Nakashima Yasuharu, Hara Daisuke, Ohishi Masanobu, Motomura Goro, Kawano Ichiro, Hamai Satoshi, Kawahara Shinya, Sato Taishi, Yamaguchi Ryosuke, Utsunomiya Takeshi, Kitamura Kenji
Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Department of Orthopaedic Surgery, Chihaya Hospital, 2-30-1 Chihaya, Higashi-ku, Fukuoka 813-8501, Japan.
J Hip Preserv Surg. 2022 Dec 13;9(4):259-264. doi: 10.1093/jhps/hnac047. eCollection 2022 Dec.
To decrease hip abductor dysfunction after periacetabular osteotomy using a lateral/trochanteric approach, we aimed to modify transposition osteotomy of the acetabulum (TOA) to not cut the greater trochanter and abductor-iliac crest detachment. We subsequently compared abductor muscle strength recovery between TOAs with [conventional TOA (C-TOA)] and without [modified TOA (M-TOA)] trochanteric osteotomy. C-TOA and M-TOA were performed in 27 and 34 hips, respectively. Hip abduction, flexion and knee extension muscle strength were measured preoperatively and at 3, 5, 10, 24 and 52 weeks postoperatively. The muscle strength ratio of the affected and contralateral lower limbs was compared between the C-TOA and M-TOA groups. Neither the mean Merle d'Aubigné-Postel score at the final follow-up nor the postoperative center-edge angle showed significant differences between the M-TOA and C-TOA groups (15.7 versus 16.4 points; = 0.25 and 38.5° versus = 0.62 and 39.8°, respectively). The mean muscle strength ratios of hip abduction at 5, 12 and 24 weeks postoperatively were significantly higher in the M-TOA group than in the C-TOA group (0.62 versus 0.39, 0.76 versus 0.59 and 0.94 versus 0.70; = 0.03, 0.04 and 0.01, respectively). There were no significant differences between groups at Postoperative Week 52 ( = 0.36). Discomfort at the greater trochanter was observed in 18 hips (66.7%) in the C-TOA group but only in 4 hips (11.2%) in the M-TOA group. In conclusion, M-TOA is less invasive than C-TOA and allows an earlier recovery of abductor muscle strength without significant correction loss.
为了减少采用外侧/转子入路进行髋臼周围截骨术后的髋关节外展肌功能障碍，我们旨在改良髋臼转位截骨术（TOA），使其不切断大转子和外展肌-髂嵴附着。随后，我们比较了进行转子截骨的传统TOA（C-TOA）和未进行转子截骨的改良TOA（M-TOA）两组患者外展肌力量恢复情况。分别对27例髋关节实施了C-TOA，34例髋关节实施了M-TOA。在术前以及术后3、5、10、24和52周测量髋关节外展、屈曲和膝关节伸展肌力。比较C-TOA组和M-TOA组患侧与对侧下肢的肌力比值。M-TOA组和C-TOA组在末次随访时的平均Merle d'Aubigné-Postel评分以及术后中心边缘角均无显著差异（分别为15.7分对16.4分，P = 0.25；38.5°对39.8°，P = 0.62）。术后5、12和24周时，M-TOA组髋关节外展的平均肌力比值显著高于C-TOA组（分别为0.62对0.39、0.76对0.59、0.94对0.70；P分别为0.03、0.04和0.01）。术后52周时两组之间无显著差异（P = 0.36）。C-TOA组18例髋关节（66.7%）出现大转子处不适，而M-TOA组仅4例髋关节（11.2%）出现。总之，M-TOA比C-TOA创伤性小，能使外展肌力量更早恢复，且无明显矫正丢失。
