Hsu Jui-Yo, Lee Chia-Che, Lin Sheng-Chieh, Wang Ting-Ming, Kuo Ken N, Wu Kuan-Wen
Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei 100, Taiwan.
Department of Orthopedic Surgery, Chung Shan Medical University Hospital, Taichung 402, Taiwan.
J Clin Med. 2022 Mar 30;11(7):1924. doi: 10.3390/jcm11071924.
Variable techniques in periacetabular osteotomy have been formulated for the treatment of acetabular dysplasia. However, few studies have compared the radiographic outcomes between different osteotomy types. This study compared modified triple innominate (MTI) osteotomy and Ganz osteotomy with respect to radiographic outcomes. Patients receiving MTI osteotomies and Ganz osteotomies at any time between 2006 and 2018 in a tertiary medical centre were recruited. Only patients with unilateral osteotomies were recruited to eliminate potential influence from the contralateral hip following periacetabular osteotomy. Patients having hip-joint dislocation, receiving simultaneous proximal femoral osteotomy, or having fewer than 2 years of follow-up were excluded. The radiographic parameters of preoperative and postoperative anteroposterior radiographs of the pelvis were measured, and Sharp’s angle (SA), the lateral centre-edge angle (CE angle), the femoral head extrusion index (FHEI), and the centre-head distance discrepancy (CHDD) were included for comparison. Among 55 participants, 23 received MTI osteotomies and 32 received Ganz osteotomies. The mean age at which patients underwent surgery was 21.9 years in the Ganz osteotomy group and 21.1 years in the MTI group. The mean follow-up length was 2.5 years. The preoperative radiographic parameters between groups differed only slightly and nonsignificantly. Both groups exhibited significantly improved SA, LCEA, and FHEI after surgery. The Ganz osteotomy group exhibited more favourable postoperative FHEI (13.5 vs. 24.3, p < 0.0001), CHDD (3.7 vs. 11.5, p < 0.0001), Sharp angle (45.0 vs. 41.8, p = 0.0489) and CE angles (28.3 vs. 21.1, p = 0.029) compared with the MTI osteotomy group. Notably, CHDD became better and worse following Ganz and MTI osteotomies, respectively; this suggests that the femoral head is pushed laterally in modified triple osteotomy. With respect to femoral head coverage and the medialization of the femoral head, Ganz osteotomy exhibits more favourable corrections in postoperative radiographic parameters than does MTI osteotomy.
髋臼周围截骨术中已制定了多种不同技术用于治疗髋臼发育不良。然而，很少有研究比较不同截骨类型之间的影像学结果。本研究比较了改良三联髋臼截骨术（MTI）和甘茨截骨术的影像学结果。招募了2006年至2018年期间在一家三级医疗中心接受MTI截骨术和甘茨截骨术的患者。仅招募接受单侧截骨术的患者，以消除髋臼周围截骨术后对侧髋关节的潜在影响。排除髋关节脱位、同时接受股骨近端截骨术或随访时间少于2年的患者。测量骨盆术前和术后前后位X线片的影像学参数，包括Sharp角（SA）、外侧中心边缘角（CE角）、股骨头挤压指数（FHEI）和中心-股骨头距离差异（CHDD）进行比较。55名参与者中，23人接受了MTI截骨术，32人接受了甘茨截骨术。甘茨截骨术组患者接受手术的平均年龄为21.9岁，MTI组为21.1岁。平均随访时间为2.5年。两组术前影像学参数仅略有差异且无统计学意义。两组术后SA、LCEA和FHEI均有显著改善。与MTI截骨术组相比，甘茨截骨术组术后FHEI（13.5对24.3，p<0.0001）、CHDD（3.7对11.5，p<0.0001）、Sharp角（45.0对41.8，p = 0.0489）和CE角（28.3对21.1，p = 0.029）更优。值得注意的是，CHDD在甘茨截骨术和MTI截骨术后分别变好和变差；这表明在改良三联截骨术中股骨头被向外推。在股骨头覆盖和股骨头内移方面，甘茨截骨术在术后影像学参数上比MTI截骨术表现出更优的矫正效果。
