Department of Orthopedic Surgery, New Taipei City Hospital, New Taipei City, Taiwan.
Clin Orthop Relat Res. 2014 Mar;472(3):1001-9. doi: 10.1007/s11999-013-3319-6. Epub 2013 Oct 5.
The Salter osteotomy and Pemberton acetabuloplasty are common procedures for a deficient acetabulum in patients with developmental dysplasia of the hip. However, the degree of increasing retroversion and anterior acetabular coverage of these two procedures remains unanswered.
QUESTIONS/PURPOSES: The purpose of this study is to show the change in anterior coverage and relevant parameters in measuring pain and function among patients who have undergone either a Salter osteotomy or Pemberton acetabuloplasty.
Forty-two patients who underwent either a Salter or Pemberton procedure at one institution between January 1981 and December 2000 and were available for followup at least 10 years later (mean, 18 years; range, 12-28 years) were evaluated retrospectively. This represented 12% of the Salter and Pemberton procedures performed in patients between 12 and 36 months old at our institution during the study period. We measured vertical-center-anterior margin angle, anterior acetabular head index, and weightbearing zone acetabular index, and we made comparisons using the radiographic parameter ratio (the division of each radiographic measurement of the operative side by that of the nonoperated side). All patients completed SF-36 and Harris hip score questionnaires at followup.
In the Salter group, there were no differences in vertical-center-anterior margin angle, anterior acetabular head index, or weightbearing zone acetabular index. In the Pemberton group, there was no difference in vertical-center-anterior margin angle or anterior acetabular head index, but the weightbearing zone acetabular index decreased, suggesting increased anterior acetabular coverage (surgically treated side, 6 [95% CI, 4.84, 7.16]; nonoperated side, 12 [95% CI, 10.07, 13.39]; p < 0.001). Compared with that in the Salter group, the weightbearing zone acetabular index ratio was smaller in the Pemberton group, which means more acquired anterior coverage after a Pemberton acetabuloplasty (Salter procedure, 0.94 [95% CI, 0.70, 1.17], Pemberton procedure, 0.53 [95% CI, 0.40, 0.65]; p < 0.001). Three patients in the Pemberton group had an anterior impingement sign at followup, whereas none in the Salter group did. The SF-36 and Harris hip scores were good and showed no differences between the two groups.
Our study suggests the weightbearing zone acetabular index on false profile radiographs of the hip, a parameter focusing on morphologic features of the anterior acetabulum, decreased after Pemberton acetabuloplasty compared with the nonoperated side and after the Salter acetabuloplasty. This suggests that by modifying the shape of the acetabulum with a hinge in the triradiate cartilage, a Pemberton acetabuloplasty may result in increasing acetabular anterior coverage and the risk of hip impingement. However, the functional results with at least 10 years followup were good and similar for both procedures.
Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
在发育性髋关节发育不良患者中，对于髋臼发育不良，Salter 截骨术和 Pemberton 髋臼成形术是常见的手术方法。然而，这两种手术增加髋臼后倾和前覆盖的程度仍未得到解答。
问题/目的：本研究旨在展示在接受 Salter 截骨术或 Pemberton 髋臼成形术的患者中，测量疼痛和功能的前覆盖和相关参数的变化。
在一家机构，1981 年 1 月至 2000 年 12 月间进行了 Salter 或 Pemberton 手术的 42 例患者，随访至少 10 年（平均 18 年；范围 12-28 年）。这代表了在研究期间，在我们机构接受 12-36 个月大的患者中进行的 Salter 和 Pemberton 手术的 12%。我们测量了垂直中心-前边缘角、前髋臼头指数和负重区髋臼指数，并使用放射学参数比值（手术侧和非手术侧每个放射学测量的比值）进行比较。所有患者在随访时均完成了 SF-36 和 Harris 髋关节评分问卷。
在 Salter 组中，垂直中心-前边缘角、前髋臼头指数或负重区髋臼指数均无差异。在 Pemberton 组中，垂直中心-前边缘角或前髋臼头指数没有差异，但负重区髋臼指数下降，表明前髋臼覆盖增加（手术侧，6 [95%CI，4.84，7.16]；非手术侧，12 [95%CI，10.07，13.39]；p<0.001）。与 Salter 组相比，Pemberton 组的负重区髋臼指数比值较小，这意味着 Pemberton 髋臼成形术后获得了更多的前覆盖（Salter 手术，0.94 [95%CI，0.70，1.17]，Pemberton 手术，0.53 [95%CI，0.40，0.65]；p<0.001）。Pemberton 组中有 3 例患者在随访时出现前撞击征，而 Salter 组中无此现象。SF-36 和 Harris 髋关节评分良好，两组之间无差异。
我们的研究表明，在髋关节假侧位片上，负重区髋臼指数，一个侧重于髋臼前形态特征的参数，与非手术侧相比，在 Pemberton 髋臼成形术后下降，与 Salter 髋臼成形术后相比。这表明，通过在三射线软骨中形成铰链来改变髋臼的形状，Pemberton 髋臼成形术可能会增加髋臼的前覆盖，并增加髋关节撞击的风险。然而，至少 10 年的随访结果显示，两种手术的功能结果均良好且相似。
III 级，治疗研究。请参阅作者说明，以获取完整的证据水平描述。
