Department of Joint Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
Department of Orthopedics, Xiangya Hospital of Central South University, Changsha, China.
Orthop Surg. 2024 May;16(5):1207-1214. doi: 10.1111/os.14034. Epub 2024 Mar 15.
Given the intricate challenges and potential complications associated with periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH). Our study aimed to compare the clinical and imaging benefits and drawbacks of two surgical approaches, the modified Stoppa combined iliac spine approach and the modified Smith-Peterson approach, for treating PAO and to provide guidance for selecting clinical approaches.
A retrospective analysis of 56 patients with 62 DDHs was conducted from June 2018 to January 2022. The experimental group underwent surgery via the modified Stoppa combined iliac spine approach, while the control group underwent surgery via the modified Smith-Peterson approach for periacetabular osteotomy and internal fixation. Basic statistical parameters, including age, sex, BMI, and preoperative imaging data, were analyzed. Differences in surgical time, intraoperative blood loss, and postoperative imaging data were compared, as were differences in preoperative and postoperative imaging data between the two groups.
There were 28 hips in the experimental group and 34 in the control group. Moreover, there was no significant difference in the basic parameters between the experimental and control groups. Before and after the operation, for the LCE angle, ACE angle, and Tonnis angle, there was no significant difference in acetabular coverage (p > 0.05). However, there were significant differences between the two groups in terms of the above four indicators before and after the operation (p < 0.05). After the operation, the experimental group exhibited significant increases in both lateral and anterior acetabular coverage of the femoral head. However, the experimental group had longer operation times and greater bleeding volumes than did the control group. Despite this, the experimental group demonstrated significant advantages in protecting the lateral femoral cutaneous nerve compared to the control group.
The modified Stoppa combined iliac spine approach can be considered a practical approach for PAO and is more suitable for patients with DDH who plan to be treated by one operation than the classic modified Smith-Peterson approach for PAO.
鉴于髋臼周围截骨术（PAO）治疗发育性髋关节发育不良（DDH）所面临的复杂挑战和潜在并发症，本研究旨在比较改良Stoppa 联合髂嵴入路与改良 Smith-Peterson 入路两种手术方法治疗 PAO 的临床和影像学优缺点，并为临床入路的选择提供指导。
回顾性分析 2018 年 6 月至 2022 年 1 月收治的 56 例 62 髋 DDH 患者，实验组采用改良 Stoppa 联合髂嵴入路，对照组采用改良 Smith-Peterson 入路行髋臼周围截骨内固定术。分析患者的基本统计学参数（年龄、性别、BMI 和术前影像学资料），比较手术时间、术中出血量、术后影像学资料的差异，以及两组患者术前和术后影像学资料的差异。
实验组 28 髋，对照组 34 髋，两组基本参数无显著差异。术前及术后 LCE 角、ACE 角、Tonnis 角髋臼覆盖无显著差异（p>0.05），但术后实验组在 LCE 角、ACE 角、Tonnis 角的四个指标均明显优于对照组（p<0.05）。术后实验组在头侧和前侧髋臼覆盖明显增加，实验组手术时间和出血量均长于对照组，但实验组在保护股外侧皮神经方面明显优于对照组。
改良 Stoppa 联合髂嵴入路可作为一种实用的 PAO 入路，对于计划一次手术治疗的 DDH 患者，较经典的改良 Smith-Peterson 入路更有优势。
