Li Xuezhou, Zheng Tong, Du Longzhuo, Wei Shusheng, Guo Yongyuan, Jia Yuhua
Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, PR China.
J Arthroplasty. 2025 May;40(5):1246-1251.e1. doi: 10.1016/j.arth.2024.10.059. Epub 2024 Oct 20.
Although subtrochanteric osteotomy is a common procedure, the use of Paavilainen osteotomy combined with total hip arthroplasty (THA) for high developmental hip dislocation is less documented. This study assessed the efficacy and complications of this approach, with a particular focus on the risk factors for nonunion postosteotomy.
All patients who had high dislocated hip dysplasia who underwent combined THA and Paavilainen osteotomy were retrospectively reviewed with over 1 year of follow-up. A total of 44 patients (51 hips) were included, with an average follow-up period of 4.4 years (range, 1.97 to 6.94). Anatomical data of the hip joints were measured on preoperative and postoperative radiographs. Demographic data, Trendelenburg sign, complications related to this procedure, Harris Hip Score, and EuroQoL-5-Dimension 5-Level health questionnaire were collected from the medical chart. Binary logistic regression analysis was used to identify predictors for bone nonunion.
Out of the 51 hips, eight displayed a positive Trendelenburg sign. Patients' Harris Hip Score saw an improvement from 43.8 ± 11.8 preoperatively to 85.7 ± 11.1 at the latest follow-up (P < 0.001), accompanied by a substantial enhancement in the average EuroQoL-5-Dimension 5-Level score from 0.38 ± 0.15 to 0.87 ± 0.13 (P < 0.001). Non-union, as the most concerning complication, occurred in 12% (seven of 56) of osteotomy cases. The contact length between the osteotomy block and femoral cortex was a key risk factor for nonunion. The receiver operating characteristic analysis identified 2.15 cm as the critical bone contact length for healing.
Paavilainen osteotomy combined with THA and subtrochanteric osteotomy proved effective and less complex than other techniques for high-dislocation hip dysplasia. A bone contact length between the greater trochanteric fragment and the femoral cortex of less than 2.15 cm is a risk factor for nonunion.
尽管转子下截骨术是一种常见的手术，但帕维莱宁截骨术联合全髋关节置换术（THA）用于治疗高位发育性髋关节脱位的相关报道较少。本研究评估了该方法的疗效和并发症，特别关注截骨术后不愈合的危险因素。
对所有接受THA联合帕维莱宁截骨术治疗高位髋关节发育不良且随访超过1年的患者进行回顾性研究。共纳入44例患者（51髋），平均随访时间为4.4年（范围1.97至6.94年）。在术前和术后X线片上测量髋关节的解剖数据。从病历中收集人口统计学数据、臀中肌步态试验、与该手术相关的并发症、Harris髋关节评分以及欧洲五维健康量表问卷。采用二元逻辑回归分析确定骨不愈合的预测因素。
在51髋中，8髋出现臀中肌步态试验阳性。患者的Harris髋关节评分从术前的43.8±11.8提高到最近一次随访时的85.7±11.1（P<0.001），同时欧洲五维健康量表平均评分从0.38±0.15大幅提高到0.87±0.13（P<0.001）。作为最令人担忧的并发症，12%（56例中的7例）的截骨病例发生了不愈合。截骨块与股骨干皮质之间的接触长度是不愈合的关键危险因素。受试者工作特征分析确定2.15 cm为愈合的关键骨接触长度。
帕维莱宁截骨术联合THA及转子下截骨术被证明是有效的，且对于高位髋关节发育不良而言，比其他技术更简单。大转子骨块与股骨干皮质之间的骨接触长度小于2.15 cm是不愈合的危险因素。
