Cao Nora, Sink Ernest L
Department of Orthopaedics Surgery, Massachusetts General Hospital, Boston, MA, USA.
Department of Hip Preservation, Hospital for Special Surgery, New York, NY, USA.
J Pediatr Soc North Am. 2024 Apr 5;7:100046. doi: 10.1016/j.jposna.2024.100046. eCollection 2024 May.
In 1982, Dr. Reinhold Ganz [1] introduced a new periacetabular osteotomy (PAO) as a therapeutic measure for hip dysplasia. The primary objective of this surgical procedure was the strategic reorientation of the acetabulum to optimize coverage of the femoral head and increase the surface area of the acetabular cartilage over the femoral head, all while preserving the structural integrity of the posterior column and maintaining the natural pelvic shape. The complexity of the Ganz periacetabular osteotomy presents a formidable learning curve, owing to the proximity of numerous neurovascular structures to the proposed cuts. Additionally, the surgical approach inherently lacks direct visualization of all osteotomy cuts, necessitating surgeons to rely on anatomic knowledge and meticulous interpretation of fluoroscopic views. This article endeavors to describe some techniques designed to facilitate and enhance the execution of the osteotomy.
(1)Superior ramus osteotomy: meticulous dissection and strategic use of retractors, such as Crego retractors, help protect obturator neurovascular structure during the superior ramus osteotomy, enabling direct visualization and precise execution of the cut.(2)Ischial osteotomy: fluoroscopic guidance aids in executing the ischial cut, with emphasis on careful consideration of sciatic nerve location, and meticulous completion of the osteotomy to prevent stress fractures into the posterior column.(3)Supra-acetabular osteotomy: creating a burr channel at the brim of the pelvic to facilitate posterior column cut later.(4)Posterior column osteotomy: performing the posterior column osteotomy involves 3 passes with a wider osteotome, regular depth checks, and an additional cut to connect the posterior column with the ischial cut.
1982年，莱因霍尔德·甘茨博士[1]引入了一种新的髋臼周围截骨术（PAO）作为治疗髋关节发育不良的措施。该手术的主要目的是对髋臼进行战略性重新定位，以优化股骨头的覆盖范围，并增加股骨头上方髋臼软骨的表面积，同时保持后柱的结构完整性并维持骨盆的自然形状。由于众多神经血管结构靠近拟进行的截骨部位，甘茨髋臼周围截骨术的复杂性呈现出一条艰巨的学习曲线。此外，手术入路本身缺乏对所有截骨切口的直接可视化，这就要求外科医生依靠解剖学知识并仔细解读荧光透视图像。本文致力于描述一些旨在促进和改进截骨术实施的技术。
（1）耻骨上支截骨术：细致的解剖分离以及战略性地使用牵开器，如克雷戈牵开器，有助于在耻骨上支截骨术中保护闭孔神经血管结构，从而实现对切口的直接可视化和精确操作。（2）坐骨截骨术：荧光透视引导有助于实施坐骨截骨术，重点是仔细考虑坐骨神经的位置，并细致完成截骨术以防止应力性骨折延伸至后柱。（3）髋臼上截骨术：在骨盆边缘创建一个磨钻通道，以便稍后进行后柱截骨。（4）后柱截骨术：进行后柱截骨术需要用较宽的骨刀进行三次操作、定期检查深度，并额外进行一次切口以连接后柱和坐骨截骨处。
