股骨外翻截骨术联合Chiari骨盆截骨术治疗髋关节骨关节炎的临床结果及预后因素
Clinical Results and Prognostic Factors for Outcomes of Valgus Femoral Osteotomy Combined with Chiari Pelvic Osteotomy for Osteoarthritis of the Hip.
作者信息
Uchiyama Katsufumi, Moriya Mitsutoshi, Fukushima Kensuke, Yamamoto Takeaki, Takahira Naonobu, Takaso Masashi
机构信息
Department of Orthopaedic Surgery, School of Medicine (K.U., M.M., K.F., T.Y., and M.T.) and School of Allied Health Sciences (N.T.), Kitasato University, Kanagawa, Japan.
出版信息
JB JS Open Access. 2017 Apr 6;2(2):e0006. doi: 10.2106/JBJS.OA.16.00006. eCollection 2017 Jun 26.
BACKGROUND
Surgeons have long debated whether advanced or end-stage osteoarthritis of the hip in young patients should be treated with total hip arthroplasty or osteotomy. We reviewed the intermediate-term clinical results of valgus femoral osteotomy combined with Chiari pelvic osteotomy (VCO) for advanced or end-stage osteoarthritis associated with severe acetabular dysplasia of the hip in young patients and analyzed prognostic factors related to conversion to total hip arthroplasty.
METHODS
The study group included 54 hips in 50 patients (5 men and 45 women; average age at the time of surgery, 45.6 years). The minimum and average durations of follow-up were 10 and 17.6 years, respectively. The Japanese Orthopaedic Association hip score (JOA score) was used for clinical evaluation. The probability of survival of the VCO from the time of the operation until the end point of conversion to total hip arthroplasty was calculated with use of the Kaplan-Meier method. We defined prognostic factors of outcome (conversion to total hip arthroplasty) with the Cox proportional hazards model.
RESULTS
The mean total JOA score increased from 53.0 points preoperatively to 77.1 points at 1 year postoperatively, 81.6 points at 5 years, and 76.8 points at 10 years. The survival rates were 83.3%, 59.7%, and 46.9% at 10, 15, and 20 years, respectively. On univariate and multivariate analyses, patients with a low degree of acetabular roof obliquity had better postoperative results.
CONCLUSIONS
VCO is a surgical approach that preserves joint function in young patients with advanced or end-stage osteoarthritis associated with severe acetabular dysplasia of the hip. The postoperative prognosis of VCO was improved in patients with a low degree of acetabular roof obliquity.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景
长期以来，外科医生一直在争论年轻患者的晚期或终末期髋关节骨关节炎应采用全髋关节置换术还是截骨术进行治疗。我们回顾了外翻股骨截骨术联合Chiari骨盆截骨术（VCO）治疗年轻患者晚期或终末期髋关节骨关节炎合并严重髋臼发育不良的中期临床结果，并分析了与转为全髋关节置换术相关的预后因素。
方法
研究组包括50例患者的54个髋关节（5例男性和45例女性；手术时的平均年龄为45.6岁）。随访的最短和平均时间分别为10年和17.6年。采用日本骨科学会髋关节评分（JOA评分）进行临床评估。使用Kaplan-Meier方法计算从手术时到转为全髋关节置换术终点的VCO生存率。我们用Cox比例风险模型定义结局（转为全髋关节置换术）的预后因素。
结果
JOA总分平均值从术前的53.0分增加到术后1年的77.1分、术后5年的81.6分和术后10年的76.8分。10年、15年和20年的生存率分别为83.3%、59.7%和46.9%。单因素和多因素分析显示，髋臼顶倾斜度低的患者术后结果更好。
结论
VCO是一种保留年轻患者晚期或终末期髋关节骨关节炎合并严重髋臼发育不良关节功能的手术方法。髋臼顶倾斜度低的患者VCO术后预后得到改善。
证据水平
治疗水平IV。有关证据水平的完整描述，请参阅作者须知。
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