Khan O H, Malviya A, Subramanian P, Agolley D, Witt J D
University College London Hospitals NHS Foundation Trust, 235 Euston Rd, Fitzrovia, London NW1 2BU, UK.
Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington NE63 9JJ, UK.
Bone Joint J. 2017 Jan;99-B(1):22-28. doi: 10.1302/0301-620X.99B1.BJJ-2016-0439.R1.
Periacetabular osteotomy is an effective way of treating symptomatic hip dysplasia. We describe a new minimally invasive technique using a modification of the Smith-Peterson approach. We performed a prospective, longitudinal cohort study to assess for any compromise in acetabular correction when using this approach, and to see if the procedure would have a higher complication rate than that quoted in the literature for other approaches. We also assessed for any improvement in functional outcome.
From 168 consecutive patients (189 hips) who underwent acetabular correction between March 2010 and March 2013 we excluded those who had undergone previous pelvic surgery for DDH and those being treated for acetabular retroversion. The remaining 151 patients (15 men, 136 women) (166 hips) had a mean age of 32 years (15 to 56) and the mean duration of follow-up was 2.8 years (1.2 to 4.5). In all 90% of cases were Tönnis grade 0 or 1. Functional outcomes were assessed using the Non Arthritic Hip Score (NAHS), University of California, Los Angeles (UCLA) and Tegner activity scores.
The mean pre-operative lateral centre-edge angle was 14.2° (-5° to 30°) and the mean acetabular index was 18.4° (4° to 40°). Post-operatively these were 31° (18° to 46°) and 3° (-7° to 29°), respectively, a significant improvement in both (p < 0.001). Allogenic blood transfusion was required in two patients (1.2%). There were no major nerve or vascular complications, and no wound infections. At the time of last follow-up, we noted a significant improvement in functional outcome scores: UCLA improved by 2.31 points, Tegner improved by 1.08 points, and the NAHS improved by 25.4 points (p < 0.001 for each). Hypermobility and longer duration of surgery were significant negative predictors for a good post-operative UCLA score, while residual retroversion was a positive predictor of post-operative UCLA score.
We have found this approach to be safe and effective, facilitating early recovery from surgery. Cite this article: Bone Joint J 2017;99-B:22-8.
髋臼周围截骨术是治疗有症状的髋关节发育不良的有效方法。我们描述了一种采用改良史密斯-彼得森入路的新型微创技术。我们进行了一项前瞻性纵向队列研究，以评估使用该入路时髋臼矫正是否会受到影响，以及该手术的并发症发生率是否高于文献中报道的其他入路。我们还评估了功能结局是否有所改善。
在2010年3月至2013年3月期间接受髋臼矫正的168例连续患者（189髋）中，我们排除了既往因发育性髋关节发育不良接受过骨盆手术的患者以及因髋臼后倾接受治疗的患者。其余151例患者（15例男性，136例女性）（166髋）的平均年龄为32岁（15至56岁），平均随访时间为2.8年（1.2至4.5年）。所有病例中90%为Tönnis 0级或1级。使用非关节炎髋关节评分（NAHS）、加利福尼亚大学洛杉矶分校（UCLA）评分和特格纳活动评分评估功能结局。
术前平均外侧中心边缘角为14.2°（-5°至30°），平均髋臼指数为18.4°（4°至40°）。术后分别为31°（18°至46°）和3°（-7°至29°），两者均有显著改善（p < 0.001）。两名患者（1.2%）需要异体输血。无重大神经或血管并发症，也无伤口感染。在最后一次随访时，我们注意到功能结局评分有显著改善：UCLA评分提高了2.31分，特格纳评分提高了1.08分，NAHS评分提高了25.4分（每项p < 0.001）。关节活动过度和手术时间延长是术后UCLA评分良好的显著负性预测因素，而残余后倾是术后UCLA评分的正性预测因素。
我们发现这种方法安全有效，有助于术后早期恢复。引用本文：《骨与关节杂志》2017年；99-B：22 - 8。
