Zhao Runkai, Wang Yiming, Liu Te, Ren Haichao, Zhao Runzhi, Feng Zeyu, Li Pengcheng, Yang Shuai, Lu Juntao, Fan Menglin, Ji Quanbo, Zhang Guoqiang
Department of Orthopedic Surgery, The General Hospital of the People's Liberation Army, Beijing, China.
Department of Orthopedic Surgery, The Army Medical University, Chongqing, China.
Orthop Surg. 2025 Mar;17(3):962-970. doi: 10.1111/os.14330. Epub 2025 Jan 20.
Determining the optimal osteotomy length for patients with unilateral Crowe-IV developmental dysplasia of the hip undergoing subtrochanteric osteotomy remains challenging due to the significant variability in pelvic and spinal alignment. Incorrect osteotomy length, compounded by pelvic or spinal tilt, can adversely affect postoperative gait and long-term outcomes. Therefore, this study could introduce a method to calculate the osteotomy length for patients with unilateral Crowe-IV developmental dysplasia of the hip, correcting spinal and pelvic tilt, and improving patient gait.
This is a retrospective study that included 28 patients with unilateral Crowe-IV developmental dysplasia of the hip collected from June 2019 to June 2020, who underwent total hip arthroplasty with measured subtrochanteric osteotomy technique. The average follow-up period was 4.3 years (last follow-up). Harris scores, pelvic tilt angles represented by iliac obliquity angle (IO) and sacral obliquity angle (SO), and postoperative complications were recorded. Statistical analysis was performed using independent sample t-tests for normally distributed data and the Mann-Whitney U test for non-normally distributed data.
Postoperatively, pelvic tilt angles improved significantly. The comparison of preoperative and postoperative 3-month IO angles (8.77° ± 3.31° vs. 5.28° ± 2.29°, p = 0.00), and postoperative 3-month and last follow-up (5.28° ± 2.29° vs. 2.88° ± 1.39°, p = 0.00) showed statistically significant differences. Similarly, the comparison of preoperative and postoperative 3-month SO angles (9.56° ± 3.1° vs. 5.81° ± 2.78°, p = 0.00), and postoperative 3-month and last follow-up (5.81 °± 2.78° vs. 3.59° ± 1.72°, p = 0.00) showed statistically significant differences. Harris scores significantly improved from preoperative to 1-year postoperative (47.35 ± 12.32 vs. 80.5 ± 7.81, p = 0.00), and from 1-year postoperative to last follow-up (80.5 ± 7.81 vs. 90.78 ± 2.86, p = 0.00) with statistical significance. There were no significant differences in adverse event rates between the two groups.
Total hip arthroplasty combined with measurement subtrochanteric osteotomy technique improves pelvic tilt and Harris scores in Crowe-IV developmental dysplasia patients. This technique may serve as a guideline for determining resection length.
对于接受转子下截骨术的单侧克罗伊四级发育性髋关节发育不良患者，由于骨盆和脊柱对线存在显著差异，确定最佳截骨长度仍然具有挑战性。截骨长度不正确，再加上骨盆或脊柱倾斜，会对术后步态和长期疗效产生不利影响。因此，本研究可以引入一种方法来计算单侧克罗伊四级发育性髋关节发育不良患者的截骨长度，纠正脊柱和骨盆倾斜，并改善患者步态。
这是一项回顾性研究，纳入了2019年6月至2020年6月收集的28例单侧克罗伊四级发育性髋关节发育不良患者，他们接受了采用测量转子下截骨技术的全髋关节置换术。平均随访期为4.3年（末次随访）。记录Harris评分、以髂骨倾斜角（IO）和骶骨倾斜角（SO）表示的骨盆倾斜角以及术后并发症。对于正态分布数据，使用独立样本t检验进行统计分析；对于非正态分布数据，使用曼-惠特尼U检验进行统计分析。
术后，骨盆倾斜角显著改善。术前与术后3个月IO角的比较（8.77°±3.31°对5.28°±2.29°，p = 0.00），以及术后3个月与末次随访的比较（5.28°±2.29°对2.88°±1.39°，p = 0.00）显示出统计学显著差异。同样，术前与术后3个月SO角的比较（9.56°±3.1°对5.81°±2.78°，p = 0.00），以及术后3个月与末次随访的比较（5.81°±2.78°对3.59°±1.72°，p = 0.00）显示出统计学显著差异。Harris评分从术前到术后1年显著改善（47.35±12.32对80.5±7.81，p = 0.00），从术后1年到末次随访也显著改善（80.5±7.81对90.78±2.86，p = 0.00），具有统计学意义。两组不良事件发生率无显著差异。
全髋关节置换术联合测量转子下截骨技术可改善克罗伊四级发育性髋关节发育不良患者的骨盆倾斜和Harris评分。该技术可作为确定截骨长度的指导方法。
