Fujii M, Nakashima Y, Noguchi Y, Yamamoto T, Mawatari T, Motomura G, Iwamoto Y
Graduate School of Medical Sciences, Kyushu University, Department of Orthopaedic Surgery, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
J Bone Joint Surg Br. 2011 Nov;93(11):1449-56. doi: 10.1302/0301-620X.93B11.27314.
In order to clarify how intra-articular lesions influence the survival of a periacetabular osteotomy in patients with dysplasia of the hip, we performed an observational study of 121 patients (121 hips) who underwent a transposition osteotomy of the acetabulum combined with an arthroscopy. Their mean age was 40.2 years (13 to 64) and the mean follow-up was 9.9 years (2 to 18). Labral and cartilage degeneration tended to originate from the anterosuperior part of the acetabulum, followed by the femoral side. In all, eight hips (6.6%) had post-operative progression to Kellgren-Lawrence grade 4 changes, and these hips were associated with the following factors: moderate osteoarthritis, decreased width of the joint space, joint incongruity, and advanced intra-articular lesions (subchondral bone exposure in the cartilage and a full-thickness labral tear). Multivariate analysis indicated subchondral bone exposure on the femoral head as an independent risk factor for progression of osteoarthritis (p = 0.003). In hips with early stage osteoarthritis, femoral subchondral bone exposure was a risk factor for progression of the grade of osteoarthritis. Although the outcome of transposition osteotomy of the acetabulum was satisfactory, post-operative progression of osteoarthritis occurred at a high rate in hips with advanced intra-articular lesions, particularly in those where the degenerative process had reached the point of femoral subchondral bone exposure.
为了阐明髋关节发育不良患者关节内病变如何影响髋臼周围截骨术的预后，我们对121例（121髋）接受髋臼转位截骨术联合关节镜检查的患者进行了一项观察性研究。他们的平均年龄为40.2岁（13至64岁），平均随访时间为9.9年（2至18年）。盂唇和软骨退变往往起源于髋臼的前上部，其次是股骨侧。共有8髋（6.6%）术后进展为Kellgren-Lawrence 4级改变，这些髋关节与以下因素相关：中度骨关节炎、关节间隙变窄、关节不协调以及严重的关节内病变（软骨下骨暴露于软骨内和全层盂唇撕裂）。多变量分析表明股骨头软骨下骨暴露是骨关节炎进展的独立危险因素（p = 0.003）。在早期骨关节炎的髋关节中，股骨软骨下骨暴露是骨关节炎分级进展的危险因素。尽管髋臼转位截骨术的结果令人满意，但在关节内病变严重的髋关节中，尤其是那些退变过程已达到股骨软骨下骨暴露程度的髋关节，骨关节炎术后进展发生率较高。
