Salter 截骨术能否矫正晚期诊断的髋关节发育不良：6.7 年后 49 髋的回顾性评估？

Can Salter osteotomy correct late diagnosed hip dysplasia: A retrospective evaluation of 49 hips after 6.7 years?

机构信息

University of Munich (LMU), Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Germany; University of Tübingen, BG Trauma Center Tübingen, Germany.

University of Munich (LMU), Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Germany.

出版信息

Orthop Traumatol Surg Res. 2018 Sep;104(5):637-643. doi: 10.1016/j.otsr.2018.05.004. Epub 2018 Jun 7.

DOI:10.1016/j.otsr.2018.05.004

PMID:29886151

Abstract

BACKGROUND

Surgical treatment of late diagnosed development dysplasia of the hip (DDH) remains challenging with several methods being described. We therefore retrospectively evaluated the outcome of Salter innominate osteotomy (SIO) in patients with fully-grown bone, to evaluate whether this surgical procedure allows sufficient acetabular correction.

MATERIAL AND METHODS

Between 2004-2012 SIO had been performed in 45 patients (49 hips) with late diagnosed DDH. The evaluation included pre- and postoperative radiographs (n=49), the complication rate (n=49) and the clinical outcome (WOMAC, HHS, UCLA) (n=34).

RESULTS

Mean age at surgery was 27.6 (16-51) with a follow-up of 6.7±2.7 (0.9-11.0) years. Radiologically, a good acetabular correction with a significant improvement of the Center Edge angle (15.4° to 34.9°), sharps angle (45.7° to 32.0°) and migration percentage (33.2% to 14.4%) (p<0.001) was found. Clinical results revealed a WOMAC of 13.9±13.3, UCLA of 7.8±2.1 and HHS of 85.0±11.8. Complications were noted for 10 patients (20%) with 7 (14%) requiring revision.

CONCLUSION

The results demonstrated that SIO achieved a satisfying acetabular correction and good clinical results in late diagnosed DDH. It therefore might be an option in some cases, although periacetabular osteotomy techniques are currently preferable used as they allow a wider range of acetabular correction.

LEVEL OF EVIDENCE

IV, retrospective observational study.

摘要

背景

对于晚期诊断的发育性髋关节发育不良（DDH），手术治疗仍然具有挑战性，已有多种方法被描述。因此，我们回顾性评估了 Salter 骨盆截骨术（SIO）在完全成熟骨骼患者中的疗效，以评估该手术是否能够实现充分的髋臼矫正。

材料和方法

2004 年至 2012 年间，我们对 45 例（49 髋）晚期诊断的 DDH 患者进行了 SIO。评估包括术前和术后的影像学检查（n=49）、并发症发生率（n=49）和临床结果（WOMAC、HHS、UCLA）（n=34）。

结果

手术时的平均年龄为 27.6 岁（16-51 岁），随访时间为 6.7±2.7 年（0.9-11.0 年）。影像学上，髋臼的矫正效果良好，中心边缘角（15.4°至 34.9°）、Sharp 角（45.7°至 32.0°）和移行百分比（33.2%至 14.4%）显著改善（均<0.001）。临床结果显示 WOMAC 为 13.9±13.3，UCLA 为 7.8±2.1，HHS 为 85.0±11.8。10 例患者（20%）发生了并发症，其中 7 例（14%）需要翻修。