de Courtivron Benoît, Brulefert Kevin, Portet Adrien, Odent Thierry
Centre de pédiatrie Gatien de Clocheville, CHU Tours, 49, Boulevard Béranger, 37000 Tours, France.
Service d'orthopédie, CHU Nantes Hotel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes Cedex 1, France.
Orthop Traumatol Surg Res. 2022 Feb;108(1S):103172. doi: 10.1016/j.otsr.2021.103172. Epub 2021 Dec 9.
Residual hip dysplasia may exist despite appropriate treatment of congenital hip dysplasia (CHD). The abnormalities chiefly affect the acetabulum and can lead to premature osteoarthritis. Although the main cause is delayed treatment of CHD, primary lesions are also possible and may be worsened by the initial treatment itself. Residual hip dysplasia must be detected during the follow-up of patients with CHD. The antero-posterior radiograph of the pelvis is the main diagnostic tool. However, the importance of non-ossified anatomical structures requires additional investigations such as arthrography and magnetic resonance imaging. The risk of premature osteoarthritis is difficult to predict based only on the imaging-study findings. Hip dysplasia is best treated before 5 years of age. The work-up at this age should allow determination of the best treatment. Surgery is required but should not be performed unnecessarily. The decision rests on the absence of improvement in the radiographic criteria and on the findings from additional imaging studies. The usual treatment is Salter's osteotomy, during which excessive anterior displacement should be avoided. At adolescence, the information provided by radiography in the coronal plane should be completed by a three-dimensional evaluation of the acetabulum and an assessment of the quality of the labrum. The shelf procedure has been proven to relieve pain and to significantly postpone the need for hip arthroplasty, when performed early, before the development of visible osteoarthritis, and on a congruent hip. Chiari's osteotomy has a role to play in complex dysplasia affecting both the acetabulum and the femur. Periacetabular osteotomy is getting more used thanks to cooperation between paediatric and adult orthopaedic surgeons. This osteotomy provides optimal correction in all three dimensions.
尽管对先天性髋关节发育不良（CHD）进行了适当治疗，但仍可能存在残余髋关节发育不良。这些异常主要影响髋臼，并可能导致过早出现骨关节炎。虽然主要原因是CHD治疗延迟，但原发性病变也有可能，并且初始治疗本身可能会使其恶化。必须在CHD患者的随访过程中检测出残余髋关节发育不良。骨盆前后位X线片是主要的诊断工具。然而，未骨化的解剖结构的重要性需要进行额外的检查，如关节造影和磁共振成像。仅根据影像学研究结果很难预测过早出现骨关节炎的风险。髋关节发育不良最好在5岁之前进行治疗。这个年龄段的检查应能确定最佳治疗方案。需要进行手术，但不应不必要地进行。这一决定取决于影像学标准是否没有改善以及额外影像学检查的结果。通常的治疗方法是Salter截骨术，在此过程中应避免过度向前移位。在青春期，冠状面X线片提供的信息应由髋臼的三维评估和盂唇质量评估来补充。当在可见骨关节炎发展之前尽早对匹配的髋关节进行手术时，髋臼加盖术已被证明可以缓解疼痛并显著推迟髋关节置换术的需求。Chiari截骨术在影响髋臼和股骨的复杂发育不良中发挥作用。由于小儿骨科医生和成人骨科医生的合作，髋臼周围截骨术的应用越来越多。这种截骨术可在所有三个维度上提供最佳矫正。
