Duquennoy A, Migaud H, Gougeon F, Fontaine C, Guire C
Service d'Orthopédie et Traumatologie B, Hôpital B, Lille.
Rev Chir Orthop Reparatrice Appar Mot. 1987;73(5):365-76.
Seventy Chiari osteotomies have been performed between 1975 and 1986. Fifty-three cases have been reviewed with a follow-up greater than a year and with a mean of four years and eight months. In half of the cases, the operation was done for very dysplastic hips, usually at an advanced stage of osteoarthritis (stage two in 37.5 per cent and stage three in 25 per cent). Post-operative complications were very rare except for two cases of non-union. The functional results were very satisfactory, with 83 per cent of very good and good results, especially in respect of relief of pain which was remarkable. These results were sustained in the long-term follow-up; 21 hips had a follow-up of 5 to 11 years, with a mean of 6.8 years. Only two hips needed a total hip arthroplasty. Radiologically, the osteotomy produced normal antero-posterior and lateral hip measurements in almost all the cases, largely due to a considerable medial displacement of more than 20 mm in 87 per cent of cases. There was improvement in the osteoarthritic changes in 74 per cent of cases. The factors which affected the outcome favourably were the degree of dysplasia, a round femoral head and a technically correct operation, with bone division close to the femoral head and a sufficiently upward slope to the osteotomy. An advanced osteoarthritis is not a contra-indication if it is due to a very marked acetabular dysplasia.
1975年至1986年间共进行了70例Chiari截骨术。对53例患者进行了随访，随访时间均超过1年，平均为4年零8个月。半数患者因髋关节发育不良严重而接受手术，通常处于骨关节炎晚期（37.5%为二期，25%为三期）。除两例骨不连外，术后并发症非常罕见。功能结果非常令人满意，83%的结果为优或良，尤其是在缓解疼痛方面效果显著。这些结果在长期随访中得以维持；21例髋关节的随访时间为5至11年，平均为6.8年。只有两例髋关节需要进行全髋关节置换术。放射学检查显示，几乎所有病例的截骨术后髋关节前后位和侧位测量结果均正常，这主要是因为87%的病例有超过20毫米的明显内侧移位。74%的病例骨关节炎改变有所改善。对结果产生有利影响的因素包括发育不良程度、股骨头圆润以及手术技术正确，即截骨靠近股骨头且截骨有足够的向上倾斜度。如果晚期骨关节炎是由非常明显的髋臼发育不良引起的，则不是手术禁忌证。
