Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207, Uehara, Nisihara-cho, Nakagami-gun, Okinawa, Japan.
Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207, Uehara, Nisihara-cho, Nakagami-gun, Okinawa, Japan.
J Orthop Sci. 2023 Sep;28(5):1034-1040. doi: 10.1016/j.jos.2022.07.016. Epub 2022 Aug 20.
Curved periacetabular osteotomy (CPO) is indicated for patients with developmental dysplasia of hip (DDH) to prevent progressive osteoarthritis. Patients with DDH have not only lateral acetabulum dysplasia but also anterior and posterior dysplasia. The full circumference acetabular coverage angle (ACA) of the femoral head should be evaluated preoperatively. This study aimed to determine the full circumference ACA in the patients with DDH before and after CPO compared with the coverage in normal patients.
Twenty-three patients (a total of 24 hips) with DDH undergoing CPO between February 2006 and March 2014 were included in this study. The normal group was defined as the normal side in patients with unilateral osteonecrosis of the femoral head (ONFH) and the non-collapsed femoral head side in patients with bilateral ONFH. Pre- and postoperative hip functions were evaluated using the Japanese Orthopedic Association (JOA) hip score. ACA was measured using pre- and postoperative three-dimensional computed tomography (3DCT) and described as a clock using a radar chart. The ACA of the normal group was evaluated in the same manner as that for patients who underwent CPO. The ACA before CPO was compared with the ACA after CPO, the ACA before CPO was compared with that of the normal group and the ACA after CPO was compared with that of the normal group at each location.
The mean JOA hip scores improved significantly from 69 preoperatively to 88 postoperatively. The superior, posterior, and anterior ACA after CPO significantly increased and the inferior ACA decreased compared with ACA before CPO. The superior, posterior, and anterior ACA before CPO were significantly smaller than ACA in the normal group. The ACA after CPO were similar to the normal group.
CPO improved the anterosuperior coverage of the femoral head but reduced its inferior coverage. The radar chart could visualize acetabulum full circumference and was useful for three-dimensional pre-postoperative evaluation.
髋臼周围截骨术（CPO）适用于发育性髋关节发育不良（DDH）患者，以预防进行性骨关节炎。DDH 患者不仅髋臼外侧发育不良，而且髋臼前、后发育不良。术前应评估股骨头全周髋臼覆盖角（ACA）。本研究旨在比较 DDH 患者 CPO 前后与正常患者的全周 ACA。
2006 年 2 月至 2014 年 3 月，23 例（共 24 髋）DDH 患者接受 CPO。正常组定义为单侧股骨头坏死（ONFH）患者的正常侧和双侧 ONFH 患者未塌陷股骨头侧。采用日本骨科协会（JOA）髋关节评分评估术前和术后髋关节功能。使用术前和术后三维 CT（3DCT）测量 ACA，并使用雷达图描述为时钟。正常组的 ACA 以与 CPO 患者相同的方式进行评估。比较 CPO 前后 ACA，CPO 前后 ACA 与正常组比较，CPO 后 ACA 与正常组各部位比较。
JOA 髋关节评分从术前的 69 分显著提高到术后的 88 分。CPO 后，股骨头的上、后、前 ACA 明显增加，下 ACA 减少。CPO 前后，股骨头的上、后、前 ACA 明显小于正常组。CPO 后 ACA 与正常组相似。
CPO 改善了股骨头前上覆盖，但减少了其下覆盖。雷达图可直观显示髋臼全周，对三维术前术后评估很有用。
