Zahedi A R, Lüring C, Janßen D
Orthopädische Klinik, Klinikum Dortmund, Beurhausstr. 40, 44137, Dortmund, Deutschland.
Orthopade. 2016 Aug;45(8):673-7. doi: 10.1007/s00132-016-3291-4.
The Tönnis and Kalchschmidt triple pelvic osteotomy (TPO) has been performed at the Klinikum Dortmund for more than 30 years. In more than 5000 cases the TPO has proven its potential to deal with even severe dysplastic hips. TPO can be easily combined with other hip procedures as intertrochanteric osteotomies and even impingement treatment can easily be done. As an elaborate technique TPO respects the growth plates and can therefore also be used for treating Legg-Calve-Perthes disease.
In most cases only conventional X‑rays are needed for proving the indication. Further imaging like MRI or CT-scans are only needed in certain cases. In addition EOS® is becoming an increasingly useful tool in planning and performing the surgery. For adequate movement of the acetabulum, three clearly defined osteotomies are needed. Current osteosynthesis methods provide an enhanced stability due to a novel technique of screw fixation. This is in line with the general trends towards short hospitalization and early mobilization.
A successful treatment requires not only experience in performing the surgical technique, but furthermore an experienced team, including care, physical examination and also pain management. The surgeon should be aware that he is performing highly elective surgery and complications or a poor outcome can significantly reduce the quality of life of the mainly young patients.
多特蒙德市立医院开展托尼斯和卡尔施密特三联骨盆截骨术(TPO)已有30多年。在5000多例病例中,TPO已证明其在治疗甚至严重发育不良性髋关节方面的潜力。TPO可轻松与其他髋关节手术相结合,如转子间截骨术,甚至撞击治疗也能轻松完成。作为一种精细的技术,TPO尊重生长板,因此也可用于治疗Legg-Calve-Perthes病。
在大多数情况下,仅需常规X线检查来证明手术指征。仅在某些情况下才需要进一步的影像学检查,如MRI或CT扫描。此外,EOS®在手术规划和实施中越来越成为一种有用的工具。为使髋臼有足够的活动度,需要进行三个明确界定的截骨术。由于一种新型螺钉固定技术,目前的骨固定方法提供了更高的稳定性。这与缩短住院时间和早期活动的总体趋势一致。
成功的治疗不仅需要手术技术方面的经验,还需要一个经验丰富的团队,包括护理、体格检查以及疼痛管理。外科医生应意识到他正在进行高度选择性的手术,并发症或不良后果会显著降低主要为年轻患者的生活质量。