Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri.
J Bone Joint Surg Am. 2022 May 4;104(9):780-789. doi: 10.2106/JBJS.21.00132. Epub 2022 Feb 23.
Residual Legg-Calvé-Perthes (LCP) deformities represent one of the most challenging disorders in hip reconstructive surgery. In complex cases, both instability (acetabular dysplasia) and multifocal femoroacetabular impingement (FAI) (proximal femoral deformities) require correction. We assessed intermediate-term patient-reported outcome measures, radiographic correction, complications, and survivorship for combined surgical dislocation (SD) and periacetabular osteotomy (PAO) for the treatment of complex LCP deformities.
A retrospective cohort study was performed on 31 hips with complex LCP deformities undergoing combined SD and PAO for concurrent instability and FAI. Treatment included femoral head reshaping, trochanteric advancement and relative femoral neck lengthening, management of intra-articular lesions, and PAO. Twenty-seven hips (87%) had a minimum follow-up of 5 years. The mean age was 19.8 years, 56% of patients were female, and 44% of patients had undergone a previous surgical procedure.
At a mean of 8.4 years, 85% of hips (23 of 27) remained preserved (no conversion to total hip arthroplasty). The survivorship estimates were 93% at 5 years and 85% at 10 years. The median (and interquartile range) increased from 64 points (55, 67 points) to 92 points (70, 97 points) (p < 0.001) for the modified Harris hip score (mHHS) and from 60 points (45, 75 points) to 86 points (75, 100 points) (p = 0.001) for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score. Symptoms (mHHS < 70 points) were reported for an additional 19% of hips (n = 5) at the final follow-up. The University of California Los Angeles (UCLA) activity score increased from a median of 8 points (6, 10 points) to 9 points (7, 10 points) (p = 0.207). Structural correction included mean improvement (and standard deviation) of 15.3° ± 7.6° for acetabular inclination, 20.7° ± 10.8° for the lateral center-edge angle, 23.4° ± 16.3° for the anterior center-edge angle, and 18 ± 10 mm for trochanteric height (p < 0.001 for all). Complications occurred in 2 hips (7%), including 1 deep wound infection and 1 superficial wound infection. There was 1 reoperation due to complication, but there were no nerve palsies, thromboembolic events, fractures, or nonunions.
At an intermediate follow-up of combined SD and PAO for complex LCP deformities, 85% of hips were preserved. This procedure provides reliable deformity correction, major pain relief, improved function, and acceptable complication and failure rates.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
残余性 Legg-Calvé-Perthes（LCP）畸形是髋关节重建手术中最具挑战性的疾病之一。在复杂病例中，髋臼发育不良（髋臼不稳定）和多灶性股骨髋臼撞击症（FAI）（股骨近端畸形）均需要矫正。我们评估了采用联合手术脱位（SD）和髋臼周围截骨术（PAO）治疗复杂 LCP 畸形的中期患者报告的结果测量、影像学矫正、并发症和存活率。
对 31 例接受联合 SD 和 PAO 治疗复杂 LCP 畸形的髋关节进行回顾性队列研究，这些病例存在髋臼不稳定和 FAI 双重问题。治疗包括股骨头重塑、转子间推进和相对股骨颈延长、关节内病变的处理以及 PAO。27 例（87%）髋关节的随访时间至少为 5 年。平均年龄为 19.8 岁，56%的患者为女性，44%的患者接受过先前的手术。
平均随访 8.4 年，27 例（87%）髋关节（23/27）得到保留（无髋关节转换为全髋关节置换）。5 年和 10 年的存活率估计值分别为 93%和 85%。改良 Harris 髋关节评分（mHHS）中位数（四分位距）从 64 分（55，67 分）增加到 92 分（70，97 分）（p < 0.001），Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）疼痛评分中位数（四分位距）从 60 分（45，75 分）增加到 86 分（75，100 分）（p = 0.001）。另外，19%（n = 5）的髋关节在最终随访时报告有额外的症状（mHHS < 70 分）。加州大学洛杉矶分校（UCLA）活动评分从中位数 8 分（6，10 分）增加到 9 分（7，10 分）（p = 0.207）。结构矫正包括髋臼倾斜度平均改善（标准差）15.3°±7.6°，外侧中心边缘角平均改善 20.7°±10.8°，前中心边缘角平均改善 23.4°±16.3°，转子间高度平均改善 18±10mm（所有 p 值均 <0.001）。2 例（7%）髋关节出现并发症，包括 1 例深部伤口感染和 1 例浅表伤口感染。有 1 例因并发症而再次手术，但无神经麻痹、血栓栓塞事件、骨折或骨不连。
在对复杂 LCP 畸形进行联合 SD 和 PAO 的中期随访中，85%的髋关节得到保留。该手术可提供可靠的畸形矫正、明显的疼痛缓解、功能改善，以及可接受的并发症和失败率。
治疗性 IV 级。请参阅《作者须知》以获取完整的证据等级描述。
