髋臼周围截骨术（PAO）治疗婴儿发育性髋关节发育不良（DDH）患者与未行婴儿期治疗患者的髋臼形态比较。

Hip Morphology in Periacetabular Osteotomy (PAO) Patients Treated for Developmental Dysplasia of the Hip (DDH) as Infants Compared With Those Without Infant Treatment.

机构信息

Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, NY.

出版信息

J Pediatr Orthop. 2022 Jul 1;42(6):e565-e569. doi: 10.1097/BPO.0000000000002137. Epub 2022 Mar 10.

DOI:10.1097/BPO.0000000000002137

PMID:35667051

Abstract

BACKGROUND

A subset of patients successfully treated for developmental dysplasia of the hip (DDH) as infants have symptomatic acetabular dysplasia at skeletal maturity leading to periacetabular osteotomy (PAO). The purpose of this study was to compare femoral and acetabular morphology in PAO patients with late acetabular dysplasia after previous treatment for DDH with PAO patients who do not have a history of DDH treatment.

METHODS

A single surgeon's patients who underwent PAO between 2011 and 2021 were retrospectively reviewed. Patients previously treated for infantile DDH with a Pavlik harness, abduction brace, closed reduction and spica casting, or open reduction and spica casting were included. Patients with previous bony hip surgery were excluded. Preoperative radiographic measurements of each hip were recorded including lateral center edge angle, anterior center edge angle, and Femoro-Epiphyseal Acetabular Roof index. Computed tomography measurements included the coronal center edge angle, sagittal center edge angle, Tönnis angle, acetabular anteversion at 1, 2, and 3 o'clock, femoral neck-shaft angle, femoral version, and alpha angle. Control PAO cases without a history of DDH diagnosis or treatment were matched with the infantile DDH treatment group in a 2:1 ratio based on coronal center edge angle, age, and sex.

RESULTS

There were 21 hips in 18 patients previously treated for infantile DDH (13 patients Pavlik harness, 3 abduction brace, 1 closed reduction, and 1 open reduction). The control PAO cohort was 42 hips in 42 patients who did not have previous DDH treatment. There was no statistically significant difference in any of the recorded measurements between patients previously treated for DDH and those without previous treatment including femoral version (P=0.494), anteversion at 1 o'clock (P=0.820), anteversion at 2 o'clock (P=0.584), anteversion at 3 o'clock (P=0.137), neck-shaft angle (P=0.612), lateral center edge angle (P=0.433), Femoro-Epiphyseal Acetabular Roof index (P=0.144), and alpha angle (P=0.156).

CONCLUSIONS

Femoral and acetabular morphology is similar between PAO patients with persistent symptomatic acetabular dysplasia following DDH treatment and patients presenting after skeletal maturity with acetabular dysplasia and no previous history of DDH treatment.

LEVEL OF EVIDENCE

Level III-case-control, prognostic study.

摘要

背景

一部分在婴儿期成功接受发育性髋关节发育不良（DDH）治疗的患者，在骨骼成熟时出现髋臼发育不良的症状，需要进行髋臼周围截骨术（PAO）。本研究的目的是比较既往接受过 DDH 治疗的 PAO 患者和既往未接受过 DDH 治疗的 PAO 患者的股骨和髋臼形态。

方法

回顾性分析了 2011 年至 2021 年间单外科医生进行的 PAO 患者。纳入了既往接受过婴儿期 DDH 治疗的患者，包括 Pavlik 吊带、外展支具、闭合复位和石膏固定、切开复位和石膏固定。排除了既往有骨髋关节手术的患者。记录了每个髋关节的术前放射学测量值，包括外侧中心边缘角、前中心边缘角和股骨颈骺髋臼顶指数。CT 测量值包括冠状中心边缘角、矢状中心边缘角、Tönnis 角、髋臼 1、2、3 点前倾角、股骨颈干角、股骨旋转和 α 角。根据冠状中心边缘角、年龄和性别，将无 DDH 诊断或治疗史的对照组 PAO 病例与婴儿期 DDH 治疗组以 2:1 的比例匹配。

结果

18 例患者中有 21 髋（13 例 Pavlik 吊带，3 例外展支具，1 例闭合复位，1 例切开复位）曾接受过婴儿 DDH 治疗。对照组 PAO 队列有 42 髋，共 42 例患者既往无 DDH 治疗。包括股骨旋转（P=0.494）、1 点前倾角（P=0.820）、2 点前倾角（P=0.584）、3 点前倾角（P=0.137）、颈干角（P=0.612）、外侧中心边缘角（P=0.433）、股骨骺髋臼顶指数（P=0.144）和α角（P=0.156）在内的所有记录测量值在有和无既往 DDH 治疗的患者之间均无统计学差异。