Dienst M, Goebel L, Birk S, Kohn D
Orthopädische Chirurgie München, 81369, Munich, Germany.
Department of Orthopaedics, Saarland University Medical Center, 66421, Homburg/Saar, Germany.
Oper Orthop Traumatol. 2018 Oct;30(5):342-358. doi: 10.1007/s00064-018-0554-8. Epub 2018 Aug 10.
Reorientation of the acetabulum to normalize load transfer or avert femoroacetabular pincer impingement to prevent osteoarthritis of the hip.
Persisting acetabular dysplasia after closure of growth plates or acetabular malrotation.
High dislocation of hip, secondary acetabulum, increased misalignment on functional X‑ray, high-grade mobility restriction. Relative: degenerative changes, advanced age.
Bernese periacetabular osteotomy through two incisions; all bone cuts are carried out under direct vision. The osteotomies are equivalent to the classic Ganz method. In a slightly tilted forward lateral decubitus position, a posterior incision is applied for the ischium osteotomy and the caudal portion of the retroacetabular osteotomy. The pubis and ilium osteotomies are performed in a supine position through an anterior approach with subsequent reorientation and screw fixation. The rectus femoris is not dissected unless joint exposure is required.
Partial weight bearing with 20 kg for the first 6 weeks postoperatively, followed by stepwise transition to full loads after radiological control.
In total, 34 patients (37 hips) were followed up for 20.4 ± 10.3 months. Tönnis osteoarthritis scale levels remained constant. The center-edge angle of Wiberg increased from 13.2 ± 7.5° to 26.5 ± 6.7°, the Tönnis angle (acetabular index) changed from 13.8 ± 6.5° to 3.4 ± 4.4°. At follow-up, the Merle d'Aubigné and Postel score was 16.5 ± 1.4; the modified Harris hip score 87.6 ± 13.9 and the International hip outcome tool (iHOT)-12 78.2 ± 20.3 points. The mean surgical time was 213 ± 29 min. Severe complications were not observed.
重新定位髋臼，使负荷传递正常化或避免股骨髋臼钳夹撞击，以预防髋关节骨关节炎。
生长板闭合后持续存在的髋臼发育不良或髋臼旋转不良。
髋关节高位脱位、继发性髋臼、功能X线片上错位增加、高度活动受限。相对禁忌症：退行性改变、高龄。
通过两个切口进行伯尔尼髋臼周围截骨术；所有截骨均在直视下进行。截骨术等同于经典的甘茨方法。在稍向前倾斜的侧卧位，通过后切口进行坐骨截骨术和髋臼后截骨术的尾侧部分。耻骨和髂骨截骨术通过前入路在仰卧位进行，随后进行重新定位和螺钉固定。除非需要暴露关节，否则不切开股直肌。
术后前6周部分负重20千克，之后在影像学检查后逐步过渡到完全负重。
总共34例患者（37髋）随访了20.4±10.3个月。托尼斯骨关节炎量表水平保持不变。维伯格中心边缘角从13.2±7.5°增加到26.5±6.7°，托尼斯角（髋臼指数）从13.8±6.5°变为3.4±4.4°。随访时，梅勒·德奥布涅和波斯泰尔评分16.5±1.4；改良哈里斯髋关节评分87.6±13.9，国际髋关节结果工具（iHOT）-12为78.2±20.3分。平均手术时间为213±29分钟。未观察到严重并发症。
