Jawish Roger, Najdi Hassan, Krayan Ali
Department of Orthopaedic Surgery, Sacré Coeur Hospital, Hazmieh, Lebanon.
J Pediatr Orthop B. 2018 May;27(3):257-263. doi: 10.1097/BPB.0000000000000472.
The periacetabular quadruple osteotomy of the pelvis (QOP), with the osteotomy of ischial spine to release the sacrospinal ligament, is reserved for older children with low potential of remodeling. Different parameters were studied with computed tomography (CT) scan before (pre-OH) and after surgery (post-OH) and for nonoperated hip (NOH). The study determined an optimal method to avoid retroversion and excessive anterior coverage. Fifteen QOP were performed in 13 patients, ranging in age from 10 to 15 years. The morphology of pelvis was analyzed with a CT scan before the surgery and 2 years after. Pathologies were Legg-Calve-Perthes (seven hips) and dysplasia (eight hips). The two-dimensional exam measured the acetabular index, the coverage, and the version of the acetabulum. The three-dimensional images measured the frontal lateral inclinations of the lips and the sagittal anterior acetabular inclination. The mean anterior acetabular index was 50.4° (NOH), 56° (pre-OH), and 58.7° (post-OH). The posterior acetabular index was 48.5° (NOH), 52.2° (pre-OH), and 40° (post-OH). The anterior coverage angle was 37.1° in (pre-OH), 27.6° (post-OH), and 30.1° (NOH). The posterior coverage was 20.4° (pre-OH), 17.2° (post-OH), and 12.4° (NOH). The acetabular version was 2.1° (pre-OH), 8.3° (post-OH), and 2.5° (NOH). The anterolateral lip inclination was 50.3° (pre-OH), 35.3° (post-OH), and 43.8° (NOH). The posterolateral lip inclination was 56.7° (pre-OH), 43.7° (post-OH), and 55.8° (NOH). The anterior acetabular inclination was 21.3° (pre-OH), 15.6° (post-OH), and 18° (NOH). The QOP enabled significant range of coverage of the hip in adolescents in whom the potential of remodeling is very low. External rotation related to figure-of-four should be omitted, whereas the maneuver to be applied, preventing the anterior impingement and decrease of the posterior coverage, should be performed by placing the acetabular fragment below the iliac bone, with a lateral inclination in the frontal plane similar to a steering wheel movement. This maneuver preserves comparable morphology of the OH with NOH and avoids retroversion with the excessive anterior coverage responsible for pain and early osteoarthritis.
骨盆髋臼周围四重截骨术（QOP），即通过坐骨棘截骨以松解骶棘韧带，适用于重塑潜力较低的大龄儿童。在手术前（术前）、手术后（术后）以及对未手术髋关节（NOH）进行计算机断层扫描（CT），研究了不同参数。该研究确定了一种避免髋臼后倾和过度前覆盖的最佳方法。对13例年龄在10至15岁的患者实施了15次QOP。在手术前和术后2年通过CT扫描分析骨盆形态。病变类型为Legg-Calve-Perthes病（7个髋关节）和发育不良（8个髋关节）。二维检查测量髋臼指数、覆盖度和髋臼旋转角。三维图像测量髋臼唇的额状面侧方倾斜度和髋臼前矢状面倾斜度。髋臼前平均指数在NOH为50.4°，术前为56°，术后为58.7°。髋臼后平均指数在NOH为48.5°，术前为52.2°，术后为40°。髋臼前覆盖角在术前为37.1°，术后为27.6°，NOH为30.1°。髋臼后覆盖角在术前为20.4°，术后为17.2°，NOH为12.4°。髋臼旋转角在术前为2.1°，术后为8.3°，NOH为2.5°。髋臼前外侧唇倾斜度在术前为50.3°，术后为35.3°，NOH为43.8°。髋臼后外侧唇倾斜度在术前为56.7°，术后为43.7°，NOH为55.8°。髋臼前倾斜度在术前为21.3°，术后为15.6°，NOH为18°。QOP能够显著扩大重塑潜力非常低的青少年髋关节的覆盖范围。应省略与“4”字试验相关的外旋动作，而防止前撞击和减少后覆盖的操作应通过将髋臼碎片置于髂骨下方进行，在额状面的侧方倾斜类似于方向盘转动。该操作可使手术髋关节与未手术髋关节保持可比的形态，并避免因过度前覆盖导致疼痛和早期骨关节炎的髋臼后倾。
