Bram Joshua T, Ellsworth Bridget K, Sink Ernest L
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr Soc North Am. 2024 Feb 12;5(2):643. doi: 10.55275/JPOSNA-2023-643. eCollection 2023 May.
Various pelvic osteotomies can be performed to improve femoral head coverage for patients with hip dysplasia and other childhood hip disorders with the goal of delaying or preventing osteoarthritis. During preoperative discussions, female patients and their parents often ask about the influence of these osteotomies on future pregnancy. The literature on this topic is varied with no consensus on the appropriateness of elective cesarean section (C-section) for such patients. Therefore, this study sought to review and summarize the literature regarding the impact of different pelvic osteotomies on birth canal anatomy and C-section rates. All studies assessing the impact of pelvic osteotomies on birth canal anatomy or pregnancy outcomes for patients were identified through a systematic search of four online databases (PubMed, Embase, CINAHL, and Cochrane Library). PRISMA guidelines were then used to evaluate all identified studies for appropriateness, leading to the final inclusion of 17 articles evaluating five general types of pelvic osteotomies. The Salter, double, and triple osteotomies were found to decrease the size of the pelvic outlet in modelbased and radiographic studies. The Chiari osteotomy decreased the dimensions of the pelvic inlet/mid-pelvis and was associated with higher reported C-section rates. The Bernese periacetabular osteotomy was not associated with any changes in pelvic diameters, with reported increased rates of C-section noted to result from obstetrician preference. For osteotomies performed prior to skeletal maturity, resulting pelvic deformities largely remodeled with growth. Pelvic osteotomies can alter normal pelvic parameters and may influence the ability for vaginal delivery. Obstetricians may recommend C-section for patients undergoing non-PAO osteotomies depending on skeletal maturity status at the time of their osteotomy and other obstetric-related factors such as fetal size and natural pelvic relaxation. The literature on this subject, however, remains limited. Level IV •Pelvic osteotomies for residual hip dysplasia or other childhood hip disorders alter normal pelvic parameters that may preclude the possibility of vaginal birth, particularly when performed after skeletal maturity.•The Chiari osteotomy primarily alters the dimensions of the pelvic inlet and mid-pelvis, while the Salter, double, and triple osteotomies decrease the size of the pelvic outlet.•The Bernese periacetabular osteotomy does not influence bony birth canal anatomy.•Pelvic deformities resulting from pelvic osteotomies performed before skeletal maturity often remodel with growth.•Obstetricians may recommend cesarean section after pelvic osteotomy, particularly when performed bilaterally, dependent on obstetric-specific factors.
可以实施各种骨盆截骨术，以改善髋关节发育不良及其他儿童期髋部疾病患者的股骨头覆盖情况，目标是延缓或预防骨关节炎。在术前讨论中，女性患者及其父母常常询问这些截骨术对未来妊娠的影响。关于这一主题的文献各不相同，对于此类患者选择性剖宫产（C 剖宫产）的适宜性没有达成共识。因此，本研究旨在回顾和总结关于不同骨盆截骨术对产道解剖结构和剖宫产率影响的文献。通过系统检索四个在线数据库（PubMed、Embase、CINAHL 和考克兰图书馆），确定了所有评估骨盆截骨术对患者产道解剖结构或妊娠结局影响的研究。然后使用 PRISMA 指南评估所有已识别研究的适宜性，最终纳入 17 篇评估五种一般类型骨盆截骨术的文章。在基于模型和影像学的研究中，发现 Salter 截骨术、双截骨术和三截骨术会减小骨盆出口的尺寸。Chiari 截骨术减小了骨盆入口/中骨盆的尺寸，并与较高的剖宫产率相关。伯尔尼髋臼周围截骨术与骨盆直径的任何变化均无关，据报道剖宫产率增加是由产科医生的偏好导致的。对于在骨骼成熟之前进行的截骨术，所导致的骨盆畸形在生长过程中大多会重塑。骨盆截骨术可改变正常的骨盆参数，并可能影响阴道分娩的能力。产科医生可能会根据患者截骨时的骨骼成熟状态以及其他产科相关因素（如胎儿大小和自然骨盆松弛情况），建议接受非 PAO 截骨术的患者进行剖宫产。然而，关于这一主题的文献仍然有限。四级证据：• 针对残留髋关节发育不良或其他儿童期髋部疾病进行的骨盆截骨术会改变正常的骨盆参数，这可能排除阴道分娩的可能性，尤其是在骨骼成熟后进行手术时。• Chiari 截骨术主要改变骨盆入口和中骨盆的尺寸，而 Salter 截骨术、双截骨术和三截骨术会减小骨盆出口的尺寸。• 伯尔尼髋臼周围截骨术不影响骨性产道解剖结构。• 在骨骼成熟之前进行骨盆截骨术所导致的骨盆畸形通常会随着生长而重塑。• 产科医生可能会在骨盆截骨术后建议剖宫产，尤其是双侧手术时，这取决于产科特定因素。
