Dahl Line B, Dengsø Kristine, Bang-Christiansen Karl, Petersen Michael M, Stürup Jens
1 Department of Orthopaedics, Rigshospitalet, Copenhagen - Denmark.
Hip Int. 2014 Jul-Aug;24(4):369-80. doi: 10.5301/hipint.5000129. Epub 2014 Apr 8.
Few papers have described results after periacetabular osteotomy (PAO) and risk factors for conversion to total hip arthroplasty (THA). The aim of the present paper was to analyse clinical and radiographic outcome, survival of the hip joint and risk factors of early conversion to THA in patients with PAO.
In the period 1999-2008, 93 patients (127 hips, median patient age 31, range 13-49 years) were operated on with PAO. Median follow-up was 7 (SD 2.1) years. Analyses of clinical and radiographic examinations, including WOMAC, were performed. Osteoarthritis was measured using Tönnis grade. Survival was assessed by the Kaplan-Meier method and predictors of conversion to THA were calculated using Cox regression analysis with THA as defined endpoint.
Centre-edge angle improved significantly with a mean of 8.7 (95% CI: 7.1; 10.3) preoperatively to a mean of 24.6 (95% CI: 22.6; 26.6) at follow-up. Likewise the acetabular roof obliquity angle improved significantly with a mean of 21.2 (95% CI: 19.7; 22.6) preoperatively to 8.7 (95% CI: 7.1; 10.4) at follow-up. Eleven out of 127 hips had conversion to THA. The 11.7 years cumulated hip joint survival rate was 85% (95% CI: 0.753; 0.945). Significant predictors of converting to THA were preoperative high grade of OA and postoperative high degree of acetabular roof obliquity angle. An improvement was found in Harris Hip Score pain score after receiving a PAO (p = 0.01).
Our results, with almost 12 years survival data, are comparable with the literature. PAO is considered as an effective treatment for young adults with painful hip dysplasia, especially when preoperative criteria for conversion to THA are highlighted.
很少有论文描述髋臼周围截骨术（PAO）后的结果以及转为全髋关节置换术（THA）的危险因素。本文的目的是分析PAO患者的临床和影像学结果、髋关节生存率以及早期转为THA的危险因素。
在1999年至2008年期间，对93例患者（127髋，患者年龄中位数为31岁，范围13 - 49岁）进行了PAO手术。中位随访时间为7（标准差2.1）年。进行了包括WOMAC在内的临床和影像学检查分析。使用Tönnis分级测量骨关节炎。采用Kaplan-Meier方法评估生存率，并以THA为定义终点，使用Cox回归分析计算转为THA的预测因素。
中心边缘角术前平均为8.7（95%可信区间：7.1；10.3），随访时显著改善至平均24.6（95%可信区间：22.6；26.6）。同样，髋臼顶倾斜角术前平均为21.2（95%可信区间：19.7；22.6），随访时显著改善至8.7（95%可信区间：7.1；10.4）。127髋中有11髋转为THA。11.7年的累积髋关节生存率为85%（95%可信区间：0.753；0.945）。转为THA的显著预测因素是术前骨关节炎高级别和术后髋臼顶倾斜角高度数。PAO术后Harris髋关节评分疼痛评分有所改善（p = 0.01）。
我们的结果，包含近12年的生存数据，与文献相当。PAO被认为是治疗年轻成人疼痛性髋关节发育不良的有效方法，尤其是在突出术前转为THA的标准时。
