Modified triple pelvic osteotomy for residual acetabular dysplasia through double incisions: Technical note and review of short-term results.

IF 1.8 Q2 ORTHOPEDICS SICOT-J Pub Date : 2024-01-01 Epub Date: 2024-04-30 DOI:10.1051/sicotj/2024012
Ahmad S Aly, Tamer A Fayyad, Shady S El-Beshry, Karim T Elhusseiny, Ahmed K El Ghazawy
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Abstract

Purpose: To assess validity, safety, and efficacy of the modified triple pelvic osteotomy (TPO) approach for correction of residual acetabular dysplasia.

Methods: This is a retrospective case series conducted on 15 hips in 15 patients from 2019 to 2023 with residual acetabular dysplasia treated by modified TPO as described by Tonnis with two modifications. The first modification is using a single medial incision for pubic and ischial cuts (the Vladimirov modification). The second modification is having the ischial cut closer to the acetabulum (Li modification) allowing free movement of the acetabular fragment for better femoral head coverage. The mean age at the time of surgery was 11.85 years, (range 8-23). Cases presenting were 10 males (66.7%) and 5 females (33.3%). The mean follow-up period was 36.533 months (24-60 months).

Results: Our study revealed significant clinical and radiological improvement. The CE angle improved from a mean value of 10° (range 2-17) pre-operatively to 32.785° (range 18°-40°) post-operatively. The AI improved from a mean value of 32° pre-operatively to a mean value of 13.89° post-operatively. HHS increased from a preoperative mean value of 74.80° to a post-operative mean value of 90.67°. Also, there was a significant improvement in ROM (abduction and internal rotation). LLD improved from a mean value of 2.60 cm preoperatively to a mean value of 0.37 cm postoperatively. Delayed union was found in 3 cases. No cases of osteonecrosis or neurovascular complication were encountered in our study.

Conclusion: The modified TPO technique using dual incisions can be considered safe and effective, providing adequate coverage of the femoral head in acetabular dysplasia with less surgical time, satisfactory functional outcomes, and minimal complications.

Level of evidence: IV.

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通过双切口进行改良三骨盆截骨术治疗残余髋臼发育不良:技术说明和短期效果回顾。
目的:评估改良三骨盆截骨术(TPO)矫正残余髋臼发育不良的有效性、安全性和疗效:这是一项回顾性病例系列研究,对2019年至2023年期间15名髋臼发育不良残余患者的15个髋部进行了治疗,治疗方法为Tonnis描述的改良TPO,并进行了两处修改。第一种改良方法是使用单个内侧切口进行耻骨和骶骨切口(Vladimirov 改良方法)。第二种改良方法是将骶骨切口靠近髋臼(Li改良方法),使髋臼碎片可以自由移动,从而更好地覆盖股骨头。手术时的平均年龄为 11.85 岁(8-23 岁不等)。病例中有 10 名男性(66.7%)和 5 名女性(33.3%)。平均随访时间为 36.533 个月(24-60 个月):结果:我们的研究显示临床和放射学均有明显改善。CE 角从术前的平均值 10°(范围 2-17)改善到术后的 32.785°(范围 18°-40°)。AI从术前的平均值32°改善到术后的平均值13.89°。HHS 从术前的平均值 74.80°增加到术后的平均值 90.67°。此外,ROM(外展和内旋)也有明显改善。LLD从术前的平均值2.60厘米提高到术后的平均值0.37厘米。3例患者出现了延迟愈合。本研究未发现骨坏死或神经血管并发症:使用双切口的改良TPO技术可以说是安全有效的,它能在髋臼发育不良的情况下充分覆盖股骨头,手术时间短,功能效果满意,并发症少:证据等级:IV。
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来源期刊
SICOT-J
SICOT-J ORTHOPEDICS-
CiteScore
3.20
自引率
12.50%
发文量
44
审稿时长
14 weeks
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