Akgul Turgut, Coskun Osman, Korkmaz Murat, Gurses Ilke Ali, Sen Cengiz, Gayretli Ozcan
Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Indian J Orthop. 2017 Nov-Dec;51(6):687-691. doi: 10.4103/ortho.IJOrtho_204_16.
Developmental hip dysplasia is diagnosed when the femoral head is not sufficiently covered by the acetabulum. Anterior and lateral cover deficiency is seen, as a result a dysplastic hip joint. Various incision modifications have been developed because of the muscle dissection and wide wound scar in Smith-Peterson incision, which was originally used in Bernese osteotomy. This study evaluates applicability of the modified Stoppa approach in the performance of Bernese periacetabular osteotomy (PAO).
Ten hemipelvises of five donor cadavers were used. The transverse Stoppa incision was made 2 cm over the symphysis pubis for quadrilateral surface exposure and pubic and ischial bone osteotomies. The second skin incision, a few centimeters lateral to the original incision, was made along the tensor fascia lata. Iliac bone osteotomy was performed starting just above the rectus femoris insertion. The displacement of the osteotomy was measured clinically and radiographically.
The mean anterior coverage calculated with center-edge angle was improved from 22.8° ±2.8 (range 20° min-28° max) preoperatively to 44.1° ± 3.7 (range 36° min-48° max). The displacement of the osteotomy at the iliopectineal line calculated on the iliac inlet view radiographs was 22.1 ± 3.4 mm (range 15 mm min-26 mm max). The clinical amount of the anterior displacement on the cadavers was 17.8 ± 3.35 mm (range 11 mm-21 mm) and lateral displacement was 20.3 ± 3.23 mm (range 15 mm-24 mm). The amount of the posterior intact bone enlargement at the quadrilateral surface was 5.3 ± 0.48 mm.
This less traumatic two-incision exposure is an adequate technique for Bernese PAO, allowing the bone to be cut under direct visual observation and reducing the need to use fluoroscopy.
当股骨头未被髋臼充分覆盖时，可诊断为发育性髋关节发育不良。可见髋臼前侧和外侧覆盖不足，从而导致髋关节发育不良。由于最初用于伯尔尼截骨术的史密斯-彼得森切口存在肌肉分离和较宽的伤口瘢痕，因此人们开发了各种切口改良方法。本研究评估改良斯托帕入路在伯尔尼髋臼周围截骨术（PAO）中的适用性。
使用了5具供体尸体的10个半骨盆。在耻骨联合上方2 cm处做横向斯托帕切口，以暴露四边形表面并进行耻骨和坐骨截骨。在原切口外侧几厘米处，沿阔筋膜张肌做第二个皮肤切口。从股直肌附着点上方开始进行髂骨截骨。通过临床和影像学方法测量截骨的移位情况。
采用中心边缘角计算的平均前侧覆盖度从术前的22.8°±2.8（范围20°-28°）提高到了44.1°±3.7（范围36°-48°）。根据髂骨入口位X线片计算，髂耻线处截骨的移位为22.1±3.4 mm（范围15-26 mm）。尸体上的临床前侧移位量为17.8±3.35 mm（范围11-21 mm），外侧移位量为20.3±3.23 mm（范围15-24 mm）。四边形表面后侧完整骨的增大量为5.3±0.48 mm。
这种创伤较小的双切口暴露法是一种适用于伯尔尼PAO的技术，可使骨切开在直视下进行，并减少了使用透视的需求。
