改良Smith Peterson入路髋臼周围截骨术治疗成人髋关节发育不良

摘要
图/表
参考文献
相关文章 (13)

全文: PDF (2325 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨改良Smith Peterson入路行髋臼周围截骨术(periacetabular osteotomy，PAO)治疗成人髋关节发育不良(developmental dysplasia of the hip，DDH))的近中期疗效。方法回顾分析泉州市正骨医院2018年4月至2021年1月采用改良Smith Peterson入路行PAO治疗的21例成人DDH，其中男1例(1髋)，女20例(20髋)；左髋12例，右髋9例；年龄18～44岁，平均(32.15±10.81)岁；改良T-nnis骨关节炎分期0期5例(5髋)，Ⅰ期14例(14髋)，Ⅱ期2例(2髋)。记录所有患者术中出血量、手术时间、住院时间、并发症发生情况以及术前术后髋关节Harris评分，通过X线片记录所有患者外侧中心边缘(lateral center edge，LCE)角、臼顶倾斜角(T-nnis角)、股骨头超出指数(extrusion index，EI)及前方中心边缘(anterior center edge，ACE)。结果患者术中出血量(779.52±29.60)mL，手术时间(115.95±4.44)min，住院时间(7.29±0.35)d。术后均获得随访，随访时间24～48个月，平均(33.73±9.12)个月。所有患者均未出现血管损伤、髋臼后柱骨折、切口愈合不良、感染、下肢深静脉血栓。2例(2髋)术后出现股外侧皮神经支配区麻木，未予特殊处理，术后3个月后自行恢复。末次随访Harris评分(89.67±3.44)分优于术前(72.67±4.32)分，差异有统计学意义(P＜0.05)。术后12个月X线片示所有患者截骨均愈合，均未出现截骨块骨坏死。术后LCE角(31.67±3.86)°优于术前(9.86±3.25)°，T-nnis角(6.57±2.44)°优于术前(15.05±2.48)°，EI(11.33±2.96)%优于术前(29.19±2.89)%，ACE角(30.67±3.71)°优于术前(8.62±3.31)°，差异均有统计学意义(P＜0.05)。结论改良Smith-Peterson入路行PAO治疗成人DDH严格把控手术适应证，重视常见手术并发症的防治，可有效改善髋关节骨性覆盖，显著改善髋关节功能，近中期疗效满意。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	林行会
	许志庆
	庄至坤
	吴昭克

关键词 ：改良Smith Peterson入路, 髋臼周围截骨术, 髋关节发育不良

Abstract：

Objective To evaluate early and mid term effectiveness of periacetabular osteotomy(PAO)through modified Smith Peterson for development dysplasia of the hip (DDH)in adults.Methods 21 adults with DDH underwent PAO through modified SmithPeterson at Quanzhou Orthopaedics Hospital between April 2018 and January 2021.There were 1 male (1 hip) and 20 females (20 hips) containing 12 left hips and 9 right hips.The ages ranged from 18 to 44 years with a mean of (32.15±10.81)years.Among them，5 cases (5 hips) were categorized as modified T-nnis stage 0，14 cases (14 hips) as stage I，and 2 cases (2 hips) as stage Ⅱ.Intraoperative blood loss，surgical duration，hospitalization duration，occurrence of complications and preand post-operative Harris hip scores were recorded.Imaging assessments included lateral center edge(LCE) angle，acetabular inclination angle (T-nnis angle)，extrusion index (EI)，and anterior center edge (ACE) measured via X-rays.Results Bleeding volume was (779.52±29.60)mL，operation time was (115.95±4.44)min，the length of hospital stay was (7.29±0.35)days.Follow-up of all patients was (33.73±9.12)months (range 24~48 months).There were no complications such as vascular injury，fracture of posterior column of acetabulum，poor wound healing，infection，deep venous thrombosis of lower extremity.Postoperative numbness of the lateral femoral cutaneous nerve occurred in 2 adults(2 hips) and disappeard postoperatively 3 months without special treatment.At last follow up，Harris hip score was (89.67±3.44)，significantly better than preoperative ones (72.67±4.32)(P＜0.05).At 1 year after operation，X-ray films showed that the all osteotomies healed and there was no osteotomy block osteonecrosis.Postoperative LCE angle was (31.67±3.86)°，significantly better than preoperative ones (9.86±3.25)°(P＜0.05).Postoperative T-nnis angle was (6.57±2.44)°，significantly better than preoperative ones(15.05±2.48)°(P＜0.05).Postoperative EI was (11.33±2.96)%，which was significantly better than preoperative ones (29.19±2.89)% (P＜0.05).Postoperative ACE angle was (30.67±3.71)°，which was significantly better than preoperative ones (8.62±3.31)°(P＜0.05).Conclusion If the indications for surgery are strictly controlled and prevention and treatment of common surgical complications are payed attention to，PAO through modified Smith Peterson for DDH in adults can effectively improve the osseous covering of hip joint and significantly improve hip joint function，providing satisfactory early and mid-term clinical outcome.

Key words： modified Smith Peterson periacetabular osteotomy development dysplasia of the hip

通讯作者: 吴昭克

作者简介: 林行会(1983－ )，男，主治医师，福建省泉州市正骨医院关节科，283892111@qq.com

引用本文:

林行会，许志庆，庄至坤，吴昭克. 改良Smith Peterson入路髋臼周围截骨术治疗成人髋关节发育不良[J]. 实用骨科杂志, 2023, 29(12): 1070-.
Ling Hanghui，Xu Zhiqing，Zhuang Zhikun，Wu Zhaoke. Periacetabular Osteotomy Through Modified Smith Peterson for Development Dysplasia of the Hip in Adults. sygkzz, 2023, 29(12): 1070-.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I12/1070

［1］Kalore NV，Cheppalli SPR，Daner ⅢWE，et al.Acetabular dysplasia in middle-aged patients：periacetabular osteotomy or total hip arthroplasty?［J］.J Arthroplasty，2016，31(9)：1894-1898.
［2］Anderton MJ，Hastie GR，Paton RW.The positive predictive value of asymmetrical skin creases in the diagnosis of pathological developmental dysplasia of the hip［J］.Bone Joint J，2018，100(5)：675-679.
［3］Matheney T，Zaltz I，Kim YJ，et al.Activity level and severity of dysplasia predict age at Bernese periacetabular osteotomy for symptomatic hip dysplasia［J］.J Bone Joint Surg(Am)，2016，98(8)：665-671.
［4］Harsanyi S，Zamborsky R，Krajciova L，et al.Developmental dysplasia of the hip：A review of etiopathogenesis，risk factors，and genetic aspects［J］.Medicina，2020，56(4)：153.
［5］Ganz R，Klaue K，Vinh TS，et al.A new periacetabular osteotomy for the treatment of hip dysplasias.Technique and preliminary results［J］.Clin Orthop Relat Res，1988(232)：26-36.
［6］Wells J，Millis M，Kim YJ，et al.Survivorship of the Bernese periacetabular osteotomy：what factors are associated with longterm failure?［J］.Clin Orthop Relat Res，2017(475)：396-405.
［7］高仁智，祝兆琛，谢宗平.经改良髂腹股沟入路行髋臼周围截骨术治疗成人髋臼发育不良的中期疗效［J］.中国修复重建外科杂志，2021，35(9)：1100-1104.
［8］李伟峰.Bernese髋臼周围截骨术治疗髋关节发育不良的短期疗效分析［D］.广州中医药大学，2021.
［9］秦勇，程实，马欣楠，等.髋臼旋转截骨术治疗成人髋臼发育不良的疗效分析［J］.实用骨科杂志，2016，22(6)：503-506.
［10］Garras DN，Crowder TT，Olson SA.Medium-term results of the Bernese periacetabular osteotomy in the treatment of symptomatic developmental dysplasia of the hip［J］.J Bone Joint Surg (Br)，2007，89(6)：721-724.
［11］Smith MV，Klein SE，Clohisy JC，et al.Lower extremity-specific measures of disability and outcomes in orthopaedic surgery［J］.J Bone Joint Surg(Am)，2012，94(5)：468-477.
［12］Ali M，Malviya A.Complications and outcome after periacetabular osteotomy-influence of surgical approach［J］.HIP International，2020，30(1)：4-15.
［13］陈哲峰，王瑞，刘久翔，等.髋臼周围截骨术结合髋关节镜手术治疗成人发育性髋关节发育不良［J］.中华骨科杂志，2021，41(14)：920-928.
［14］Matsuda DK，Martin HD，Parvizi J.Endoscopy-assisted periacetabular osteotomy［J］.Arthroscopy Techniques，2016，5(2)：e275-e280.
［15］Steppacher SD，Tannast M，Ganz R，et al.Mean 20-year follow up of Bernese periacetabular osteotomy［J］.Clinical orthopaedics and related research，2008，466：1633-1644.
［16］Grammatopoulos G，Wales J，Kothari A，et al.What is the early/mid-term survivorship and functional outcome after Bernese periacetabular osteotomy in a pediatric surgeon practice?［J］.Clin Orthop Relat Res，2016(474)：1216-1223.
［17］Lerch TD，Steppacher SD，Liechti EF，et al.Onethird of hips after periacetabular osteotomy survive 30 years with good clinical results，no progression of arthritis，or conversion to THA［J］.Clin Orthop Relat Res，2017(475)：1154-1168.
［18］程徽，张洪，罗殿中，等.伯尔尼髋臼周围截骨术治疗髋关节发育不良的中长期疗效［J］.中华骨科杂志，2014，(12)：1190-1197.
［19］宋永兴，曾忠友，陈晓东，等.髋臼周围截骨术治疗中青年髋关节发育不良［J］.中国矫形外科杂志，2018，26(10)：878-882.
［20］Ahmad SS，Giebel GM，Perka C，et al.Survival of the dysplastic hip after periacetabular osteotomy：A meta-analysis［J］.Hip International，2023，33(2)：306-312.
［21］Tan SHS，Tan JHI，Lim AKS，et al.Periacetabular osteotomy for acetabular retroversion：A systematic review and meta-analysis［J］.Orthop Traumatol Surg Res，2021，107(8)：103078.
［22］罗殿中，张洪，张伟佳.髋臼周围截骨三种手术入路比较［J］.实用骨科杂志，2013，19 (6)：481-484.
［23］Redmond JM，Gupta A，Stake CE，et al.The prevalence of hip labral and chondral lesions identified by method of detection during periacetabular osteotomy：Arthroscopy versus arthrotomy［J］.Arthroscopy，2014，30(3)：382-388.
［24］孔令超，杨先腾，陈龙，等.3D打印术前规划辅助髋臼周围截骨治疗早期发育性髋关节脱位［J］.中华创伤骨科杂志，2020，22(6)：523-528.
［25］Ahmad SS，Haertlé M，Konrads C，et al.The scientific evolution of periacetabular osteotomy：A global review［J］.J Clin Med，2022，11(20)：6099.
［26］Zhu J，Chen X，Cui Y，et al.Midterm results of Bernese periacetabular osteotomy for developmental dysplasia of hip in middle aged patients［J］.Int Orthop，2013，37(4)：589-594.
［27］Lara J，Tobar C，Besomi J.Bernese periacetabular osteotomy for hip dysplasia.A modification to original technique and South American perspective［J］.Curr Rev Musculoskelet Med，2014，7(4)：337-341.