Bernese髋臼周围截骨治疗髋臼发育不良

Bernese periacetabular osteotomy for the treatment of acetabular dysplasia

背景:改变髋臼朝向是纠正髋臼发育不良的最好方法,而Bernese髋臼周围截骨是当前最常应用也是最成功的治疗方法之一。目的:总结分析Bernese髋臼周围截骨的适应证及技术和影响效果的因素,以期更好的应用于临床。方法:使用"Bernese osteotomy,Ganz osteotomy,periacetabular ostetomy"作为关键词,采用计算机检索PubMed、Elsevier和Springer数据库中2012年12月以前的相关文章。纳入与Bernese髋臼周围截骨治疗在髋臼发育不良患者中临床应用的相关文献;排除重复研究和Meta分析类文章。重点对Bernese髋臼周围截骨治疗的适应证及技术和治疗效果的影响因素进行综合分析。结果与结论:计算机初检得到483篇文献,根据纳入排除标准,对其中43篇文献进行分析。Bernese截骨术是采用改良的Smith-Peterson入路在髋臼周围进行多边形截骨。虽然手术技术逐渐改进,但是主要截骨步骤一直保持不变,只是改良了软组织松解方法。影响Bernese髋臼周围截骨治疗后效果的直接因素是影像学上髋关节退变和发育不良的严重程度。将来随着对髋关节畸形理解的深入,Bernese髋臼周围截骨治疗的指征、技术方式也将得到发展。

BACKGROUND：Changing the acetabular orientation is the best method for the treatment of acetabular dysplasia, and Bernese periacetabular osteotomy is one of the most commonly used and successful treatment methods. OBJECTIVE：To review and analyze the operation indication, surgical technique and influencing factors of Bernese periacetabular osteotomy for better clinical application. METHODS：The PubMed database, Elsevier database and Springer database were retrieved for related articles published before December 2012 with the key words of“Bernese osteotomy, Ganz osteotomy, periacetabular ostetomy”. The articles that related to the clinical application of Bernese periacetabular osteotomy in patients with acetabular dysplasia were enrol ed in this study. Repetitive studies and Meta analysis were excluded. And the analysis emphasis was put on the operation indication, surgery technique and influencing factors of Bernese periacetabular osteotomy. RESULTS AND CONCLUSION：A total of 483 articles were screened out after primary computer-based online research. And according to the exclusion criteria, 43 articles were selected for review. Bernese periacetubular osteotomy was performed through polygonous osteotomy around the acetabula by modified Smith-Peterson approach. The surgical technology was improved gradual y, but the major osteotomy procedures never changed, only the soft tissue release method was modified. The direct factors that influence the surgical effect of Bernese periacetabular osteotomy are the degree of radiographic hip degeneration and dysplasia. In the future, with the in-depth understanding of hip deformity, the operation indication and technique of Bernese periacetabular osteotomy wil also developed.