Ali Mohammed, Malviya Ajay
Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
Hip Int. 2020 Jan;30(1):4-15. doi: 10.1177/1120700019871195. Epub 2019 Sep 16.
Bernese periacetabular osteotomy (PAO) was introduced by Ganz as a novel surgical technique for hip dysplasia with a congruent hip to reorient the acetabulum in skeletally mature patients. The PAO through a modified Smith-Petersen (Iliofemoral) approach, has been subject to many modifications in order to avoid complications and to minimise risks for failure.
The aim of this review was to report on the complication rates, functional and radiological outcomes in relation to surgical approaches.
A search of NICE healthcare database advanced search, was conducted from the year of inception to May 2018. We included studies that reported complications of PAO. Data extracted from case series was analysed to detect the incidence of complications, relation to surgical approach and temporal trend of complications.
40 studies including 4070 hips with a mean age of 29 years and a mean follow-up of 52.8 month, were analysed. Outcome measures demonstrated good to excellent outcome in 82%. Higher rates of LFCN and sciatic nerve injuries were found to be associated with the ilioinguinal and the 2-incision approach. Minimally invasive (MIS) modified Smith-Petersen (MSP), minimally invasive trans-sartorial and trans-trochanteric approaches were not reported to be associated with any major wound complications. Radiological correction achieved with a mean improvement in acetabular inclination of 17.90 (range 4.5-40), anterior centre-edge correction 25.40 (range 10-51), lateral centre-edge correction 23.30 (range 15-44.6) and medial translation of 6 mm (range 3.2-10).
The complication rates seem to be lower in this current review (7%) as compared to the previous review performed by Clohisy et al. (6-37%). The MIS trans-sartorial/MIS MSP and intertrochanteric approaches are associated with an even reduced complications rates. This review enables favouring the minimally invasive approaches with regard to reducing nerve injury and wound complications.
甘茨引入的伯尔尼髋臼周围截骨术（PAO）是一种用于髋关节发育不良且髋关节匹配的骨骼成熟患者重新定位髋臼的新型手术技术。通过改良的史密斯-彼得森（髂股）入路进行的PAO已经历了许多改进，以避免并发症并将失败风险降至最低。
本综述的目的是报告与手术入路相关的并发症发生率、功能和放射学结果。
对NICE医疗保健数据库高级搜索进行了从创建年份到2018年5月的检索。我们纳入了报告PAO并发症的研究。对从病例系列中提取的数据进行分析，以检测并发症的发生率、与手术入路的关系以及并发症的时间趋势。
分析了40项研究，包括4070例髋关节，平均年龄29岁，平均随访52.8个月。结果测量显示82%的结果良好至优秀。发现股外侧皮神经（LFCN）和坐骨神经损伤发生率较高与髂腹股沟入路和双切口入路相关。未报告微创（MIS）改良史密斯-彼得森（MSP）入路、微创经缝匠肌入路和经转子入路与任何重大伤口并发症相关。放射学矫正平均髋臼倾斜度改善17.9°（范围4.5-40°），前中心边缘矫正25.4°（范围10-51°），外侧中心边缘矫正23.3°（范围15-44.6°），内侧移位6毫米（范围3.2-10毫米）。
与克洛西等人之前进行的综述（6%-37%）相比，本次综述中的并发症发生率似乎较低（7%）。MIS经缝匠肌/MIS MSP入路和转子间入路的并发症发生率甚至更低。本综述支持在减少神经损伤和伤口并发症方面采用微创入路。
