髋臼旋转截骨术治疗髋臼发育不良

目的 :介绍髋臼旋转截骨术 (RAO)治疗髋臼发育不良 (DDH)的方法及疗效。方法 :对 2 4例 2 8髋DDH施行RAO ,按将CE角矫正至 3 0°的术前设计 ,在距髋臼缘 2 0cm处做穹隆状截骨 ,将髋臼向前外下方旋转 ,交叉克氏针固定。本组中髋关节骨性关节炎 (OAH)前期 4髋 ,早期 15髋 ,进展期 9髋 ,平均CE角 16 4° ,Sharp角 48 6° ,AHI 3 3 8%。结果 :经平均 3年 2个月随访 ,平均疼痛增加 2 3 6分 ,步行能力增加 2 6分 ,关节活动范围增加 0 4分 ,生活工作障碍程度增加 2 4分 ,CE角增加 16 7° ,Sharp角减少 16 6° ,AHI增加 48 8%。原疼痛、跛行症状均缓解 ,恢复正常劳动及工作。共出现并发症 2例 ,大转子固定螺钉松脱 1例 ,轻度臀中肌无力步态 1例。结论 :RAO手术可矫正头臼间异常的匹配关系 ,使头臼间的应力分布均匀 ,避免或延缓OAH的发生和发展 ,对髋关节的骚扰小 ,截骨处易愈合 ,是治疗DDH合并早、中期OAH的理想术式     

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.     

髋臼周围截骨术治疗伴有囊变的髋臼发育不良

目的探讨髋臼周围截骨术治疗伴有囊变的髋臼发育不良（DDH）继发骨关节炎患者的临床结果，以及截骨术对囊变的影响。方法从1997年10月至2002年12月，共为28例31髋伴有囊变的DDH继发骨关节炎患者进行了髋臼周围截骨术。男2例，女26例；平均年龄28．7岁。平均随访5．8年。结果Harris髋关节评分从术前平均75．5分增加到末次随访的92．1分；外侧CE角从平均8．3°增加到22．7°，前方CE角从平均-3．2°增加到34．4°，臼顶倾斜角从平均27．1°下降到6．4°。骨关节炎表现改善和未进展者27髋（87％），有不同进展者4髋（13％）。31髋中，9髋囊变被完全吸收，15髋囊变范围变小，6髋无变化，1髋囊变范围增大。主要并发症有2髋矫正不足。结论尽管囊变存在，髋臼周围截骨术治疗DDH仍能获得满意的疗效。当外侧CE角矫正充分时，髋臼周围截骨术能够诱导骨重塑，使囊变区变小或被完全吸收。     

对髋臼发育不良患者髋臼后倾的临床研究

目的探讨髋臼后倾在髋臼发育不良患者中的发生率和影像学特点,以及采用传统的截骨旋转方式对这部分病例进行髋臼周围截骨术后,髋臼后倾角的改变。方法2001年12月至2003年11月共对43位髋臼发育不良患者(45髋)行Bernese髋臼周围截骨术。其中女37例39髋,男6例6髋,年龄15～45岁,平均28．9岁。对所有患者术前和术后的标准骨盆正位X线片进行观察,当髋臼前后缘的轮廓线出现“交叉征”和“后壁征”时,诊断为髋臼后倾。结果45髋中的8髋表现为“交叉征”( ),且其中5髋同时伴有“后壁征”( ),后倾发生率为17．8％。术前髋臼前后缘轮廓线的交叉点均位于髋臼近端1／3处,说明后倾主要发生在髋臼的近端1／3。截骨术后,所有髋臼仍然后倾,且前后缘的交叉点均移至髋臼远端1／3处,甚至更远的位置,并全部表现为“后壁征”( )。结论在髋臼发育不良的患者中,约有1／6的患者髋臼后倾,而后倾主要发生在髋臼的近端1／3,标准的骨盆正位X线片就可以对这部分患者加以识别。髋臼周围截骨术将髋臼向前外侧旋转的方法,加大了髋臼后倾的范围和程度,不适用于这部分患者。     

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。     

髋臼旋转截骨术治疗成人髋臼发育不良

目的　评估髋臼旋转截骨术治疗成人髋臼发育不良的近、远期疗效。　方法　42例(50侧髋)髋臼发育不良的成年病人均接受髋臼旋转截骨术治疗,分别测定术前和术后JOA评分、中心边缘角和Sharp角。术前骨性关节炎分期:前期32侧髋,早期17侧髋,进展期1侧髋。　结果　术后平均随访7. 4年, 49侧髋的骨性关节炎得到明显改善(98. 0% ); 1侧无明显变化(2. 0% ); 无一例患髋的骨性关节炎病变继续恶化。JOA评分术前平均为76. 4分, 术后为96. 3分; 中心边缘角术前、术后平均为-14. 5°和30. 0°;Sharp角术前平均为50. 5°,术后为36. 3°,术前、术后比较具有显著性差异(P<0. 05)。结论　髋臼旋转截骨术能使发育不良的髋臼对股骨头的包容得到有效的改善,使疼痛症状得到缓解,并使骨性关节炎的过程得到有效遏制。     

髋臼造盖股骨粗隆下旋转截骨术矫正髋部畸形的疗效分析

目的 探讨髋部畸形功能障碍患者行髋臼造盖股骨粗隆下旋转截骨术的疗效.方法 对7例陈旧性股骨粗隆间骨折畸形愈合,颈干角增大或变小(右侧5例,髋外翻,颈干角＞145°;左侧2例,髋内翻,颈干角＜110°)行粗隆下旋转截骨术;另外2例陈旧性髋关节脱位伴股骨上端畸形行髋臼造盖股骨粗隆下旋转截骨术.结果 术后随访2～4年,2例髋...     

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。     

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     

Acetabular osteotomy: indications and results

Acetabular osteotomy is the treatment of choice for young patients with symptomatic structural abnormalities of the acetabulum in the absence of severe secondary degenerative changes. These disorders can include hip instability from classic developmental dysplasia or posttraumatic acetabular dysplasia, hip impingement from retrotorsional acetabular deformities, or rarely, posttraumatic problems. During the last 15 years, various techniques of acetabular reorientation have evolved, making the procedure reliable, reproducible, and durable. In this report, the current indications and results of acetabular osteotomy in patients with symptomatic acetabular structural problems will be discussed.     

V形镍钛合金支架植入治疗犬髋臼发育不良的实验研究

目的 探讨Ｖ形镍钛合金（记忆合金）支架植入髋臼顶部后,对其髋臼发育不良的矫正及对其髋臼发育的影响。方法 选用髋臼发育不良的幼犬１０只,随机分为２组,在髋臼顶部距臼缘上０．５ｃｍ处用弧形骨刀做与髋臼弧度一致的截骨,其截骨深达Ｙ形软骨,将截骨后的骨瓣向下扳压,在骨瓣上方植入２￣３只Ｖ形镍钛合金支架,术后４、１２周行双髋关节Ｘ线摄片,进行大体及组织学观察。结果 术后１２周髋臼顶部由术前斜坡形恢复为弧形,     

Osteotomies for acetabular dysplasia in adults and adolescents

The aims of treatment for acetabular dysplasia are the normalization of the relationship between the femoral head and acetabulum on weight bearing position, and to provide a painless, stable, and functional hip in the long-term. The reason of this abnormal relationship may arise either from the acetabulum (deficiency, maldirection) or the femoral head (aspheric, subluxation, valgus, varus). For this reason, preoperative planning, assessment, and patient selection are very important. Acetabular dysplasia is the main reason for hip osteoarthritis. Overcorrection is an important complication of acetabular osteotomies. This review summarizes different kinds of acetabular osteotomies with relevant presentation of our technique.     

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 of the femoral head after triple pelvic osteotomy: no relation to outcome in 51 hips followed for 8-15 years

In developmental dysplasia of the hip in adolescents and young adults, pelvic osteotomies aim to improve acetabular coverage of the femoral head by reorienting the acetabulum. We determined whether acetabular coverage is related to long-term clinical results after triple osteotomy of the pelvis. We used a previously published computer program (Konishi and Mieno 1993) which calculates three-dimensional coverage of the femoral head from plain anteroposterior radiographs. We studied the pelvic radiographs of 51 hips in 43 patients and the results were correlated with studies on clinical outcome (de Kleuver et al. 1997). Total acetabular coverage improved from a mean of 56% to 70%. We did not find a relationship between total acetabular coverage and long-term outcome, nor could we determine an optimal coverage. Reduced coverage of the posterolateral quadrant of the femoral head was related to a reduced score for walking ability (p = 0.03), and therefore care should be taken not to overcorrect the acetabulum forwards when attempting to improve the deficient anterior coverage. We challenge the concept that total acetabular coverage is a prerequisite for a good long-term outcome after triple pelvic osteotomy, and hypothesize that other factors such as the change in load across the hip are probably more important in determining the outcome.     

Acetabular coverage of the femoral head after triple pelvic osteotomy: No relation to outcome in 51 hips followed for 8-15 years

In developmental dysplasia of the hip in adolescents and young adults, pelvic osteotomies aim to improve acetabular coverage of the femoral head by reorienting the acetabulum. We determined whether acetabular coverage is related to long-term clinical results after triple osteotomy of the pelvis. We used a previously published computer program (Konishi and Mieno 1993) which calculates three-dimensional coverage of the femoral head from plain anteroposterior radiographs. We studied the pelvic radiographs of 51 hips in 43 patients and the results were correlated with studies on clinical outcome (de Kleuver et al. 1997). Total acetabular coverage improved from a mean of 56% to 70%. We did not find a relationship between total acetabular coverage and long-term outcome, nor could we determine an optimal coverage. Reduced coverage of the posterolateral quadrant of the femoral head was related to a reduced score for walking ability (p = 0.03), and therefore care should be taken not to overcorrect the acetabulum forwards when attempting to improve the deficient anterior coverage. We challenge the concept that total acetabular coverage is a prerequisite for a good long-term outcome after triple pelvic osteotomy, and hypothesize that other factors such as the change in load across the hip are probably more important in determining the outcome.