改良三联骨盆截骨术治疗成人症状性髋臼发育不良：中期随访的临床及影像学结果

Modified triple pelvic osteotomy for adult symptomatic acetabular dysplasia: clinical and radiographic results at midterm follow-up.

作者信息

Wu Jiajun, Yang Yang, Wang Xiuhui, Zhou Xiaoxiao, Zhang Changqing

机构信息

Department of Orthopedics, Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences, No. 1500 Zhouyuan Road, Pudong New Area, Shanghai, 201318, China.

Department of Orthopedics, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang, China.

出版信息

J Orthop Surg Res. 2018 Sep 15;13(1):236. doi: 10.1186/s13018-018-0922-y.

DOI:10.1186/s13018-018-0922-y

PMID:30219063

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6139145/

Abstract

BACKGROUND

Acetabular dysplasia is the most common cause of secondary arthritis of the hip joint. Achieving maximum restoration of the acetabular coverage and medialization of the femoral head remains difficult with the original Steel triple pelvic osteotomy for acetabular dysplasia in children and adults. This study intended to answer the following questions: (1) Are the midterm functional results of our modified procedure favorable, particularly in relation to Harris scores? and (2) On the basis of the Tönnis grade, does this procedure has a different effect on radiographic parameters and functional results at midterm follow-up?

METHODS

This study included 26 consecutive adult patients with symptomatic acetabular dysplasia (28 hips) who underwent modified triple pelvic osteotomy through two incisions between July 2005 and June 2012. According to the preoperative Tönnis grade, the patients were divided into T0 (Tönnis grade 0), T1 (Tönnis grade 1), and T2 (Tönnis grade 2) groups. Wiberg center-edge (CE) angle, Sharp acetabular angle, lateralization, and Harris scores were analyzed to assess the radiographic and clinical outcomes.

RESULTS

The mean CE angle (28.43° [± 3.58°], p < 0.05), Sharp acetabular angle (36.39° [± 3.26°], p < 0.05), lateralization (16.82 mm [± 3.10 mm], p < 0.05), and Harris scores (89.07 [± 4.97], p < 0.05) at the last follow-up significantly improved compared to those preoperatively. Multiple comparisons of radiographic outcomes among the three groups indicated no significant difference (p < 0.05). Harris scores in group T2 were significantly lower than those in groups T0 (p < 0.05) and T1 (p < 0.05). No major complication was observed.

CONCLUSIONS

Our modified triple pelvic osteotomy for adult symptomatic acetabular dysplasia with early-stage osteoarthritis could lead to excellent radiographic outcomes, good clinical results, and lower complication rates.

摘要

背景

髋臼发育不良是髋关节继发性关节炎最常见的病因。对于儿童和成人髋臼发育不良，采用原始的Steel三联骨盆截骨术来实现髋臼覆盖的最大恢复和股骨头的内移仍然具有挑战性。本研究旨在回答以下问题：（1）我们改良手术的中期功能结果是否良好，尤其是与Harris评分相关的结果？（2）根据Tönnis分级，该手术在中期随访时对影像学参数和功能结果是否有不同影响？

方法

本研究纳入了2005年7月至2012年6月期间连续26例有症状的髋臼发育不良成年患者（28髋），这些患者通过两个切口接受了改良三联骨盆截骨术。根据术前Tönnis分级，将患者分为T0组（Tönnis 0级）、T1组（Tönnis 1级）和T2组（Tönnis 2级）。分析Wiberg中心边缘（CE）角、Sharp髋臼角、外移程度和Harris评分，以评估影像学和临床结果。

结果

末次随访时，平均CE角（28.43°[±3.58°]，p<0.05）、Sharp髋臼角（36.39°[±3.26°]，p<0.05）、外移程度（16.82 mm[±3.10 mm]，p<0.05）和Harris评分（89.07[±4.97]，p<0.05）与术前相比均有显著改善。三组之间影像学结果的多重比较显示无显著差异（p<0.05）。T2组的Harris评分显著低于T0组（p<0.05）和T1组（p<0.05）。未观察到重大并发症。