基于 CT 的骨盆髋臼旋转截骨术后 1 年所有截骨部位的骨愈合情况。
Bone union status of all osteotomy sites one year after curved periacetabular osteotomy based on computed tomography.
机构信息
Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, 814-0180 Fukuoka, Japan.
Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, 814-0180 Fukuoka, Japan.
出版信息
Orthop Traumatol Surg Res. 2021 Dec;107(8):102955. doi: 10.1016/j.otsr.2021.102955. Epub 2021 May 1.
BACKGROUND
Curved periacetabular osteotomy (CPO) is a joint-preservation surgery to treat acetabular dysplasia. It is performed via an anterior approach with the osteotomy of the anterosuperior iliac spine (ASIS). One of the complications associated with CPO includes non-union of the osteotomy sites. However, all osteotomy sites including the ASIS have not been simultaneously evaluated. Therefore, we investigated: (1) the bone union status of all osteotomy sites; and (2) the predictors of non-union at one year after CPO based on computed tomography (CT).
HYPOTHESIS
The bone union status may be different in each osteotomy site.
PATIENTS AND METHODS
This retrospective review included 147 hips of 124 patients with symptomatic acetabular dysplasia who underwent CPO from 2011 to 2018. At one year postoperatively, we evaluated the bone union status of all osteotomy sites: the ASIS, ischium, pubis, and ilium using CT and investigated the predictors for achieving bone union.
RESULTS
Bone union was confirmed in both the ASIS and ilium in all cases. In contrast, ischial and pubic non-union was confirmed 15/147 hips (10.2%) and 42/147 hips (28.5%), respectively. The multivariate analysis revealed that the predictors of ischial non-union were both large width of the gap at the pubic osteotomy site and small postoperative acetabular roof obliquity, and that the predictor of pubic non-union was large width of the gap at the pubic osteotomy site.
DISCUSSION
At one year after CPO, both the ASIS and ilium obtained complete bone union, while ischial and pubic non-union were observed. Large width of the gap at the pubic osteotomy site was the predictor of both ischial and pubic non-union. In CPO, sufficient bone union can be achieved at the ASIS and the ilium, while it is necessary to reduce the width of the gap at the pubic osteotomy site to prevent ischial and pubic non-union.
LEVEL OF EVIDENCE
IV; retrospective study.
背景
髋臼周围截骨术（CPO）是一种保关节手术，用于治疗髋臼发育不良。该手术采用前方入路，截骨部位在前上髂棘（ASIS）。CPO 术后的并发症之一是截骨部位不愈合。然而，并非所有截骨部位，包括 ASIS，都同时进行了评估。因此，我们研究了：（1）所有截骨部位的骨愈合情况；（2）基于 CT 评估的 CPO 术后 1 年不愈合的预测因素。
假设
各截骨部位的骨愈合情况可能不同。
患者和方法
本回顾性研究纳入了 2011 年至 2018 年间因症状性髋臼发育不良行 CPO 的 124 例患者的 147 髋。术后 1 年，我们使用 CT 评估所有截骨部位（ASIS、坐骨、耻骨和髂骨）的骨愈合情况，并研究了实现骨愈合的预测因素。
结果
所有病例均确认 ASIS 和髂骨均愈合。相比之下，15/147 髋（10.2%）和 42/147 髋（28.5%）确认存在坐骨和耻骨不愈合。多变量分析显示，坐骨不愈合的预测因素是耻骨截骨部位的间隙较宽和术后髋臼顶倾斜度较小，而耻骨不愈合的预测因素是耻骨截骨部位的间隙较宽。
讨论
CPO 术后 1 年，ASIS 和髂骨均获得完全骨愈合，而坐骨和耻骨不愈合。耻骨截骨部位的间隙较宽是坐骨和耻骨不愈合的共同预测因素。在 CPO 中，ASIS 和髂骨可以获得充分的骨愈合，而需要减小耻骨截骨部位的间隙宽度，以防止坐骨和耻骨不愈合。
证据等级
IV；回顾性研究。
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