University Hospital Southampton NHS Foundation Trust, Southampton.
Acta Orthop. 2014 Feb;85(1):66-70. doi: 10.3109/17453674.2014.886030. Epub 2014 Jan 24.
Residual acetabular dysplasia is one of the most common complications after treatment for developmental dysplasia of the hip. The acetabular growth response after reduction of a dislocated hip varies. The options are to wait and add a redirectional osteotomy as a secondary procedure at an older age, or to perform a primary acetabuloplasty at the time of the open reduction to stimulate acetabular development. We present the early results of such a procedure-open reduction and an incomplete periacetabular acetabuloplasty-as a one-stop procedure for developmental dysplasia of the hip.
We retrospectively reviewed the results obtained with 55 hips (in 48 patients, 43 of them girls) treated between September 2004 and February 2011. This cohort included late presentations and failures of nonoperative treatment and excluded unsuccessful previous surgical treatment (including closed reductions), neuromuscular disease, and other teratological conditions. Patients were treated once the ossific nucleus was present or when they reached one year of age. 31 cases were late presentations while 17 represented failures of nonoperative treatment. The mean age of the patients at surgery was 1.3 (0.6-2.6) years. The mean follow-up period was 4 (2-8) years. According to the IHDI classification, 1 was grade I, 9 were grade II, 13 were grade III, and 32 were grade IV. Results The mean acetabular index fell from 38 (23-49) preoperatively to 21 (10-27) at the last follow-up. There were no infections, nerve palsies, or graft extrusions. None of the cases required secondary surgery for residual acetabular dysplasia. 8 patients developed avascular necrosis (AVN) of grade II or more. The incidence of AVN was significantly associated with previous, failed nonoperative treatment. 1 patient developed coxa magna requiring shelf arthroplasty 4 years after the index procedure and 1 patient with lateral growth arrest required medial screw epiphysiodesis.
This incomplete periacetabular acetabuloplasty is a reliable adjunct to open reductions, and it is followed by a rapid acetabular growth response that avoids secondary pelvic procedures. It is a one-stop surgery with predictable outcome that can be performed in 0.5- to 2.5-year-old children.
残余髋臼发育不良是髋关节发育不良治疗后最常见的并发症之一。脱位髋关节复位后髋臼的生长反应各不相同。选择是等待并在年龄较大时作为二次手术添加定向截骨术，还是在切开复位时进行初次髋臼成形术以刺激髋臼发育。我们介绍了这种作为髋关节发育不良的一站式手术——切开复位和不完全髋臼周围髋臼成形术的早期结果。
我们回顾性分析了 2004 年 9 月至 2011 年 2 月期间治疗的 55 髋（48 例患者，其中 43 例为女性）的结果。该队列包括晚期表现和非手术治疗失败的病例，以及排除了不成功的既往手术治疗（包括闭合复位）、神经肌肉疾病和其他发育畸形。患者在出现骨核或达到 1 岁时进行治疗。31 例为晚期表现，17 例为非手术治疗失败。患者手术时的平均年龄为 1.3（0.6-2.6）岁。平均随访时间为 4（2-8）年。根据 IHDI 分类，1 例为 I 级，9 例为 II 级，13 例为 III 级，32 例为 IV 级。结果髋臼指数从术前的 38（23-49）平均下降至末次随访时的 21（10-27）。无感染、神经麻痹或移植物脱出。无 1 例因残余髋臼发育不良需要二次手术。8 例发生 II 级或更高级别的股骨头缺血性坏死（AVN）。AVN 的发生率与既往失败的非手术治疗显著相关。1 例患者在索引手术后 4 年发生巨髋，需要行髋臼架成形术，1 例外侧生长停滞患者需要行内侧螺钉骺板融合术。
这种不完全髋臼周围髋臼成形术是切开复位的可靠辅助手段，可迅速促进髋臼生长，避免二次骨盆手术。它是一种具有可预测结果的一站式手术，可以在 0.5-2.5 岁的儿童中进行。
