Druschel C, Heck K, Kraft C, Placzek R
Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
Schwerpunkt Kinder- und Neuroorthopädie Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
Oper Orthop Traumatol. 2016 Dec;28(6):472-488. doi: 10.1007/s00064-016-0468-2. Epub 2016 Sep 14.
PemberSal osteotomy to improve femoral head coverage by rotating the acetabular roof ventrally and laterally.
Insufficient coverage of the femoral head, and can be combined with other surgical procedures such as femoral intertrochanteric varus-derotation osteotomy and open reduction for developmental dysplasia and dislocation of the hip or to improve sphericity and containment in Legg-Calvé-Perthes disease. This specific acetabuloplasty can only be performed in patients with an open epiphyseal growth-plate.
Increased bleeding tendency (e.g., inherited or iatrogenic); elevated anesthetic risk such as in cerebral palsy, arthrogryposis multiplex congenital, trisomies; syndromes require explicit interdisciplinary clarification to reduce perioperative risks; infections as in other elective surgeries; diseases/deformities making postoperative spica casting impossible or impractical (e.g., deformities of spinal cord or urogenital system, hernias requiring treatment); closed epiphyseal plate requires complex three-dimensional corrections of the acetabular roof (e.g., triple/periacetabular osteotomy).
Osteotomy from the iliac bone to the posterior ilioischial arm of the epiphyseal growth-plate cartilage; controlled fracture of the cancellous bone without breaking the medial cortex of the iliac bone for ventrocaudal rotation of the acetabular roof. To refill and stabilize the osteotomy site, an allogenic bone-wedge is interponated and secured by a resorbable screw or kirschner wire. This method also allows more complex reconstructions of the acetabular roof, e.g., by including the pseudo-cup in a modified Rejholec technique.
A spica cast is applied to immobilize the hip for 6 weeks. Afterwards physiotherapy can be performed under weight-bearing as tolerated. Radiographic check-ups every 6 months.
潘伯萨尔截骨术通过将髋臼顶向腹侧和外侧旋转来改善股骨头覆盖。
股骨头覆盖不足，可与其他外科手术联合进行，如股骨粗隆间内翻旋转截骨术及发育性髋关节发育不良和脱位的切开复位术，或用于改善Legg-Calvé-Perthes病中的球形度和包容度。这种特定的髋臼成形术仅适用于骨骺生长板开放的患者。
出血倾向增加（如遗传性或医源性）；麻醉风险升高，如脑瘫、先天性多发性关节挛缩症、三体综合征患者；对于综合征患者，需要进行明确的多学科会诊以降低围手术期风险；与其他择期手术一样存在感染情况；疾病/畸形导致术后髋人字石膏固定无法实施或不切实际（如脊髓或泌尿生殖系统畸形、需要治疗的疝气）；闭合的骨骺板需要对髋臼顶进行复杂的三维矫正（如三联/髋臼周围截骨术）。
从髂骨至骨骺生长板软骨的后髂坐骨臂进行截骨；控制松质骨骨折，不破坏髂骨内侧皮质，以实现髋臼顶的腹尾侧旋转。为填充和稳定截骨部位，置入异体骨楔并用可吸收螺钉或克氏针固定。该方法还允许对髋臼顶进行更复杂的重建，例如通过改良雷霍莱克技术纳入假臼。
应用髋人字石膏固定髋关节6周。之后可在耐受负重的情况下进行物理治疗。每6个月进行一次影像学检查。
