Hersche O, Casillas M, Ganz R
Department of Orthopaedic Surgery, University of Berne, Switzerland.
Clin Orthop Relat Res. 1998 Feb(347):19-26.
Residual hip dysplasia in the adult is characterized by deficient anterior and lateral acetabular coverage with subsequent hip joint incongruity and instability. The frequency of periacetabular osteotomy for the treatment of residual hip dysplasia is increasing. In certain morphologic conditions preoperative abduction or intraoperative radiographs reveal that congruency after a periacetabular osteotomy is not optimum; at this point the surgeon may consider the addition of an intertrochanteric osteotomy. In a retrospective study, the radiographs of 25 patients who had a femoral osteotomy with or after periacetabular osteotomy were analyzed and the results were compared with a control group of 34 patients who had periacetabular osteotomy without a femoral osteotomy. The analyzed parameters included: the femoral head extrusion index and the acetabular index, before and after periacetabular osteotomy; the femoral neck shaft angle; the presence of femoral head deformity; the presence of osteoarthrosis; the presence of a secondary acetabulum; the influence of previous ipsilateral hip surgery; the effect of hip adduction or abduction on joint congruency; and the age of the patient. The variables that had a statistically significant association with the performance of an intertrochanteric osteotomy included a femoral head extrusion index and an acetabular index after periacetabular osteotomy outside the normal limits, a neck shaft angle outside the limits of the control group, a deformed femoral head, an osteoarthritic hip, a secondary acetabulum, and a joint space height and congruency dependent on position of the proximal femur. When using statistically significant variables, a discriminant analysis predicted the correct group (periacetabular osteotomy with femoral osteotomy, or periacetabular osteotomy without femoral osteotomy) for 89% of the cases.
成人残留性髋关节发育不良的特征是髋臼前侧和外侧覆盖不足，继而导致髋关节不匹配和不稳定。用于治疗残留性髋关节发育不良的髋臼周围截骨术的频率正在增加。在某些形态学情况下，术前外展或术中X线片显示髋臼周围截骨术后的匹配度并非最佳；此时，外科医生可能会考虑加做转子间截骨术。在一项回顾性研究中，分析了25例在髋臼周围截骨术时或之后接受股骨截骨术患者的X线片，并将结果与34例未进行股骨截骨术的髋臼周围截骨术对照组患者进行比较。分析的参数包括：髋臼周围截骨术前和术后的股骨头挤压指数和髋臼指数；股骨颈干角；股骨头畸形的存在情况；骨关节炎的存在情况；继发髋臼的存在情况；同侧髋关节既往手术的影响；髋关节内收或外展对关节匹配度的影响；以及患者的年龄。与转子间截骨术的实施具有统计学显著关联的变量包括髋臼周围截骨术后股骨头挤压指数和髋臼指数超出正常范围、颈干角超出对照组范围、股骨头畸形、骨关节炎性髋关节、继发髋臼，以及关节间隙高度和匹配度取决于股骨近端位置。使用具有统计学显著意义的变量时，判别分析对89%的病例预测出正确分组（髋臼周围截骨术加股骨截骨术，或单纯髋臼周围截骨术）。
