髋臼周围截骨术治疗髋臼发育不良

目的探讨髋臼周围截骨术治疗髋臼发育不良的方法及疗效。方法对36例髋臼发育不良患者(43髋)行手术治疗,通过髋臼周围截骨、旋转髋臼向前外侧移位恢复髋臼的正确位置,并增加髋臼覆盖面。结果 36例均获随访,时间6个月～3年。术后髋痛、跛行完全消失或有明显改善,髋关节活动范围基本正常。CE角和Sharp角均基本恢复正常。结论髋臼周围截骨术可有效改善临床症状,恢复髋关节的生物力学特点,是治疗髋臼发育不良的有效方法。     

改良髋臼旋转截骨术治疗髋臼发育不良

[目的]研究改良的髋臼旋转截骨术治疗髋臼发育不良的方法及有效性.[方法]自2002年10月～2007年8月采用改良的Ninomiya方法治疗27例髋臼发育不良的患者,其中男3例3髋,女24例27髋;平均年龄29.4岁(15～42岁).术前、术后拍摄骨盆正位、双髋侧位及外展位像,测量髋臼的CE角(中心边缘角)和AC角(臼顶倾斜角),记录髋关节旋转中心及Shenton氏线变化、骨关节炎的严重程度并进行随访,行髋关节Harris评分并进行评价.[结果]所有患者截骨术后股骨头覆盖均得到改善,CE角由术前的3.2°(-15°～15°)矫正为28.5°(20°～40°),AC角由术前的26.6°(15°～38°)矫正为3.9°(0°～12°),髋臼旋转中心内移率为63.3%(19/30),Shenton氏线不连续率由67%降为23%.平均随访4.2年(1.5～7年),1髋失随访,28髋疼痛减轻、骨关节炎得到控制,1髋疼痛加重,Harris评分由术前82.7分(67～96分)改善为97.8分(87～100分).术后2例患者出现耻骨纤维愈合,1例出现耻骨下支应力骨折,无截骨块或大粗隆不愈合病例.[结论]改良的髋臼旋转截骨术能有效地治疗髋臼发育不良,是一种有效、安全的手术方式.     

改良Bernese髋臼周围截骨术治疗成人髋臼发育不良

[目的]介绍经改良的经髂腹股沟入路在骨盆内壁行Bemese髋臼周围截骨术治疗成人髋臼发育不良.[方法] 10例髋关节发育不良造成髋关节疼痛的患者行髂腹股沟入路髋臼周围截骨术,并对原截骨方法进行适当改良.患者平均年龄29岁,术前患者平均疼痛2.5年,髋关节活动度正常或基本正常,髋关节间隙正常或轻度狭窄.术前术后均测量CE角和AC角及Harris评分.[结果]术后10例经12 ～28个月(平均20个月)的随访.髋术后疼痛明显减轻,髋关节活动度保持正常.术后CE角和AC角及Harri评分明显改善,术中术后无明显并发症发生.[结论]骨盆内髋臼周围截骨术治疗成人髋臼发育不良可以获得良好疗效.     

成人髋臼发育不良的髋臼周围截骨术

髋臼周围截骨术(Periacetabular Osteotomy)的目的是移动发育不良的髋臼，使其更接近解剖部位，矫正髋臼结构缺损，提供股骨头包容，使通过髋关节的力的分布更正常，避免行全髋关节置换术。适用于髋臼发育不良出现疼痛症状，X线表现少或无继发性退变但髋关节外展位X线片显示关节面相吻合的患者。如果存在髋外翻，骨盆截骨联合内翻粗隆     

髋臼旋转截骨术治疗先天性髋臼发育不良

介绍髋臼旋转截骨术治疗先天性髋臼发育不良。方法：该术式通过髋臼周围截骨,旋转髋臼向前外侧、内侧及下方移位,以恢复发育不良髋臼的正确位置,并增加髋臼覆盖面。结果：在１９９０～１９９７年间,应用该术式治疗先天性髋臼发育不良病人１２例（１３髋）,年龄在１８～４８岁间。所有病人均获随访１～７年（平均３年８个月）,术后髋痛、跛行完全消失或有明显改善,髋关节活动范围基本正常。ＣＥ角和Ｓｈａｒｐ角均基本恢复正常。结论：该术式设计合理,适应证广泛,术后疗效确切,是先天性髋臼发育不良患者的择优手术方案。     

伯尔尼髋臼周围截骨术对严重髋臼发育不良的治疗

目的 研究和分析使用伯尔尼髋臼周围截骨术治疗严重髋臼发育不良的中期临床和影像学结果.方法 1997年10月至2002年12月对18例(20髋)严重髋臼发育不良(Severin分级Ⅳb级)的患者接受了伯尔尼髋臼周围截骨术.患者手术时平均年龄21岁,平均随访时间6.2年.本组患者术前患髋均已出现疼痛,术前功能位片显示关节面吻合.术后影像学评价畸形的矫正范围,截骨处的愈合情况及关节炎的进展.临床结果和髋关节功能由Harris评分进行评价,术前Harris评分平均78.5分.结果 比较术前和术后X线片,外侧中心边缘角(CE角)、前方CE角和臼顶倾斜角均有显著改善.所有髂骨截骨均愈合.患者术后末次随访Harris评分平均91.1分.18例患者中的14例对手术效果表示满意.20髋中16髋临床结果优.但有5髋存在畸形矫正不足.结论 伯尔尼髋臼周围截骨术是治疗严重髋臼发育不良的有效术式.这一截骨术可以在各个平面对严重的骨缺损进行矫正,中期临床结果令人满意.     

成人髋臼发育不良的髋臼周围截骨术

髋臼周围截骨术 (PeriacetabularOsteotomy)的目的是移动发育不良的髋臼 ,使其更接近解剖部位 ,矫正髋臼结构缺损 ,提供股骨头包容 ,使通过髋关节的力的分布更正常 ,避免行全髋关节置换术。适用于髋臼发育不良出现疼痛症状 ,X线表现少或无继发性退变但髋关节外展位X线片显示关节面相吻合的患者。如果存在髋外翻 ,骨盆截骨联合内翻粗隆间截骨将提供准确的股骨头覆盖。如果股骨头外形有变化 ,采用骨盆截骨术治疗时手术难度大 ,很难获得理想的效果。髋臼周围截骨术包括球形和旋转髋臼截骨术 ,Bernese髋臼周围截骨术和非同心圆髋臼旋转截骨术…     

三联髋臼周围截骨治疗成人髋臼发育不良

目的探讨三联髋臼周围截骨治疗成人髋臼发育不良的临床疗效。方法对27例(34髋)因髋臼发育不良造成髋关节疼痛的患者行三联髋臼周围截骨术。结果 34髋关节活动度保持正常,髋关节疼痛消失或明显改善。结论三联髋臼周围截骨治疗成人髋臼发育不良可以获得良好疗效,髋关节功能恢复快,关节活动度正常,跛行改善,对控制和延缓骨性关节炎的进展有积极的作用。     

髋臼前倾和后倾的影像学及生物力学研究

目的探讨髋臼前、后倾的影像学特点和在前、后倾时髋臼缘的生物力学特点,为临床治疗提供相关的依据。方法应用成年防腐骨盆标本制作4例发生髋臼前倾及后倾的骨盆模型,拍模型的标准骨盆正位片,模型加载,分别对前倾组及后倾组进行生物力学测定和影像学观察。结果标准骨盆正位片上前倾时出现“人”字形,后倾时出现交叉征及后壁征。前倾组各点应变值正常时与前倾时经秩和检验,P〈0．05,差异有统计学意义;后倾组各点应变值正常时与前倾时经秩和检验P〈0．05,差异有统计学意义。结论本实验对髋臼前、后倾髋臼缘力学测定,可以推测髋臼前、后倾与许多髋关节退行性疾病有密切联系。通过影像学特点早期发现、早期治疗,并根据生物力学特点制定适当的方案,可提高临床治疗效果。     

髋臼旋转截骨术治疗髋臼发育不良28例疗效分析

目的：探讨髋臼旋转截骨术治疗髋臼发育不良的临床效果。方法：采用田川法髋臼旋转截骨术治疗髋臼发育不良共２８例（２９髋），随访时间３．２年。手术前后Ｘ线变化及临床评定结果：全部病例术后可使髋关节疼痛消失，功能改善，髋臼和股骨头之间恢复了正常匹配关系。结论：髋臼旋转截骨术是从根本上治疗髋臼发育不良的最有效方法     

Postoperative acetabular retroversion causes posterior osteoarthritis of the hip

We retrospectively reviewed 68 hips in 62 patients with acetabular dysplasia who underwent curved periacetabular osteotomy. Among the 68 hips, 33 had acetabular retroversion (retroversion group) and 35 had anteversion (control group) preoperatively. All hips were evaluated according to the Harris hip score. Radiographic evaluations of acetabular retroversion and posterior wall deficiency were based on the cross-over sign and posterior wall sign, respectively. The clinical scores of the two groups at the final follow-up were similar. In the retroversion group, 12 hips had anteverted acetabulum postoperatively. The posterior wall sign disappeared in these hips, but remained in 21 hips with retroverted acetabulum postoperatively. Among the 21 hips with retroverted acetabulum, posterior osteoarthritis of the hip developed postoperatively in five hips. When performing corrective osteotomy for a dysplastic hip with acetabular retroversion, it is important to correct the acetabular retroversion to prevent posterior osteoarthritis of the hip due to posterior wall deficiency.     

An algorithmic approach to surgical decision making in acetabular retroversion

The optimum treatment for the young adult patient with symptomatic femoroacetabular impingement due predominately to acetabular retroversion remains unknown. The retroversion deformity can be associated with a volumetrically deficient or sufficient acetabulum based on the adequacy of lateral and posterior coverage. We prospectively collected clinical data from 2001 to 2006 on 60 hips with symptomatic femoroacetabular impingement that had radiographic evidence of acetabular retroversion defined as a crossover sign on an adequate anteroposterior radiograph or retroversion on magnetic resonance imaging or computed tomography. Our treatment algorithm for acetabular retroversion used measurements of acetabular coverage (lateral center edge angle and the posterior wall sign) and condition of acetabular cartilage to direct treatment of acetabular retroversion. The algorithm directed the surgeon to perform a periacetabular osteotomy in 30 hips and a surgical dislocation and osteochondroplasty of the femoral head-neck junction and acetabular rim in 30 hips. Harris Hip Score improved from 52 to 90 in the hips treated with surgical dislocation and osteochondroplasty and 72 to 91 in the hips treated with periacetabular osteotomy, with an overall survivorship of 96% at 4 years. Patient follow-up averaged 46 months (range, 24-75 months). Elimination of the crossover sign and correction of the posterior wall sign occurred in >90% of all patients when present. The results indicate that hips with acetabular retroversion, deficient posterior and/or lateral acetabular coverage, and intact hyaline cartilage can be effectively treated with acetabular reorientation, while retroverted hips with anterior overcoverage but sufficient posterior coverage are effectively treated with osteochondroplasty of the acetabulum and proximal femur.     

High prevalence of acetabular retroversion in both affected and unaffected hips after Legg-Calvé-Perthes disease

Background

Acetabular retroversion is observed in hips after various pediatric hip diseases. This study sought to examine the frequency of acetabular retroversion in both affected and unaffected hips after Legg-Calvé-Perthes disease and its correlation with the prominence of the ischial spine.

Methods

We retrospectively investigated the version and morphological features of the acetabulum using pelvic radiographs after Legg-Calvé-Perthes disease (107 affected hips treated non-operatively and 72 unaffected hips from the contralateral side). The diagnosis of acetabular retroversion was made based on the presence of a positive cross-over sign on anteroposterior pelvic radiographs. The correlation between the presence of a positive cross-over sign and modified Stulberg classes, the onset age of Legg-Calvé-Perthes disease, radiographic parameters for acetabular dysplasia and the prominence of the ischial spine were examined.

Results

The prevalence of a positive cross-over sign was 49.5 % (45 of 91 hips) in affected hips and 45.8 % (33 of 72 hips) in unaffected hips. Hips with a positive cross-over sign were significantly coexistent bilaterally. The prevalence of prominence of the ischial spine in the positive cross-over sign group was 71.4 % in the affected side and 81.8 % in the unaffected side, indicating a significant correlation between the cross-over sign and the prominence of the ischial spine in both affected and unaffected hips. The positive cross-over sign did not have any correlation with the parameters for acetabular dysplasia and the onset age, however, had a significant correlation with the severity of the femoral head deformity.

Conclusions

High prevalence of acetabular retroversion in both affected and unaffected hips after Legg-Calvé-Perthes disease was demonstrated. Symmetric acetabular deformity and the coexistence of prominence of the ischial spine suggested the effects of the Legg-Calvé-Perthes disease lesions on the skeletal development of the whole pelvis. Further follow-up is needed to clarify the pathological significance of acetabular retroversion after Legg-Calvé-Perthes disease.     

The prevalence of acetabular retroversion among various disorders of the hip

BACKGROUND: Acetabular retroversion can result from posterior wall deficiency in an otherwise normally oriented acetabulum or from excessive anterior coverage secondary to a malpositioned acetabulum, or both. Theoretically, a retroverted acetabulum, which adversely affects load transmission across the hip, may occur more frequently in hips with degenerative arthritis. The aim of this study was to assess the prevalence of acetabular retroversion in normal hips and in hips with osteoarthritis, developmental dysplasia, osteonecrosis, and Legg-Calvé-Perthes disease. METHODS: We retrospectively examined anteroposterior radiographs of the pelvis of 250 patients (342 hips). Fifty-six patients (112 hips) had normal findings; sixty-six patients (seventy hips) had osteoarthritis; sixty-four (seventy-four hips), developmental dysplasia; thirty (thirty-six hips), osteonecrosis of the femoral head; and thirty-four (fifty hips), Legg-Calvé-Perthes disease. The sole criterion for a diagnosis of acetabular retroversion was the presence of a so-called cross-over sign on the anteroposterior radiograph of the pelvis. RESULTS: The prevalence of acetabular retroversion was 6% (seven of 112 hips) in the normal group, 20% (fourteen of seventy hips) in the osteoarthritis group, 18% (thirteen of seventy-four hips) in the developmental dysplasia group, 6% (two of thirty-six hips) in the group with osteonecrosis of the femoral head, and 42% (twenty-one of fifty hips) in the group with Legg-Calvé-Perthes disease. In patients with Legg-Calvé-Perthes disease, the prevalence of acetabular retroversion was 68% in twenty-five hips with Stulberg class-III, IV, or V involvement. In contrast, only four (16%) of twenty-five hips with Stulberg class-I or II involvement had acetabular retroversion. The difference was significant (p = 0.0002). Patients with osteoarthritis, developmental dysplasia, or Legg-Calvé-Perthes disease are significantly more likely to have acetabular retroversion than are normal subjects (p < 0.05). CONCLUSIONS: Acetabular retroversion occurs more commonly in association with a variety of hip diseases, in which the prevalence of subsequent degenerative arthritis is increased, than has been previously noted.     

Acetabular coverage after innominate osteotomy

A criticism of innominate osteotomy is that it may cause relative acetabular retroversion, predisposing to osteoarthritis. This study was designed to address that hypothesis. We had access to standing hip radiographs of 30 patients (36 hips) who had undergone open reduction and innominate osteotomy for late presenting developmental hip dislocation at least 40 years earlier. A single independent investigator used the validated method of Hefti (1995) to measure anterior and posterior acetabular coverage, contact area, and version. Ten operated hips had advanced osteoarthritis obscuring acetabular landmarks. Twenty-six operated hips were readable despite some radiographs showing signs of mild-to-moderate osteoarthritis. Twenty contralateral hips without developmental hip dysplasia formed a comparison group and 21 age-matched and sex-matched "normal hips" were used as a control. A significant difference between the groups was found for contact area (P < 0.001). There was no significant difference between the other 3 outcomes: anterior coverage (P = 0.509), posterior coverage (P = 0.135), and anteversion (P = 0.845). Anteversion in hips with a good outcome after innominate osteotomy and open reduction was not different to a control group of radiographically normal hips. The early osteoarthritic changes seen in these hips may relate to decreased contact area compared with the normal population. In this series, innominate osteotomy before the age of 5 years did not consistently cause acetabular retroversion that persisted into adulthood. Apparently unaffected hips contralateral to the dislocated side display reduced contact area relative to controls indicating probable occult dysplasia.     

Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy

BACKGROUND: This study was performed to evaluate whether symptomatic anterior femoro-acetabular impingement due to acetabular retroversion can be treated effectively with a periacetabular osteotomy. METHODS: The diagnosis of femoro-acetabular impingement was based on clinical symptoms, a positive anterior impingement test, and findings of acetabular rim lesions on magnetic resonance imaging. The radiographic diagnosis of acetabular retroversion was based on the cross-over and posterior wall signs. Twenty-nine hips in twenty-two patients (average age, twenty-three years) underwent a periacetabular osteotomy. An arthrotomy was performed in twenty-six hips in order to visualize intra-articular lesions and, in selected cases, to improve a low femoral head-neck offset. The range of motion of the hip was measured, clinical evaluation was performed with use of the score described by Merle d'Aubigné and Postel, and the anterior center-edge angle of Lequesne and de Sèze was measured on radiographs preoperatively and at the time of the latest follow-up. RESULTS: The duration of follow-up averaged thirty months (range, twenty-four to forty-nine months). The anterior center-edge angle of Lequesne and de Sèze decreased significantly from a preoperative average of 36 degrees (range, 26 degrees to 52 degrees ) to a postoperative average of 28 degrees (range, 16 degrees to 46 degrees ) (p = 0.002). There was a significant increase in the average range of internal rotation (10 degrees, p = 0.006), flexion (7 degrees, p = 0.014), and adduction (8 degrees, p = 0.017). The average Merle d'Aubigné score increased from 14.0 points (range, 12 to 16 points) preoperatively to 16.9 points (range, 15 to 18 points) postoperatively (p < 0.001), and the result was good or excellent for twenty-six hips. Three hips underwent subsequent surgery: one, because of early postoperative loss of reduction; one, for correction of posteroinferior impingement; and one, because of recurrent signs of anterior impingement. CONCLUSION: Periacetabular osteotomy is an effective way to reorient the acetabulum in young adults with symptomatic anterior femoro-acetabular impingement due to acetabular retroversion     

Ischial Spine Projection into the Pelvis

Femoroacetabular impingement may occur in patients with so-called acetabular retroversion, which is seen as the crossover sign on standard radiographs. We noticed when a crossover sign was present the ischial spine commonly projected into the pelvic cavity on an anteroposterior pelvic radiograph. To confirm this finding, we reviewed the anteroposterior pelvic radiographs of 1010 patients. Nonstandardized radiographs were excluded, leaving 149 radiographs (298 hips) for analysis. The crossover sign and the prominence of the ischial spine into the pelvis were recorded and measured. Interobserver and intraobserver variabilities were assessed. The presence of a prominent ischial spine projecting into the pelvis as diagnostic of acetabular retroversion had a sensitivity of 91% (95% confidence interval, 0.85%-0.95%), a specificity of 98% (0.94%-1.00%), a positive predictive value of 98% (0.94%-1.00%), and a negative predictive value of 92% (0.87%-0.96%). Greater prominence of the ischial spine was associated with a longer acetabular roof to crossover sign distance. The high correlation between the prominence of the ischial spine and the crossover sign shows retroversion is not just a periacetabular phenomenon. The affected inferior hemipelvis is retroverted entirely. Retroversion is not caused by a hypoplastic posterior wall or a prominence of the anterior wall only and this finding may influence management of acetabular disorders.     

Evaluation of acetabular versions after a curved periacetabular osteotomy for dysplastic hips

The purpose of this study is to investigate the early clinical and radiographic findings related to acetabular orientation after a curved periacetabular osteotomy (CPO). 106 dysplastic hips of 88 patients underwent CPO were investigated retrospectively with an average follow-up of 3.6 years. Conventional anteroposterior radiographs were used to measure the radiographic findings and range of motion were used for clinical evaluations. A significant improvement was noted in radiographic measurements including lateral centre-edge angle, acetabular index, and acetabular angle of Sharp. However, a high rate of postoperative acetabular retroversion was observed (62% hips) and a marked decrease in free flexion was noted. The Tönnis scale revealed a one-grade progression in most retroversion hips. Acetabular retroversion is a high risk factor leading to degenerative osteoarthritis of hip. Therefore, special consideration must be taken in surgical planning and careful intraoperative confirmation is required whilst manoeuvring the acetabular fragment in CPO.     

Acetabular retroversion is associated with osteoarthritis of the hip

Primary osteoarthritis of the hip may have a structural basis. It was hypothesized that the radiographic appearance of acetabular retroversion could be created by altering the morphologic features of the acetabular walls, and that acetabular retroversion, as defined on an anteroposterior radiograph of the pelvis, is associated with osteoarthritis of the hip. A model pelvis was used to simulate normal, augmented, deficient, and rotated walls of the acetabulum, and radiographs were taken to compare the projections of the modified acetabular walls with the known plain radiographic appearance of a retroverted acetabulum. One hundred thirty-one good quality anteroposterior radiographs of the pelvis taken before total hip arthroplasty for idiopathic hip osteoarthritis were compared with 99 good quality radiographs taken for nonorthopaedic reasons. The prevalence of radiographic acetabular retroversion is 20% among patients with idiopathic hip osteoarthritis and 5% among the general population. The appearance of acetabular retroversion on an anteoroposterior radiograph of the pelvis is created by deficiency of the posterior wall of the acetabulum. There is a statistically significant association between radiographic acetabular retroversion and hip osteoarthritis. These findings have applicability to understanding the mechanical etiology of hip osteoarthritis, and to surgical technique during periacetabular osteotomy and total hip arthroplasty.