Clohisy John C, Ackerman Jeffrey, Baca Geneva, Baty Jack, Beaulé Paul E, Kim Young-Jo, Millis Michael B, Podeszwa David A, Schoenecker Perry L, Sierra Rafael J, Sink Ernest L, Sucato Daniel J, Trousdale Robert T, Zaltz Ira
1Departments of Orthopaedic Surgery (J.C.C. and G.B.) and Biostatistics (J.B.), Washington University School of Medicine, St. Louis, Missouri 2Illinois Bone & Joint Institute, Chicago, Illinois 3Ottawa General Hospital, Ottawa, Ontario, Canada 4Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts 5Texas Scottish Rite Hospital, Dallas, Texas 6Shriners Hospitals for Children, St. Louis, Missouri 7Mayo Clinic, Rochester, Minnesota 8Hospital for Special Surgery, New York, NY 9Beaumont Hospital, Royal Oak, Michigan.
J Bone Joint Surg Am. 2017 Jan 4;99(1):33-41. doi: 10.2106/JBJS.15.00798.
Current literature describing the periacetabular osteotomy (PAO) is mostly limited to retrospective case series. Larger, prospective cohort studies are needed to provide better clinical evidence regarding this procedure. The goals of the current study were to (1) report minimum 2-year patient-reported outcomes (pain, hip function, activity, overall health, and quality of life), (2) investigate preoperative clinical and disease characteristics as predictors of clinical outcomes, and (3) report the rate of early failures and reoperations in patients undergoing contemporary PAO surgery.
A large, prospective, multicenter cohort of PAO procedures was established, and outcomes at a minimum of 2 years were analyzed. A total of 391 hips were included for analysis (79% of the patients were female, and the average patient age was 25.4 years). Patient-reported outcomes, conversion to total hip replacement, reoperations, and major complications were documented. Variables with a p value of ≤0.10 in the univariate linear regressions were included in the multivariate linear regression. The backward stepwise selection method was used to determine the final risk factors of clinical outcomes.
Clinical outcome analysis demonstrated major clinically important improvements in pain, function, quality of life, overall health, and activity level. Increasing age and a body mass index status of overweight or obese were predictive of improved results for certain outcome metrics. Male sex and mild acetabular dysplasia were predictive of lesser improvements in certain outcome measures. Three (0.8%) of the hips underwent early conversion to total hip arthroplasty, 12 (3%) required reoperation, and 26 (7%) experienced a major complication.
This large, prospective cohort study demonstrated the clinical success of contemporary PAO surgery for the treatment of symptomatic acetabular dysplasia. Patient and disease characteristics demonstrated predictive value that should be considered in surgical decision-making.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
目前描述髋臼周围截骨术（PAO）的文献大多局限于回顾性病例系列。需要更大规模的前瞻性队列研究来提供关于该手术的更好临床证据。本研究的目的是：（1）报告至少2年的患者报告结局（疼痛、髋关节功能、活动能力、总体健康状况和生活质量）；（2）调查术前临床和疾病特征作为临床结局的预测因素；（3）报告接受当代PAO手术患者的早期失败率和再次手术率。
建立了一个大型、前瞻性、多中心的PAO手术队列，并分析了至少2年的结局。共有391例髋关节纳入分析（79%的患者为女性，患者平均年龄为25.4岁）。记录患者报告的结局、转为全髋关节置换术、再次手术和主要并发症。单变量线性回归中p值≤0.10的变量纳入多变量线性回归。采用向后逐步选择法确定临床结局的最终危险因素。
临床结局分析表明，在疼痛、功能、生活质量、总体健康状况和活动水平方面有重大的临床重要改善。年龄增加以及超重或肥胖的体重指数状态可预测某些结局指标的改善结果。男性和轻度髋臼发育不良可预测某些结局指标的改善较小。3例（0.8%）髋关节早期转为全髋关节置换术，12例（3%）需要再次手术，26例（7%）发生主要并发症。
这项大型前瞻性队列研究证明了当代PAO手术治疗有症状髋臼发育不良的临床成功。患者和疾病特征显示出预测价值，在手术决策中应予以考虑。
治疗性IV级。有关证据水平的完整描述，请参阅作者须知。
