Chiari 截骨术是否能改善多发性骨骺发育不良和假性软骨发育不全的长期髋关节退变？
Can Chiari Osteotomy Favorably Influence Long-term Hip Degradation in Multiple Epiphyseal Dysplasia and Pseudoachondroplasia?
机构信息
Pediatric Orthopedic Department, UZ Brussel, Brussels, Belgium.
Pediatric Orthopedic Department, Necker Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France.
出版信息
J Pediatr Orthop. 2021 Feb 1;41(2):e135-e140. doi: 10.1097/BPO.0000000000001708.
BACKGROUND
Multiple epiphyseal dysplasia (MED) and pseudoachondroplasia (PSACH) are congenital skeletal disorders characterized by irregular epiphyses, mild or severe short stature and early-onset osteoarthritis which frequently affect the hips. The current study evaluates the long-term results of the Chiari osteotomy in MED and PSACH patients.
METHODS
Twenty patients (14 MED and 6 PSACH) were retrospectively included. Clinical assessment used the Postel Merle d'Aubigné (PMA) score and the Hip disability and Osteoarthritis Outcome Score (HOOS). Risser index, Sharp angle, acetabular depth index, center-edge angle, Tönnis angle, and femoral head coverage were measured on the preoperative radiographs and at last follow-up. The Treble index, which identifies the hip at risk in MED patients, was also determined. Stulberg classification (grades I to V) was used to evaluate the risk of osteoarthritis in the mature hips.Statistical analyses determined differences between preoperative and postoperative data. The Kaplan Meier method was used to calculate the survival rate of the operated hips using total hip arthroplasty as the endpoint.
RESULTS
Thirty-three hips which underwent a Chiari osteotomy were reviewed. The average follow-up was 20.1 years. The PMA scores were significantly better at last follow-up than preoperatively. All radiographic parameters significantly improved. Moreover, the Sharp angle, center-edge angle, and femoral head coverage improved to a normal value at hip maturity. All of the operated hips had a Treble index of type I. At hip maturity, a majority of hip were aspherical congruent (Stulberg grades of III and IV). The survival rate of the operated hips was 80.7% at 24 years postoperative.
CONCLUSIONS
The Chiari osteotomy is a satisfying solution for severe symptomatic hip lesions in MED and PSACH patients. At long-term follow-up, this procedure lessens pain and improves hip function, which delays total hip arthroplasty indication.
LEVEL OF EVIDENCE
Level IV.
背景
多发性骨骺发育不良（MED）和假性软骨发育不全（PSACH）是两种先天性骨骼疾病，其特征为骨骺不规则、轻度或重度身材矮小以及早发性骨关节炎，这些疾病常影响髋关节。本研究评估了 Chiari 截骨术在 MED 和 PSACH 患者中的长期疗效。
方法
回顾性纳入 20 例患者（14 例 MED 和 6 例 PSACH）。临床评估采用 Postel Merle d'Aubigné（PMA）评分和髋关节残疾和骨关节炎结局评分（HOOS）。在术前和末次随访时测量 Risser 指数、Sharp 角、髋臼深度指数、中心边缘角、Tönnis 角和股骨头覆盖率。还确定了 MED 患者中识别髋关节风险的 Treble 指数。采用 Stulberg 分级（I 至 V 级）评估成熟髋关节的骨关节炎风险。统计分析确定了术前与术后数据之间的差异。Kaplan-Meier 方法用于计算以全髋关节置换术为终点的手术髋关节的生存率。
结果
共回顾了 33 个接受 Chiari 截骨术的髋关节。平均随访时间为 20.1 年。末次随访时 PMA 评分明显优于术前。所有影像学参数均显著改善。此外，Sharp 角、中心边缘角和股骨头覆盖率在髋关节成熟时改善至正常。所有手术髋关节的 Treble 指数均为 I 型。在髋关节成熟时，大多数髋关节呈非球形一致（Stulberg 分级为 III 级和 IV 级）。术后 24 年时，手术髋关节的生存率为 80.7%。
结论
Chiari 截骨术是治疗 MED 和 PSACH 患者严重症状性髋关节病变的一种满意方法。长期随访表明，该手术减轻了疼痛，改善了髋关节功能，从而延迟了全髋关节置换术的适应证。
证据等级
IV 级。
Zotero 插件