Shihab Wasim, Luck Connor, Oakley Jennifer, McClincy Michael
Department of Orthopaedic Surgery, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC), 4401 Penn Avenue Pittsburgh, PA 15224, USA.
J Hip Preserv Surg. 2025 Jan 30;12(2):139-143. doi: 10.1093/jhps/hnaf007. eCollection 2025 Jul.
Iatrogenic femoroacetabular impingement following periacetabular osteotomy (PAO) is a well-documented cause of postoperative complications. The anterior inferior iliac spine (AIIS) is an increasingly recognized source of impingement, and previous studies have documented high rates of abnormal AIIS subtypes in dysplastic hips undergoing PAO. This study evaluates the effects of PAO with concomitant AIIS osteoplasty on a range of motion and function. We performed a retrospective study of 63 hips that underwent PAO with concomitant open AIIS osteoplasty. AIIS was classified using 3D-reconstruction Computed tomography (CT) and femoral version was measured on axial-CT. Pre- and post.-operative lateral center-edge angle, Tönnis-angle, and anterior center-edge angle were calculated using X-ray imaging. Hip internal rotation (IR) at 90° flexion was recorded preoperatively, intraoperatively following PAO (pre- and postosteoplasty), and 6 months postoperatively. Pre- and postoperative Merle-d'Aubigné (MDA) scores were compared using pairwise -test. IR motion changes were compared using repeated measures analysis of variance. Regression analyses evaluated the impact of femoral version on IR before and after osteoplasty. MDA significantly improved postoperatively. Intraoperative IR prior to AIIS osteoplasty was significantly reduced compared to other timepoints, but addition of the osteoplasty improved IR intraoperatively and 6 months postoperatively. No differences were noted in IR between pre- and postoperative examination. The impact of IR restoration with AIIS osteoplasty correlated significantly with femoral version, with greater motion improvement noted in patients with lower version. When planning PAO, careful appreciation of motion parameters is critical. Regardless of AIIS morphology, consideration of an intraoperative AIIS osteoplasty should occur when IR is decreased following acetabular reorientation.
髋臼周围截骨术（PAO）后医源性股骨髋臼撞击是术后并发症的一个已被充分记录的原因。髂前下棘（AIIS）是一个越来越被认可的撞击源，先前的研究记录了接受PAO的发育不良髋关节中AIIS异常亚型的高发生率。本研究评估了PAO联合AIIS截骨术对一系列运动和功能的影响。我们对63例接受PAO联合开放性AIIS截骨术的髋关节进行了回顾性研究。使用三维重建计算机断层扫描（CT）对AIIS进行分类，并在轴向CT上测量股骨扭转角。使用X线成像计算术前、术后的外侧中心边缘角、Tönnis角和前中心边缘角。记录术前、PAO术中（截骨术前和术后）以及术后6个月时髋关节在90°屈曲位的内旋（IR）情况。使用配对检验比较术前和术后的Merle-d'Aubigné（MDA）评分。使用重复测量方差分析比较IR运动变化。回归分析评估股骨扭转角对截骨术前和术后IR的影响。术后MDA评分显著改善。与其他时间点相比，AIIS截骨术前的术中IR显著降低，但增加截骨术可改善术中及术后6个月的IR。术前和术后检查的IR无差异。AIIS截骨术恢复IR的影响与股骨扭转角显著相关，扭转角较低的患者运动改善更大。在计划PAO时，仔细评估运动参数至关重要。无论AIIS形态如何，当髋臼重新定位后IR降低时，应考虑术中进行AIIS截骨术。
