Hövel M, Jäger M
Klinik für Orthopädie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland,
Oper Orthop Traumatol. 2013 Oct;25(5):439-56. doi: 10.1007/s00064-013-0239-2.
In simple pelvic osteotomy in childhood the aim is for better lateral roofing, a safe centering of the femoral head and tuning between the volumes of the acetabulum and the femoral head. By the combination of anterior modified Pemberton osteotomy with dorsal osteotomy according to Salter these objectives can be achieved.
Dysplasia of the acetabulum in patients between 2 years old and adolescence, subluxation and dislocation of the femoral head, also in neurological diseases as cerebral palsy and hypercontainment in Legg-Calvé-Perthes disease.
Critically small pelvic bones in toddlers younger than 18 months, children with a delay in skeletal formation. In patients aged more than 15 years if the symphysis is too taut for an effectual pivoting of the acetabulum and the acetabulum has no potential for future maturing.
Surgery is carried out by making a skin incision by the iliac crest ending in the middle of the groin, the cartilaginous iliac apophysis is split and the periosteum is elevated from the medial and lateral wall of the ilium to the inner pelvic ring. A K-wire is used to mark the level and the center of the osteotomy and dorsal to the K-wire a straight osteotomy is performed with a Gigli saw and anteriorly an arc-shaped and tilted cut is made with a chisel. The distal iliac fragment is rotated widely outwards and forwards and a triangular bone graft is removed from the anterior part of the iliac crest. The graft is inserted into the opened up osteotomy, three K-wires are used to fix the desired position of the iliac fragments and the two halves of the iliac apophysis are sutured together.
After the operation uncooperative children receive a scotch cast for 4 weeks. Cooperative children are mobilized after 3 weeks of bed rest. Partial weight-bearing is allowed after 6 weeks and full weight-bearing after 8-10 weeks.
A total of 56 combined Salter-Pemberton pelvic osteotomies were performed in 49 patients from 1999 to 2008. The results of these studies demonstrate that this osteotomy is a safe and effective procedure which enables not only sufficient correction in classical dysplasia of the hip joint but also in high grade dislocation of the hip joint caused by cerebral palsy.
在儿童单纯骨盆截骨术中，目标是实现更好的外侧覆盖、股骨头的安全归位以及髋臼与股骨头容积的匹配。通过将改良的前方彭伯顿截骨术与根据索尔特法进行的后方截骨术相结合，可实现这些目标。
2岁至青春期患者的髋臼发育不良、股骨头半脱位和脱位，也适用于神经系统疾病，如脑瘫以及莱-卡-佩病中的过度包容。
18个月以下幼儿骨盆骨过小、骨骼发育延迟的儿童。15岁以上患者，如果耻骨联合过紧，髋臼无法有效旋转且髋臼无未来成熟潜力。
手术通过沿髂嵴做皮肤切口，切口止于腹股沟中部，劈开软骨性髂骨骨骺，将骨膜从髂骨内侧和外侧壁提升至盆腔内环。用一根克氏针标记截骨水平和中心，在克氏针后方用线锯进行直线截骨，前方用凿子做弧形倾斜切口。将髂骨远端广泛向外向前旋转，从髂嵴前部取出一块三角形骨块。将骨块插入打开的截骨处，用三根克氏针固定髂骨碎片的理想位置，将髂骨骨骺的两半缝合在一起。
术后，不配合的儿童需佩戴苏格兰石膏固定4周。配合的儿童在卧床休息3周后开始活动。6周后允许部分负重，8至10周后完全负重。
1999年至2008年，共对49例患者进行了56例索尔特-彭伯顿联合骨盆截骨术。这些研究结果表明，这种截骨术是一种安全有效的手术方法，不仅能对经典髋关节发育不良进行充分矫正，也能对脑瘫导致的髋关节高位脱位进行矫正。
