Siebenrock Klaus A, Steppacher Simon D, Tannast Moritz, Büchler Lorenz
Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland. E-mail address for K.A. Siebenrock:
JBJS Essent Surg Tech. 2015 Jan 14;5(1):e1. doi: 10.2106/JBJS.ST.N.00036. eCollection 2015 Feb 25.
The periacetabular osteotomy procedure reorients a retroverted acetabulum into a more anatomically appropriate position.
STEP 1 EVALUATION OF ACETABULAR RETROVERSION: Evaluate acetabular retroversion on the basis of a combination of radiographic signs.
STEP 2 PATIENT POSITIONING AND SKIN INCISION: After draping and sterile preparation with the patient in a supine position, make an incision following the skin lines of the inguinal fold.
STEP 3 EXPOSURE OF THE DEEP MUSCLE LAYERS AND THE PELVIC BRIM: Detach the abdominal wall muscles from the anterior iliac crest and detach the sartorius muscle and the inguinal ligament to expose the iliac fossa and the pelvic brim.
STEP 4 SURGICAL DISSECTION FOR PREPARATION OF THE ISCHIAL OSTEOTOMY: Detach the iliocapsularis muscle and mobilize it medially to allow access to the infra-articular space and palpation of the ischial bone.
STEP 5 INCOMPLETE PARTIAL ISCHIAL OSTEOTOMY: Introduce a curved chisel with a crescent-shaped tip into the infra-articular space in order to perform the osteotomy of the ischial bone.
STEP 6 OSTEOTOMY OF THE SUPERIOR PUBIC RAMUS: Place subperiosteal blunt retractors around the superior pubic ramus to ensure safe and complete pubic bone osteotomy.
STEP 7 SUPRA-ACETABULAR AND RETROACETABULAR OSTEOTOMY: Start the supra-acetabular horizontal osteotomy at the anterior superior iliac spine and end it 2 cm lateral to the pelvic brim, where the osteotomy is angled 100° distally.
STEP 8 MOBILIZATION OF THE ACETABULAR FRAGMENT: With the help of a spreader and a 4.5-mm threaded Schanz pin, free and mobilize the acetabular fragment.
STEP 9 REORIENTATION OF THE ACETABULAR FRAGMENT: Perform internal rotation of the acetabular fragment with the help of the threaded Schanz pin.
STEP 10 IMPROVEMENT OF ANTERIOR HEAD-NECK OFFSET FEMORAL NECK OSTEOPLASTY: Anterior capsulotomy and improvement of anterior head-neck offset is recommended when internal rotation is <30°.
STEP 11 ANTEROPOSTERIOR PELVIC RADIOGRAPH FOLLOWING PERIACETABULAR OSTEOTOMY: Ideally, a postoperative radiograph should show negative crossover and posterior wall signs while the ischial spine sign typically remains positive.
The long-term results of the periacetabular osteotomy in a series of twenty-two patients (twenty-nine hips) with symptomatic acetabular retroversion were evaluated after a mean duration of follow-up of eleven years (range, nine to twelve years).IndicationsContraindicationsPitfalls & Challenges.
髋臼周围截骨术可将后倾的髋臼重新定位到更符合解剖学的合适位置。
步骤1髋臼后倾评估：根据多种影像学征象评估髋臼后倾情况。
步骤2患者体位及皮肤切口：患者仰卧位铺巾并消毒后，沿腹股沟皱襞皮肤纹路做切口。
步骤3深层肌肉层及骨盆边缘暴露：将腹壁肌肉从髂前嵴分离，分离缝匠肌和腹股沟韧带以暴露髂窝和骨盆边缘。
步骤4坐骨截骨准备的手术解剖：分离髂关节囊肌并将其向内侧游离，以便进入关节下间隙并触摸坐骨。
步骤5不完全部分坐骨截骨：将带新月形尖端的弯凿插入关节下间隙以进行坐骨截骨。
步骤6耻骨上支截骨：在耻骨上支周围放置骨膜下钝性牵开器，以确保安全、完整地进行耻骨截骨。
步骤7髋臼上缘和髋臼后缘截骨：从髂前上棘开始髋臼上缘水平截骨，在距骨盆边缘外侧2cm处结束，此处截骨向远端成100°角。
步骤8髋臼碎片的游离：在撑开器和一根4.5mm螺纹斯氏针的帮助下，游离并移动髋臼碎片。
步骤9髋臼碎片的重新定位：在螺纹斯氏针的帮助下对髋臼碎片进行内旋。
步骤10改善股骨头颈前侧偏移的股骨颈截骨成形术：当内旋角度<30°时，建议进行前侧关节囊切开术并改善股骨头颈前侧偏移。
步骤11髋臼周围截骨术后骨盆前后位X线片：理想情况下，术后X线片应显示无交叉征和后壁征，而坐骨棘征通常仍为阳性。
对22例（29髋）有症状的髋臼后倾患者进行髋臼周围截骨术的长期结果进行了评估，平均随访时间为11年（范围9至12年）。适应证、禁忌证、陷阱与挑战。
