偏心髋臼旋转截骨术的生物力学机制及初步临床疗效

 目的 探讨偏心髋臼旋转截骨术治疗髋关节发育不良的生物力学机制及其初步临床疗效。方法 取6具经福尔马林防腐处理的女性尸体骨盆标本,建立髋关节生物力学模型,在模型上模拟偏心髋臼旋转截骨术。对骨盆缓慢施加连续纵向压力0~500 N,测量术前和术后载荷100、200、300、400、500 N时的股骨头承重区应变值,计算应力值。2007年7月至2014年10月应用偏心髋臼旋转截骨术治疗髋关节发育不良25例（26髋）,男6例,女19例;年龄11~57岁,平均31岁。术后以Harris髋关节评分评价髋关节功能,摄骨盆正位X线片测量头臼指数、中心边缘角（center-edge-angle,CE角）及Sharp角。结果-随着脊柱纵向压力加大,股骨头上的应力值随之增加。偏心髋臼旋转截骨术后应力值在载荷超过300 N后由上升趋势转变为下降趋势,总体呈抛物线状。100~500 N载荷下偏心髋臼旋转截骨术后的应力值与术前差异均无统计学意义。临床随访18例（19髋）,随访率72%。随访时间7~85个月,平均40个月。Harris髋关节评分由术前（64.3±7.2）分提高至末次随访时（85.6±5.3）分;头臼指数平均增加36.5%、CE角平均增加33.1°、Sharp角平均减少12.3°,与术前比较差异均有统计学意义。结论-偏心髋臼旋转截骨术具有较好的矫正髋臼畸形的能力,可增大股骨头的髋臼覆盖面和降低承重区压力。     

成人髋臼发育不良伴骨关节炎行髋臼结构性植骨重建关节置换术的力学分析

目的：利用三维有限元力学分析方法,研究髋关节发育不良患者髋臼外上缘结构性植骨重建髋臼、增加臼杯假体包容对髋臼假体-骨界面间的应力分布情况的影响。方法选取髋关节发育不良患者的骨盆为实验对象,用螺旋CT做全长连续扫描,然后利用计算机仿真技术对CT图像进行三维重建,建立髋关节发育不良骨盆模型。在计算机环境中对重建模型进行髋臼外上缘结构性植骨重建髋臼并臼杯植入的模拟手术,利用有限元分析软件对重建模型进行有限元网格化及力学分析。结果髋臼植骨重建后,臼杯置入无需突破髋臼底,髋臼外上缘得到植骨块的包容覆盖,臼杯接触面积增大,单位面积所受应力相对较少,应力集中的情况得到明显改善。同时,植骨块及原髋臼外上缘区域承担了臼杯较多的应力。结论结构性植骨重建髋臼使骨床与臼杯接触面积较大,单位面积所受应力较小且均匀,有利于臼杯的稳定,植骨块承担了臼杯较多的应力,若臼杯外上缘外露面积过大,而过多的靠植骨块来弥补骨床的覆盖,使植骨块所受应力过大则臼杯松动的风险较大。     

髋臼内壁内移截骨全髋置换治疗髋关节发育不良髋关节旋转中心重建的病例对比分析

目的通过临床病例的对比分析研究,探讨髋关节发育不良的患者行全髋置换时,髋臼内壁内移截骨术和传统术式在恢复髋关节旋转中心方面的作用。方法将笔者行传统全髋置换术治疗的髋关节发育不良11例(传统术式组),与文献报道张洪行髋臼内壁内移截骨全髋置换17例(髋臼内壁内移截骨组)进行对比,通过在骨盆正位X线片上绘制Ranawat三角获得髋关节理想旋转中心,测量手术前、后实际股骨头旋转中心距理想旋转中心的水平和垂直距离,探讨两种术式在全髋置换髋臼重建时恢复髋关节旋转中心方面的作用。结果传统术式组术前水平距离为8～58mm,平均25.92mm,术后为6～34mm,平均16.46mm,手术前后比较有统计学差异(t=3.802,P0.01);术前垂直距离为4～38mm,平均20mm,术后为2～36mm,平均18.46mm,手术前后比较有统计学差异(t=2.589,P0.05)。两组手术前后水平距离差值的平均值分别为17.36mm、8.81mm,髋臼内壁内移截骨组大于传统术式组,有统计学差异(t=2.56,P0.05);两组手术前后垂直距离差值的平均值分别为10.41mm、3.47mm,髋臼内壁内移截骨组大于传统术式组,有统计学差异(t=2.27,P0.05)。结论传统术式有恢复髋关节旋转中心的作用;在恢复髋关节旋转中心作用上,髋臼内壁内移截骨术优于传统术式。     

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     

髋臼旋转截骨术治疗早中期髋关节发育不良

目的探讨髋臼旋转截骨术治疗早中期髋关节发育不良的手术技术要点及中期疗效。方法2000年5月至2006年5月对12例（14髋）早、中期髋关节发育不良患者进行了髋臼旋转截骨术,所有患者均为女性,手术时年龄13—46岁,平均28．9岁。随访时间3．1—9．1年,平均6．0年。术前、术后及随访时X线片上测量CE角,髋臼顶角及头外移指数。Harris评分判断髋关节功能。手术采用Oilier外侧“U”形入路,股骨大转子截骨显露。术后未行外固定。结果患者疼痛症状得到明显改善,Harris评分术前72分,术后91分（P〈0．001）。CE角术前0．9°,术后27°（P〈0．001）;髋臼顶角术前为29°,术后5°;头外移指数术前为0．68,术后0．65。所有病例截骨块及股骨大转子截骨处愈合良好。结论Oilier外侧“U”形入路行髋臼旋转截骨术髋臼缘显露充分;治疗早中期髋关节发育不良可以缓解疼痛,延缓骨关节炎的进展速度,中期随访疗效满意。     

髋臼内壁截骨术在发育不良髋关节全髋置换髋臼重建中的应用

目的探讨髋臼内壁截骨术在发育不良髋关节髋臼重建中的应用。方法2001年5月至2002年12月,采用结合髋臼内壁截骨术的全髋关节置换术治疗髋关节发育不良患者17例18髋,男1例1髋,女16例17髋,年龄35～70岁,平均51.4岁。其中CroweⅠ期4髋,Ⅱ期7髋,Ⅲ期4髋,Ⅳ期3髋。通过在手术前、后X线片上绘制Ranawat三角,对照手术前、后髋关节旋转中心与理想旋转中心的距离,测量术后臼杯穹顶与Kohler线的距离、臼杯直径等研究髋关节旋转中心重建与臼杯固定的效果。结果所有人工臼杯均安置于真臼位置,臼杯直径44～56mm,平均50.78mm。术前股骨头中心距理想旋转中心水平距离为12～40mm,平均21.09mm;术后股骨头中心距理想旋转中心水平距离为-3～10.1mm,平均3.73mm;手术前、后比较差异有统计学意义(t=7.95,P<0.01)。术前股骨头中心距理想旋转中心垂直距离为5～32mm,平均15.39mm;术后股骨头中心距理想旋转中心垂直距离为-18～26.3m m,平均4.98mm;手术前、后比较差异有统计学意义(t=3.42,P<0.01)。随访3个月以上者,截骨部位均骨性愈合。结论内壁截骨术有助于将发育不良髋关节的髋臼安置于真臼位置,保留髋臼底部的骨量,避免髋臼外上方植骨的并发症。     

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…     

髋臼成形截骨治疗成人髋臼发育不良

目的　探讨治疗成人髋臼发育不良的新方法。方法　沿髋臼上缘截骨 ,截骨后将骨瓣尽量向下翻转以加大髋臼对股骨头的包容。截骨间隙采用髂骨植骨填充并用克氏针固定。结果　 18例平均随访 3 5年 ,根据Gordon标准评定疗效 ,优 9例 ,良 7例 ,中 2例。结论　该方法是治疗成人髋臼发育不良的有效方法     

髋臼旋转截骨术治疗髋臼发育不良

目的探讨髋臼旋转截骨术治疗髋臼发育不良的疗效。方法应用髋臼旋转截骨术治疗髋臼发育不良16例（18髋）,截骨线距臼周缘2 cm,做穹隆状截骨,凿断后再用弧度骨凿将髋臼向前外下方旋转。髋臼矫正到较正常位置后,截骨间隙呈楔形状,用类似间隙大小的楔形同种异体骨块嵌入,并用可注射状人工骨填满间隙,最后用2枚可吸收螺钉固定。测定并比较术前和术后JOA评分、CE角和Sharp角。结果16例均获随访,时间442个月。术后摄片髋关节复位位置好,股骨头及髋臼形状基本正常。髋臼旋转截骨及植入骨块2个月后骨性愈合,6个月后髋关节功能恢复正常17髋,较差1髋,无患髋的骨性关节炎病变继续恶化。JOA评分：术前为75.2分±3.1分,术后为93.5分±3.5分;CE角：术前为15.8°±1.3°,术后为33.4°±1.7°;Sharp角：术前为47.3°±2.5°,术后为29.8°±2.1°。JOA评分术后增加18.3分;CE角增加17.6°,Sharp角减少17.5°,差异有统计学意义（P〈0.05）。结论髋臼旋转截骨术可矫正头臼间异常的匹配关系,使疼痛得到缓解,并使骨性关节炎的过程得到有效遏制,是治疗髋臼发育不良合并早、中期骨性关节炎的理想术式。     

应用髋臼旋转截骨术治疗髋臼发育不良32例分析

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 :应用髋臼旋转截骨术治疗髋臼发育不良 3 2例 (年龄组 14～ 2 1岁 ,平均年龄 17岁 ) ,从解剖结构上矫正髋臼发育不良。结果 :全部病例术后可使髋关节疼痛消失 ,功能改善 ,X线复查显示髋关节正常的解剖关系得以重建 ,恢复了髋臼和股骨头之间正常的匹配关系。结论 :髋臼旋转截骨术是从根本上治疗髋臼发育不良的有效方法。     

Rotational acetabular osteotomy for acetabular dysplasia of the hip with a giant acetabular bone cyst: a case report

In acetabular dysplasia of the hip joint accompanied by a giant acetabular bone cyst, rotational acetabular osteotomy may cause serious complications, such as bone necrosis after surgery or fracture of the fragile acetabulum during the operation. In a patient with this condition, we performed a two-stage operation: first, autogenous bone grafting supplemented with hydroxyapatite filling, then rotational acetabular osteotomy (after new bone formation had been assured). Radiographs and CT scans showed favorable fusion of the grafted bone. Some 18 months after the second operation, arthrograms showed no inflow of contrast medium from the articular cavity into the bone cyst region, although this had been observed before treatment. Thus, an effective remodeling of bony congruency was indicated in the mobile acetabulum 5 years after the second operation. This two-stage operation appears to be useful for correcting acetabular dysplasia accompanied by a giant bone cyst and to carry a reduced risk of serious complications, such as deterioration of the articular surface of the acetabulum or necrosis of the translocated acetabulum.     

Eccentric rotational acetabular osteotomy for acetabular dysplasia: follow-up of one hundred and thirty-two hips for five to ten years

BACKGROUND: Eccentric rotational acetabular osteotomy for the operative treatment of acetabular dysplasia consists of a spherical but eccentric osteotomy and rotation of the acetabulum that moves the center of rotation of the head of the femur medially and distally. No bone graft is needed. The reorientation of the acetabular fragment not only improves acetabular coverage but also restores the center of rotation of the subluxated hip. The purpose of this paper was to describe eccentric rotational acetabular osteotomy for the treatment of acetabular dysplasia and to evaluate its clinical and radiographic outcomes. METHODS: We performed this procedure consecutively in 132 hips in 126 patients with dysplasia of the hip. Eighteen hips had no osteoarthritis, fifty-three had early osteoarthritis, and sixty-one had advanced osteoarthritis. Seven patients were male, and 119 were female. The average age was 36.5 years at the time of the index operation, and the average duration of follow-up was 7.5 years. Twenty-three hips in twenty-two patients were also treated with intertrochanteric valgus osteotomy to further improve joint congruency at the time of the acetabular osteotomy. RESULTS: The average preoperative Harris hip score of 71 points improved to an average score of 89 points at the time of the latest follow-up. The average center-edge angle improved from 0 to 36 . An apparent change in the stage of the arthritis was observed in seven hips (5%), one of which had had early-stage disease and six of which had had advanced disease preoperatively. CONCLUSIONS: Eccentric rotational acetabular osteotomy appears to be a good treatment option for young patients with either early or advanced hip osteoarthritis secondary to dysplasia.     

Ectopic bone formation around the poly-<Emphasis Type="SmallCaps">l</Emphasis>-lactide screw head in rotational acetabular osteotomy for hip dysplasia

Ectopic bone formation around the poly-l-lactide (PLLA) screw head in eccentric rotational acetabular osteotomy for hip dysplasia was investigated. A total of 174 hips in 165 patients with hip dysplasia were consecutively treated with eccentric rotational acetabular osteotomy. Average age at the time of operation was 37 years. Acetabular fragments of 123 patients (132 hips) were fixed by Kirschner wires (K-wire group), and 42 hips in 42 patients were fixed with PLLA screws (PLLA group). There was no statistically significant difference between the backgrounds of the two groups. All patients were evaluated clinically and radiologically. In the K-wire group, ectopic bone formation of class 2 was observed in only 1 hip. In the PLLA group, ectopic bone formation of class 3 in 1 hip and class 2 in 3 hips was observed around the screw head 3 months postoperatively, and all hips but 1 showed class 2 at final follow-up. One hip with class 3 at 1 year developed marked reduction of range of motion, and this patient complained of moderate hip pain and stiffness. PLLA screws significantly enhanced ectopic bone formation around the screw head in eccentric rotational acetabular osteotomy.     

成人髋臼发育不良Bernese经髋臼周围骨盆截骨术的两维有限元分析

目的：建立成人髋臼发育不良Bernese经髋臼周围骨盆截骨术后模型，并进行生物力学有限元分析。方法:制备尸体标本成人髋臼发育不良模型，并利用Ansys 6．0软件，对髋臼发育不良Bernese术后矫枉过正及合适矫正模型进行生物力学分析。结果：术后矫枉过正模型组外侧、前侧髋臼边缘出现应力增加趋势，作用于髋臼及股骨头的水平分力及剪应力是正常组的2—3倍。结论：探讨髋臼合适矫正的标准Bernese术后髋臼矫枉过正，将会导致髋臼进行性的向前侧、外侧突起畸形及股骨头颈髋臼盂唇撞击综合征。久之导致骨性关节炎。     

Hip-shelf procedure in the treatment of osteonecrosis of the transpositioned acetabulum after rotational acetabular osteotomy

Necrosis of the transpositioned acetabulum after rotational acetabular osteotomy (RAO) is a major complication characteristic of this procedure. This complication, although rare, has been thought difficult to treat. We report a patient with acetabular osteonecrosis and subsequent collapse after RAO that was effectively treated with a shelf operation, providing satisfactory remodeling of the hip joint. A 16-year-old female had undergone RAO for the treatment of developmental acetabular dysplasia. Postoperative radiography showed that the osteotomized acetabular fragment was unusually thin, and that the osteotome entered the hip joint during the surgery. Five months after the RAO, X-rays revealed significant collapse of the transpositioned acetabulum, and femoral head subluxation caused by postoperative osteonecrosis. Seven months after the RAO, the patient underwent a hip-shelf procedure. The remaining acetabular fragment was used in this procedure, according to the Spitzy method. Seven years after the second operation, favorable remodeling of the hip joint was observed; however, early osteoarthritic changes, including slight joint space narrowing, bone sclerosis of the new acetabulum, and bone cysts within the femoral head, were seen. Received: November 30, 2000 / Accepted: April 16, 2001     

Morphometric changes in the acetabulum after Dega osteotomy in patients with cerebral palsy

We carried out a morphometric analysis of the acetabulum following Dega osteotomy in patients with cerebral palsy using three-dimensional CT. We assessed 17 acetabula in 12 patients with instability of the hip. A Dega osteotomy and varus derotation femoral osteotomy were performed in all 17 hips. Three-dimensional CT scans were taken before and approximately one year after operation. Acetabular cover was evaluated using anterosuperior, superolateral and posterosuperior acetabular indices, and the change in the acetabular volume was calculated. Inter- and intra-observer reliability was assessed using the intraclass correlation coefficient. After the osteotomy, the anterosuperior, superolateral and posterosuperior cover had improved significantly towards the value seen in a control group. The mean acetabular volume increased by 68%.     

Does Dega osteotomy increase acetabular volume in developmental dysplasia of the hip?

Whether acetabular volume increases or decreases after acetabular Dega osteotomy is not known. The purpose of this study is to determine the effect of Dega osteotomy on the volume of the acetabulum in patients with developmental dysplasia of the hip. Nine hips of seven patients with developmental dysplasia of the hip that have undergone Dega osteotomy were included in the study. The acetabular index, acetabular depth, and acetabular volume of each hip were calculated before and after surgery. Magnetic resonance imaging was used for the measurement of the acetabular volume. The difference between the preoperative and postoperative values of acetabular index, acetabular depth, and acetabular volume was statistically significant. We conclude that Dega acetabular osteotomy increases the volume of the acetabulum.     

Acetabular medial wall displacement osteotomy in total hip arthroplasty: a technique to optimize the acetabular reconstruction in acetabular dysplasia

Twenty-six patients (30 hips) who had acetabular dysplasia were operated on by circumferential acetabular medial wall displacement osteotomy to reconstruct the acetabulum during total hip arthroplasty. All patients had cementless acetabular components implanted. The average acetabular component size was 50 mm (range, 44-56 mm). Only 2 hips needed structural bone graft. The mean follow-up period was 22 months (range, 6-32 months). Harris hip score had changed from 47.31 (range, 19-69 points) to 94.69 (range, 85-100 points) postoperatively (P < .01). Using the Ranawat acetabular triangle to determine the optimal hip center of rotation, the postoperative hip biomechanical environment had been improved. Our short-term follow-up suggests this technique is reliable and reproducible and generally avoids the use of bone graft and graft site morbidity. In addition, it allows the use of standard modular cementless components in patients with acetabular dysplasia.     

髋臼发育不良的光弹性生物力学研究

目的 从生物力学角度探讨髋臼发育不良继发骨关节炎的发病机理,为髋臼旋转截骨术提供依据。方法 用环氧树脂制作骨盆、股骨模型,其中包括４个不同Ｓｈａｒｐ角、３个不同软骨厚度及３个颈干角模型,采用二维光弹性方法进行生物力学分析。结果 随着Ｓｈａｒｐ角的增大,髋关节的合力增大,生物应力向髋臼外侧缘移动;关节软骨缺损一半时,髋关节合力未见明显变化,当关节软骨不存在时,生物应力为正常时的２．５倍;随着颈干角的增大,生物应力集中的位置没有变化,但生物应力及合力随之增大。结论 髋臼发育不良因生物力学因素可继发骨关节炎,髋臼旋转截骨术是对其有效的治疗方法。     

Eccentric Rotational Acetabular Osteotomy Using Computed Navigation Guidance for Developmental Dysplasia of the Hip,Sacroiliac Fusion,and Femoroacetabular Impingement Owing to Acetabular Retroversion: A Case Report

BackgroundDevelopmental dysplasia of the hip (DDH) is the main factor that causes secondary osteoarthritis of the hip (hip OA). Acetabular retroversion results in pincer‐type femoroacetabular impingement (FAI), and this is also known to cause secondary hip OA. However, few cases of DDH with acetabular retroversion have been reported, and there is no definite opinion on the optimal treatment. We report a rare case of DDH and FAI owing to acetabular retroversion and dysostosis of the sacroiliac joint that was treated with eccentric acetabular rotational osteotomy (ERAO) using navigation guidance.Case PresentationA 27‐year‐old woman presented with DDH and acetabular retroversion with FAI and dysostosis of the sacroiliac joint on the contralateral side. We performed ERAO using computed navigation guidance and improved the coverage and retroversion of the acetabulum. The acetabular anteversion angle improved from 1° retroversion to 9° anteversion after surgery, the center edge angle improved from 18° to 43°, and the acetabular head index improved from 69% to 93%. The cam lesion of the femur was resected. The Harris Hip Score improved from 55.7 to 100 points at the final examination 2 years after surgery.ConclusionsIn this rare case of DDH and FAI, ERAO using computed navigation guidance accurately improved the coverage and retroversion of the acetabulum.