Periacetabular Osteotomy Through a Modified Ollier Transtrochanteric Approach for Treatment of Painful Dysplastic Hips

J. Ko, Ching‐Jen Wang, C. Lin, C. Shih
{"title":"Periacetabular Osteotomy Through a Modified Ollier Transtrochanteric Approach for Treatment of Painful Dysplastic Hips","authors":"J. Ko, Ching‐Jen Wang, C. Lin, C. Shih","doi":"10.2106/00004623-200209000-00012","DOIUrl":null,"url":null,"abstract":"Background: Elimination of abnormally high joint-loading resulting in excessive contact stresses may prevent or reduce the onset of osteoarthrosis in a dysplastic hip. A number of periacetabular osteotomies have been shown to be effective in restoring normal hip-joint mechanics. We treat acetabular dysplasia with a periacetabular osteotomy performed through a modified Ollier transtrochanteric approach. In this report, we describe the operative technique and the clinical and radiographic results.Methods: Thirty-six patients (thirty-eight hips) in whom a painful dysplastic hip had been treated with a periacetabular osteotomy between March 1991 and June 1999 were included in the study. There were thirty-five female patients and one male patient with a mean age (and standard deviation) at the operation of 29.42 ± 9.1 years. The technique utilizes a u-shaped skin incision, and a routine osteotomy of the greater trochanter with distal transfer if needed, and allows excellent visualization enabling the surgeon to perform the periacetabular osteotomy without penetrating the joint.Results: At a mean of five years and six months postoperatively, the mean modified Harris hip score had improved from 59.1 ± 15.8 points preoperatively to 87.97 ± 14.3 points. Radiographically, the degree of osteoarthrosis had decreased in eleven hips, remained unchanged in twenty-four, and worsened in three. The mean anterior center-edge angle had increased from 22.0° ± 12.9° to 36.1° ± 12.3°, the mean lateral center-edge angle had increased from -2.7° ± 14.4° to 26.6° ± 14.1°, the mean acetabular index angle had improved from 23.4° ± 6.6° to 12.7° ± 4.6°, and the mean acetabular head index had increased from 48.2% ± 12.7% to 73.1% ± 16.0%. The Shenton line was restored in eleven hips. Thirty patients (thirty-two hips; 84%) had a satisfactory result. A poor preoperative functional score was associated with an unsatisfactory outcome (p = 0.00191). Complications included prolonged limping (eleven hips); numbness in the distribution of the lateral femoral cutaneous nerve (four); osteonecrosis of the rotated acetabular fragment (two); and acetabulofemoral impingement, heterotopic ossification, and a defect on the rotated ilium (one hip each).Conclusions: Painful dysplastic hips should be treated before function becomes seriously impaired. We believe that periacetabular osteotomy through a modified Ollier approach, which allows osseous cuts to be made under direct vision, can be learned readily. It provides improved femoral head coverage and relief of symptoms in most painful dysplastic hips in adolescents and young adults.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"11 3 1","pages":"1594–1604"},"PeriodicalIF":0.0000,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"36","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Journal of Bone & Joint Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2106/00004623-200209000-00012","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 36

Abstract

Background: Elimination of abnormally high joint-loading resulting in excessive contact stresses may prevent or reduce the onset of osteoarthrosis in a dysplastic hip. A number of periacetabular osteotomies have been shown to be effective in restoring normal hip-joint mechanics. We treat acetabular dysplasia with a periacetabular osteotomy performed through a modified Ollier transtrochanteric approach. In this report, we describe the operative technique and the clinical and radiographic results.Methods: Thirty-six patients (thirty-eight hips) in whom a painful dysplastic hip had been treated with a periacetabular osteotomy between March 1991 and June 1999 were included in the study. There were thirty-five female patients and one male patient with a mean age (and standard deviation) at the operation of 29.42 ± 9.1 years. The technique utilizes a u-shaped skin incision, and a routine osteotomy of the greater trochanter with distal transfer if needed, and allows excellent visualization enabling the surgeon to perform the periacetabular osteotomy without penetrating the joint.Results: At a mean of five years and six months postoperatively, the mean modified Harris hip score had improved from 59.1 ± 15.8 points preoperatively to 87.97 ± 14.3 points. Radiographically, the degree of osteoarthrosis had decreased in eleven hips, remained unchanged in twenty-four, and worsened in three. The mean anterior center-edge angle had increased from 22.0° ± 12.9° to 36.1° ± 12.3°, the mean lateral center-edge angle had increased from -2.7° ± 14.4° to 26.6° ± 14.1°, the mean acetabular index angle had improved from 23.4° ± 6.6° to 12.7° ± 4.6°, and the mean acetabular head index had increased from 48.2% ± 12.7% to 73.1% ± 16.0%. The Shenton line was restored in eleven hips. Thirty patients (thirty-two hips; 84%) had a satisfactory result. A poor preoperative functional score was associated with an unsatisfactory outcome (p = 0.00191). Complications included prolonged limping (eleven hips); numbness in the distribution of the lateral femoral cutaneous nerve (four); osteonecrosis of the rotated acetabular fragment (two); and acetabulofemoral impingement, heterotopic ossification, and a defect on the rotated ilium (one hip each).Conclusions: Painful dysplastic hips should be treated before function becomes seriously impaired. We believe that periacetabular osteotomy through a modified Ollier approach, which allows osseous cuts to be made under direct vision, can be learned readily. It provides improved femoral head coverage and relief of symptoms in most painful dysplastic hips in adolescents and young adults.
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
改良经粗隆入路行髋臼周围截骨术治疗疼痛性发育不良髋
背景:消除异常高关节负荷导致的过度接触应力可能预防或减少发育不良髋关节骨关节病的发生。许多髋臼周围截骨术已被证明在恢复正常髋关节力学方面是有效的。我们通过改良的Ollier经粗隆入路行髋臼周围截骨术治疗髋臼发育不良。在这篇报告中,我们描述了手术技术和临床及影像学结果。方法:1991年3月至1999年6月间,36例(38髋)髋臼周围截骨术治疗疼痛性发育不良髋。女性35例,男性1例,手术时平均年龄(及标准差)为29.42±9.1岁。该技术采用u形皮肤切口和常规大转子截骨术,必要时可进行远端骨转移,使外科医生能够在不穿透关节的情况下进行髋臼周围截骨术。结果:术后5年6个月,改良Harris髋关节平均评分由术前59.1±15.8分提高到87.97±14.3分。x线摄影显示,11例髋关节骨关节病程度下降,24例保持不变,3例恶化。平均前中心边缘角由22.0°±12.9°增加到36.1°±12.3°,平均外侧中心边缘角由-2.7°±14.4°增加到26.6°±14.1°,平均髋臼指数由23.4°±6.6°增加到12.7°±4.6°,髋臼头指数由48.2%±12.7%增加到73.1%±16.0%。11个髋部恢复了申顿线。30例患者(32髋;84%)获得满意的结果。术前功能评分差与预后不理想相关(p = 0.00191)。并发症包括长时间跛行(11髋);股外侧皮神经分布麻木(四);旋转髋臼碎片骨坏死(2例);髋股撞击,异位骨化,旋转髂骨缺损(各一个髋关节)。结论:疼痛性发育不良髋应在功能严重受损前治疗。我们相信,通过改进的Ollier入路进行髋臼周围截骨术,可以在直接视觉下进行骨切割,可以很容易地学习。它改善了股骨头覆盖范围,缓解了青少年和年轻人最痛苦的发育不良髋关节的症状。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
Corticosteroid Effects on Upper Esophageal Sphincter Function in Anterior Cervical Discectomy and Fusion: A Study Using High-Resolution Impedance Manometry. Early Sagittal Shape of the Spine Predicts Scoliosis Development in a Syndromic (22q11.2DS) Population: A Prospective Longitudinal Study. Dual-Mobility Articulations in Revision Total Hip Arthroplasty: A Comparison with Metal or Ceramic on Highly Cross-Linked Polyethylene and Constrained Articulations. To Provide Care, or to Care for?: The Influence of Language on Medicine. A Computer Modeling-Based Target Zone for Transposition Osteotomy of the Acetabulum in Patients with Hip Dysplasia.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1