Seo Hajime, Naito Masatoshi, Kinoshita Koichi, Minamikawa Tomohiko, Yamamoto Takuaki
Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
Department of Orthopaedic Surgery, Fukuoka Sanno Hospital, Fukuoka, Japan.
JB JS Open Access. 2018 May 29;3(2):e0048. doi: 10.2106/JBJS.OA.17.00048. eCollection 2018 Jun 28.
Patients with acetabular dysplasia often have abnormal femoral and acetabular version. The effect of combined femoral and acetabular version on clinical outcomes after periacetabular osteotomy for the treatment of acetabular dysplasia remains unclear. The purposes of the present study were (1) to evaluate the association of combined femoral and acetabular version with clinical outcome after periacetabular osteotomy and (2) to investigate the association of femoral version independently with clinical outcome after periacetabular osteotomy.
We retrospectively reviewed the records for 92 consecutive patients (95 hips) who had undergone periacetabular osteotomy for the treatment of symptomatic acetabular dysplasia. The patient cohort comprised 85 females and 7 males with a mean age of 38.9 years at the time of surgery. The mean duration of follow-up was 4.8 years (range, 2.0 to 7.2 years). Femoral and acetabular version and the alpha angle were measured on postoperative computed tomography scans. Clinical outcomes included range of motion and the modified Harris hip score. Analysis of variance was used to investigate the effect of femoral version on clinical outcomes. Analysis of covariance was used to adjust for potential covariates.
Combined femoral and acetabular version after periacetabular osteotomy was slightly, but significantly, correlated with postoperative flexion (r = 0.222; p = 0.031) and internal rotation in flexion (r = 0.326; p = 0.001). Patients with mild femoral version (<15°) experienced significantly less postoperative internal rotation in flexion than those with severe femoral version (>35°); however, this difference was lost after adjustment for potential covariates. There were no differences among femoral version groups (mild, moderate, and severe) in terms of improvements in the clinical outcomes of pain, function, and activity.
Combined femoral and acetabular version after periacetabular osteotomy was significantly correlated with postoperative range of motion. Abnormality of femoral version associated with acetabular dysplasia did not demonstrate any effect on the clinical outcomes of periacetabular osteotomy.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
髋臼发育不良患者常存在股骨和髋臼扭转异常。髋臼周围截骨术治疗髋臼发育不良后，股骨和髋臼扭转联合情况对临床疗效的影响尚不清楚。本研究的目的是：（1）评估髋臼周围截骨术后股骨和髋臼扭转联合情况与临床疗效的相关性；（2）研究髋臼周围截骨术后股骨扭转单独与临床疗效的相关性。
我们回顾性分析了92例连续接受髋臼周围截骨术治疗有症状髋臼发育不良患者（95髋）的记录。患者队列包括85名女性和7名男性，手术时平均年龄为38.9岁。平均随访时间为4.8年（范围2.0至7.2年）。术后计算机断层扫描测量股骨和髋臼扭转以及α角。临床疗效包括活动范围和改良Harris髋关节评分。采用方差分析研究股骨扭转对临床疗效的影响。采用协方差分析调整潜在协变量。
髋臼周围截骨术后股骨和髋臼扭转联合情况与术后屈曲（r = 0.222；p = 0.031）和屈曲内旋（r = 0.326；p = 0.001）呈轻度但显著的相关性。股骨扭转轻度（<15°）的患者术后屈曲内旋明显少于股骨扭转重度（>35°）的患者；然而，在调整潜在协变量后，这种差异消失。在疼痛、功能和活动的临床疗效改善方面，股骨扭转组（轻度、中度和重度）之间没有差异。
髋臼周围截骨术后股骨和髋臼扭转联合情况与术后活动范围显著相关。与髋臼发育不良相关的股骨扭转异常对髋臼周围截骨术的临床疗效未显示出任何影响。
预后IV级。有关证据水平的完整描述，请参阅作者指南。
