经髂腹股沟入路伯尔尼髋臼周围截骨术后并发症:182例回顾性分析

Complications of Bernese periacetabular osteotomy through ilioinguinal approach:A retrospective analysis of 182 cases

目的:经髂腹股沟入路髋臼周围截骨术是一项对术者技术要求很高的手术,也意味着它存在一个非常陡峭的学习曲线,在早期往往会遇到比较严重的并发症。统计分析经髂腹股沟入路髋臼周围截骨术存在的手术并发症,探讨如何从手术方法上减少并发症的发生,从而缩短学习曲线。方法:选择1997-10/2007-05北京积水潭医院矫形骨科进行的伯尔尼髋臼周围截骨术患者182例202髋。男17例,女165例;年龄12～48岁,平均27岁。患者手术前后均测量了CE角、AC角并进行了Harris评分。对该组患者术后并发症进行回顾分析。结果:182例全部进入结果分析。①患者术前外侧CE角平均为2.94°,AC角平均为27.7°,前方CE角平均为8.94°,术后外侧CE角平均为30.1°,AC角平均为5.5°,前方CE角平均为26.9°。②患者术前Harris评分平均87分,术后平均93分。③共有42例出现术后并发症,占总病例数的20.8%。与截骨相关的并发症有关节内截骨2例,截骨矫正不足或过度矫正5例,耻骨支截骨不愈合8例,因患者没有症状或症状轻微,未进行处理,内固定失效1例;血管神经并发症有股静脉损伤2例,术后下肢静脉血栓5例,股神经损伤1例,坐骨神经损伤1例,股外侧皮神经永久性损伤9例;膀胱功能障碍2例;切口疝4例;男性性功能障碍2例。上述并发症中发生在早期经验不足阶段约为81%。结论:经髂腹股沟入路髋臼周围截骨术是治疗成人髋臼发育不良非常有效的手术方法,因手术方法技术要求高,约81%并发症发生在早期经验不足阶段。

AIM： The Bernese periacetabular osteotomy （PAO） through ilioinguinal approach requires a high specification of surgeons and an extremely steep learning curve. Severe complications may appear at the early stage. The purpose of this study is to analyze the complications of the Bernese PAO through ilioinguinal approach, find how to reduce the frequency of the complications by surgeries and shorten the learning curve. METHODS： Totally 182 cases （202 hips） underwent the Bernese PAO in Department of Orthopaedics, Beijing Jishuitan Hospital between October 1997 and May 2007, were adopted in this study. They included 17 males and 165 females, aged 12-48 years with a mean of 27. Before and after operation, the patients were respectively measured for CE angle and AC angle, as well as progressed Harris Score. A retrospective analysis was conducted for the postoperative complications of these patients. RESULTS： All the 182 cases were involved in the result analysis, ①Before and after operation, the mean lateral CE angle of the patients was 2.94° and 30.1°, mean AC angle was 27.7° and 5.5°, mean anterior CE angle was 8.94° and 26.9°, separately.②Harris scores of the patients were 87 preoperation and 93 postoperation. ③Complications were happened in 42 cases, accounting for 20.8%. Complications related to osteotomy included intraarticular osteotomy in 2 cases, under-reorientation or over-reorientation of the acetabular fragment in 5 cases, nonunions of pubic osteotomy in 8 cases and failure of internal fixation in 1 untreated case, due to none or mild symptom presence. Neurovascular complications included femoral vein injury in 2 cases, postoperative deep venous thrombosis in 5 cases, femoral nerve injury in 1 case, sciatic nerve injury in 1 case and lateral femoral cutaneous nerve permanent injury in 9 cases. Additionally there were 2 cases with bladder dysfunction, 4 with incisional herniation and 2 male patients with erectile dysfunction. 81% of these complications appeared at the early stage, which lacked the experiences. CONCLUSION： Bernese PAO through ilioinguinal approach is an effective procedure for the treatment of adult acetabular dysplasia, and 81% complications happen in the early period without much experience, owing to the high demand for technique skill.