University Paris Descartes, Sorbonne Paris Cité, Department of Pediatric Orthopedics, Hospital Necker Enfants-Malades Paris France.
University Paris Descartes, Sorbonne Paris Cité, Department of Pediatric Orthopedics, Hospital Necker Enfants-Malades Paris France.
Orthop Traumatol Surg Res. 2018 May;104(3):383-387. doi: 10.1016/j.otsr.2017.12.020. Epub 2018 Feb 21.
Triple pelvic osteotomy (TPO) is a treatment option in children and adolescents with residual acetabular dysplasia after developmental dislocation of the hip (DDH). However, TPO to redirect the acetabulum is often blamed for anterior and lateral overcoverage of the femoral head. The main objectives of this study were to assess the potential clinical impact, frequency, and radiological features of acetabular overcorrection. Evidence of post-operative remodelling and associations linking younger age at surgery and/or dysplasia severity to the existence and magnitude of overcorrection were sought.
Acetabular overcorrection has little or no clinical impact.
TPO was performed on 41 hips in 31 patients at a mean age of 6.3 years (range, 3.0-15.2 years). Mean follow-up was 13.8 years (range, 5.4-28.7 years) and mean age at last re-evaluation was 22.1 years (range, 13-39 years). Clinical outcomes were assessed based on the Harris Hip Score (HHS) and Postel-Merle d'Aubigné (PMA) score. Radiographs were used to look for a cross-over sign (CO+) and to measure the vertical-centre edge (VCE) and vertical-centre anterior (VCA) angles and the acetabular index (AI). Overcorrection was defined as AI≤0° and/or VCE≥35° and/or VCA≥40° and/or CO+.
The HHS and PMA score values were good or excellent for 39 (94%) hips. One or more parameters indicated overcorrection of 33 (80.5%) hips. No significant differences were found between the overcorrected hips and the hips with normal parameters.
TPO effectively corrects residual acetabular dysplasia. Overcorrection is common in all three planes but has little clinical impact in young adults. The high frequency of overcorrection mandates a careful pre- and intra-operative evaluation of acetabular version.
IV, retrospective study.
三骨盆截骨术（TPO）是髋关节发育性脱位（DDH）后残余髋臼发育不良患儿和青少年的一种治疗选择。然而，TPO 转位髋臼常常被归咎于股骨头前侧和外侧覆盖过度。本研究的主要目的是评估髋臼过度矫正的潜在临床影响、频率和影像学特征。研究还寻求了术后重塑的证据，并将手术时年龄较小和/或发育不良程度与过度矫正的存在和程度联系起来。
髋臼过度矫正几乎没有或没有临床影响。
对 31 名患者的 41 髋进行了 TPO，平均年龄为 6.3 岁（范围，3.0-15.2 岁）。平均随访时间为 13.8 年（范围，5.4-28.7 年），最后一次评估时的平均年龄为 22.1 岁（范围，13-39 岁）。临床结果根据 Harris 髋关节评分（HHS）和 Postel-Merle d'Aubigné（PMA）评分进行评估。通过 X 线片观察交叉征（CO+），并测量垂直中心边缘角（VCE）和垂直中心前角（VCA）以及髋臼指数（AI）。将 AI≤0°和/或 VCE≥35°和/或 VCA≥40°和/或 CO+定义为过度矫正。
39 髋（94%）HHS 和 PMA 评分值良好或优秀。33 髋（80.5%）有一个或多个参数表明过度矫正。过度矫正的髋关节与参数正常的髋关节之间无显著差异。
TPO 可有效矫正残余髋臼发育不良。在所有三个平面上，过度矫正都很常见，但在年轻人中几乎没有临床影响。过度矫正的高频率要求在术前和术中仔细评估髋臼的版本。
IV，回顾性研究。
