Ahmad Sufian S, Giudici Gaia, Stamp Justus, Karisch Quentin, Windhagen Henning, Haertlé Marco
Department of Orthopaedic Surgery, Hannover Medical School, Hannover, Germany.
Bone Jt Open. 2025 Jul 3;6(7):748-754. doi: 10.1302/2633-1462.67.BJO-2024-0223.R1.
Periacetabular osteotomy (PAO) has become widely recognized as the gold standard for the correction of acetabular pathomorphologies. However, the pubic cut has raised concerns due to complications such as delayed union and its association with anterior hip syndrome. The aim of this study was to examine the impact of the position of the pubic cut on the displacement of the pubic root during PAO surgery.
The study included thin-sliced CT scans of 58 hips with symptomatic hip dysplasia. Overall, 3D simulations of PAO were performed in triplicate, incorporating three variations of the pubic cut, specifically positioned 5, 10, or 15 mm medial to the iliopectineal eminence. Full displacement of the pubic osteotomy was noted by two independent investigators. Analysis of variance was used for comparison between means. Logistic regression was used to determine factors influencing displacement of the pubic root.
The incidence of complete pubic bone displacement increased with the medial position of the cut, with rates of 17.24% for a 5 mm cut, 36.21% for a 10 mm cut, and the highest at 82.76% for a 15 mm cut medial to the iliopectineal eminence (p < 0.001). The odds of complete displacement were reduced ten-fold with a lateral 5 mm pubic cut (odds ratio 0.1, 95% CI 0.04 to 0.20, p < 0.001).
The position of the pubic cut is the most significant determinant of pubic root displacement in PAO surgery. Loss of contact at the pubic osteotomy is likely associated with delayed union and postoperative anterior hip syndrome. Choosing a lateral pubic cut positioned 5 mm medial to the iliopectineal eminence is expected to result in a ten-fold reduction in the risk of complete pubic bone displacement. Appreciating the results of this study when performing the pubic cut may help mitigate the risk of post-PAO anterior hip syndrome.
髋臼周围截骨术（PAO）已被广泛认可为矫正髋臼病理形态的金标准。然而，耻骨截骨引发了人们对诸如延迟愈合及其与髋关节前侧综合征的关联等并发症的担忧。本研究的目的是探讨耻骨截骨位置对PAO手术中耻骨根部移位的影响。
该研究纳入了58例有症状的髋关节发育不良患者的髋关节薄层CT扫描。总体而言，对PAO进行了三次三维模拟，纳入了耻骨截骨的三种变化，具体位置为耻骨梳结节内侧5、10或15毫米。两名独立研究人员记录耻骨截骨的完全移位情况。采用方差分析进行均值比较。采用逻辑回归确定影响耻骨根部移位的因素。
耻骨完全移位的发生率随截骨内侧位置的增加而升高，耻骨梳结节内侧5毫米截骨的发生率为17.24%，10毫米截骨的发生率为36.21%，耻骨梳结节内侧15毫米截骨的发生率最高，为82.76%（p<0.001）。耻骨外侧5毫米截骨时完全移位的几率降低了10倍（优势比0.1，95%可信区间0.04至0.20，p<0.001）。
耻骨截骨位置是PAO手术中耻骨根部移位的最重要决定因素。耻骨截骨处失去接触可能与延迟愈合和术后髋关节前侧综合征有关。选择耻骨梳结节内侧5毫米的外侧耻骨截骨有望使耻骨完全移位的风险降低10倍。在进行耻骨截骨时了解本研究结果可能有助于降低PAO术后髋关节前侧综合征的风险。
