Naito Masatoshi, Nakamura Yoshinari
Department of Orthopaedic Surgery, Fukuoka University School of Medicine, Fukuoka, Japan.
Clin Orthop Surg. 2014 Jun;6(2):127-37. doi: 10.4055/cios.2014.6.2.127. Epub 2014 May 16.
Curved periacetabular osteotomy (CPO) was developed for the treatment of dysplastic hips in 1995. In CPO, the exposure of osteotomy sites and osteotomy of the ischium are made in the same manner as Bernese periacetabular osteotomy, and iliac and pubic osteotomies are performed in the same manner as rotational acetabular osteotomy. We studied the dynamic instabilities of 25 dysplastic hips before and after CPO using triaxial accelerometry. Overall magnitude of acceleration was significantly decreased from 2.30 ± 0.57 m/sec(2) preoperatively to 1.55 ± 0.31 m/sec(2) postoperatively. Pain relief and improvement of acetabular coverage resulting from acetabular reorientation seem to be related with reduction of dynamic instabilities of dysplastic hips. Isokinetic muscle strengths of 24 hips in 22 patients were measured preoperatively and after CPO. At 12 months postoperatively, the mean muscle strength exceeded the preoperative values. These results seem to be obtained due to no dissection of abductor muscles in CPO. The preoperative presence of acetabular cysts did not influence the results of CPO. An adequate rotation of the acetabular fragment induced cyst remodeling. Satisfactory results were obtained clinically and radiographically after CPO in patients aged 50 years or older. CPO alone for the treatment of severe dysplastic hips classified as subluxated hips of Severin group IV-b with preoperative CE angles of up to -20° could restore the acetabular coverage, weight-bearing area and medialization of the hip joint. CPO without any other combined procedure, as a treatment for 17 hips in 16 patients with Perthes-like deformities, produced good mid-term clinical and radiographic results. We have been performing CPO in conjunction with osteochondroplasty for the treatment of acatabular dysplasia associated with femoroacetabular impingement since 2006. The combined procedure has been providing effective correction of both acetabular dysplasia and associated femoral head-neck deformities without any increased complication rate. We have encountered an obturator artery injury in one case and two intraoperative comminuted fractures. Although serious complications such as motor nerve palsy, deep infection, necrosis of the femoral head or acetabulum, and delayed union or nonunion of the ilium were reported, such complications have never occurred in our 700 cases so far.
髋臼周围截骨术（CPO）于1995年被开发用于治疗发育性髋关节发育不良。在CPO中，截骨部位的暴露和坐骨截骨的方式与伯尔尼髋臼周围截骨术相同，髂骨和耻骨截骨的方式与旋转髋臼截骨术相同。我们使用三轴加速度计研究了25例发育性髋关节发育不良患者在CPO前后的动态不稳定性。总体加速度大小从术前的2.30±0.57米/秒²显著降低至术后的1.55±0.31米/秒²。髋臼重新定位带来的疼痛缓解和髋臼覆盖改善似乎与发育性髋关节动态不稳定性的降低有关。对22例患者的24个髋关节在术前和CPO后进行了等速肌力测量。术后12个月时，平均肌力超过了术前值。这些结果似乎是由于CPO中未对外展肌进行剥离而获得的。术前髋臼囊肿的存在并未影响CPO的结果。髋臼碎片的适当旋转导致囊肿重塑。50岁及以上患者在CPO后在临床和影像学上均获得了满意的结果。单独使用CPO治疗术前CE角高达-20°的Severin IV-b组半脱位型严重发育性髋关节发育不良，可恢复髋臼覆盖、负重面积和髋关节内移。对于16例佩特兹样畸形患者的17个髋关节，在未进行任何其他联合手术的情况下进行CPO，取得了良好的中期临床和影像学结果。自2006年以来，我们一直将CPO与骨软骨成形术联合用于治疗与股骨髋臼撞击相关的髋臼发育不良。该联合手术在不增加并发症发生率的情况下有效矫正了髋臼发育不良和相关的股骨头颈畸形。我们遇到过1例闭孔动脉损伤和2例术中粉碎性骨折。虽然有报道称出现过诸如运动神经麻痹、深部感染、股骨头或髋臼坏死以及髂骨延迟愈合或不愈合等严重并发症，但在我们目前的700例病例中从未发生过此类并发症。
