Haider Shamrez, Mayfield Laura, Kim Harry K, Gill Corey S, Sucato Daniel J, Podeszwa David A, Morris William Z
Scottish Rite for Children.
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
J Pediatr Orthop. 2025 Jul 21. doi: 10.1097/BPO.0000000000003067.
After reduction of developmental hip dislocations, residual dysplasia is common with rates of secondary reconstructive surgery with pelvic osteotomy ranging from 19% to 60%. The determination and timing of when to proceed with surgery is difficult as acetabular remodeling occurs gradually over the first few years after reduction. The purpose of this study was to evaluate how age at secondary reconstructive surgery influences the clinical and radiographic outcomes after pelvic osteotomy for residual dysplasia.
After IRB approval, we retrospectively reviewed all isolated Salter or Pemberton pelvic osteotomies performed for residual dysplasia after an index closed or open reduction at a single institution between 1983 and 2020 with radiographic follow-up through skeletal maturity. Acetabular index (AI) and migration index (MI) were measured on preoperative, immediate postoperative, and 2-year follow-up radiographs. After triradiate cartilage closure, anterior-posterior pelvis radiographs were measured for lateral center-edge angle (LCEA), Tönnis angle, MI, and lateralization ratio (LR). Univariate and multivariate analysis were used to evaluate outcomes based on age at time of surgery.
Ninety-two hips from 83 patients were included. 55 Salter (60%) and 37 Pemberton osteotomies (40%) were performed with mean age at surgery of 5.2±1.7 years. 46% (42/92) hips across both treatment groups had residual dysplasia (LCEA<25 deg.) at final follow-up (mean age 15±3.2 y). However, there was no significant difference in acetabular dysplasia at 2 years postop or after triradiate closure between those hips treated before or after 5 years of age (all P>0.05). Multivariate analysis revealed that only the immediate postoperative MI predicted the final follow-up LCEA (P<0.01), although the rate of dysplasia was still 24% in the most covered hips (MI<10%).
Even after pelvic osteotomy for residual dysplasia, there are high rates of dysplasia at skeletal maturity. Only the femoral head coverage achieved, not the age at time of surgery, predicted dysplasia at skeletal maturity. These findings suggest that there is no opportunity cost to short-term continued observation while monitoring for acetabular remodeling.
Level III.
发育性髋关节脱位复位后，残余发育异常很常见，骨盆截骨二次重建手术的发生率在19%至60%之间。由于髋臼重塑在复位后的头几年逐渐发生，因此确定何时进行手术以及手术时机很困难。本研究的目的是评估二次重建手术时的年龄如何影响骨盆截骨治疗残余发育异常后的临床和影像学结果。
经机构审查委员会批准后，我们回顾性分析了1983年至2020年间在单一机构进行初次闭合或开放复位后因残余发育异常而进行的所有孤立的Salter或Pemberton骨盆截骨术，并进行了影像学随访直至骨骼成熟。在术前、术后即刻和2年随访X线片上测量髋臼指数（AI）和移位指数（MI）。在三叶软骨闭合后，测量骨盆前后位X线片的外侧中心边缘角（LCEA）、Tönnis角、MI和外移率（LR）。采用单因素和多因素分析根据手术时的年龄评估结果。
纳入了83例患者的92髋。共进行了55例Salter截骨术（60%）和37例Pemberton截骨术（40%），手术平均年龄为5.2±1.7岁。两个治疗组中46%（42/92）的髋关节在最终随访时（平均年龄15±3.2岁）存在残余发育异常（LCEA<25°）。然而，5岁之前或之后接受治疗的髋关节在术后2年或三叶软骨闭合后的髋臼发育异常方面没有显著差异（所有P>0.05）。多因素分析显示，只有术后即刻的MI可预测最终随访时的LCEA（P<0.01），尽管覆盖最好的髋关节（MI<10%）发育异常率仍为24%。
即使进行骨盆截骨治疗残余发育异常，骨骼成熟时发育异常的发生率仍很高。预测骨骼成熟时发育异常的是股骨头覆盖情况，而非手术时的年龄。这些发现表明，在监测髋臼重塑时，短期持续观察不存在机会成本。
三级。
