Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado.
Hip Preservation and Sports Surgery, MultiCare Health System, Auburn, Washington.
J Bone Joint Surg Am. 2019 Aug 21;101(16):1495-1504. doi: 10.2106/JBJS.19.00005.
The aims of this study were to describe a novel minimally invasive, interlocking periacetabular osteotomy (PAO) for the treatment of hip dysplasia that was developed at our institution and to report on its safety, complications, and early clinical outcomes.
This was a prospective longitudinal study of the first 200 consecutive hips that underwent the CU (University of Colorado) PAO, an interlocking osteotomy combining the benefits of the Birmingham interlocking pelvic osteotomy (BIPO) and the Ganz PAO. The technique provides direct visualization of the sciatic nerve during the ischial osteotomy and allows for immediate weight-bearing postoperatively. Demographic characteristics, intraoperative and perioperative parameters, and functional outcomes were documented. All patients underwent hip arthroscopy 3 to 10 days prior to the PAO to address concomitant intra-articular pathology. Mechanical deep venous thrombosis (DVT) prophylaxis was used for 2 weeks postoperatively. Results were stratified to compare the first 100 and the second 100 cases.
A total of 161 patients (200 hips) underwent primary PAO; mean follow-up was 20 months (range, 3 to 33 months). The mean patient age at the time of surgery was 29.4 years (range, 13 to 55 years). Females accounted for 89% of the patients included in this study. The average length of stay was 4 days. A concomitant proximal femoral derotational osteotomy was performed in 19 hips. The lateral center-edge angle (LCEA) improved from a mean of 18.8° preoperatively to 31.5° postoperatively (p < 0.001). The mean Non-Arthritic Hip Score (NAHS) improved from 56.0 preoperatively to 89.4 at the 24-month follow-up (p < 0.0001). Paresthesias in the distribution of the lateral femoral cutaneous nerve were common (65% at 2 weeks postoperatively) but resolved in 85% of the patients within the first 6 months. There were no sciatic nerve-related complications, deep infections, or DVTs.
The CU PAO enables corrective realignment of symptomatic acetabular dysplasia with direct visualization of the sciatic nerve, early weight-bearing, cosmetic incisions, and good short-term outcomes.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在描述一种新的微创、互锁性髋臼周围截骨术（PAO），用于治疗髋关节发育不良，该术式由我们医院开发，并报告其安全性、并发症和早期临床结果。
这是一项前瞻性纵向研究，纳入了 200 例连续接受 CU（科罗拉多大学）PAO 的髋关节，这是一种互锁性截骨术，结合了 Birmingham 互锁骨盆截骨术（BIPO）和 Ganz PAO 的优点。该技术可在坐骨神经截骨术中直接观察到坐骨神经，并允许术后立即负重。记录人口统计学特征、术中及围手术期参数和功能结果。所有患者均在 PAO 前 3 至 10 天接受髋关节镜检查，以解决伴发的关节内病变。术后使用机械性深静脉血栓形成（DVT）预防治疗 2 周。结果分层比较前 100 例和后 100 例。
共 161 例患者（200 髋）接受了初次 PAO；平均随访 20 个月（3 至 33 个月）。手术时患者的平均年龄为 29.4 岁（13 至 55 岁）。女性占研究对象的 89%。平均住院时间为 4 天。19 髋同时行股骨近端旋转截骨术。外侧中心边缘角（LCEA）从术前的平均 18.8°改善至术后的 31.5°（p < 0.001）。非关节炎性髋关节评分（NAHS）从术前的 56.0 分改善至术后 24 个月的 89.4 分（p < 0.0001）。股外侧皮神经分布区的感觉异常很常见（术后 2 周时为 65%），但 85%的患者在 6 个月内得到缓解。无坐骨神经相关并发症、深部感染或 DVT。
CU PAO 可通过直视坐骨神经，实现对有症状的髋臼发育不良的矫正，早期负重，美容切口和良好的短期结果。
治疗 IV 级。请参阅作者说明，以获取完整的证据水平描述。
