术可成功稳定髋关节并矫正唐氏综合征患者的髋臼发育不良。
