髋臼周围截骨治疗对发育性髋关节发育不良骨盆矢状位倾斜的影响

Effect of periacetabular osteotomy on pelvic sagittal tilt in developmental dysplasia of hip

背景:发育性髋关节发育不良指髋臼、股骨近端存在骨性结构畸型,可导致髋关节不稳及髋骨关节炎。髋臼周围截骨术是青少年及成年人非终末期发育性髋关节发育不良治疗的主要方式。骨盆倾斜在髋关节生物力学中发挥至关重要的作用,它決定了髋关节的应力方向。在髋关节疾病中可出现骨盆代偿性倾斜,以尽量减少髋关节的异常应力。目的:观察发育性髋关节发育不良患者行髋臼周围截骨治疗是否改变患者骨盆矢状位倾斜,并探讨髋臼覆盖对骨盆矢状位倾斜的影响。方法:回顾性分析2019年8月至2022年6月在四川大学华西医院因发育性髋关节发育不良行髋臼周围截骨的患者29例,收集患者术前及术后6个月站立位骨盆正位X射线片,测量髋关节外侧中心边缘角、通力氏角、耻骨联合到骶髂关节距离、耻骨联合到骶髂关节连线中点距离、骶骨-股骨头-耻骨角及骨盆矢状位倾斜;所有患者均于术前及术后6个月采用髋关节残疾及骨关节炎评分及Harris评分行髋关节功能评估。结果与结论:(1)与术前相比,术后6个月髋关节外侧中心边缘角、耻骨联合到骶髂关节连线中点距离、骶骨-股骨头-耻骨角均较术前显著增大(P <0.05);而通力氏角及骨盆矢状位倾斜则显著减小(P <0.05);耻骨联合到骶髂关节距离与术前无明显差异(P> 0.05);(2)术后6个月髋关节残疾及骨关节炎评分及Harris评分均较术前显著提高(P <0.01);(3)提示髋臼周围截骨显著改善了发育性髋关节发育不良患者的髋臼覆盖,且骨盆出现显著前倾改变。

BACKGROUND:Developmental dysplasia of hip refers to the deformity of acetabulum and proximal femur,which can lead to hip instability and hip osteoarthritis.Periacetabular osteotomy is the main treatment for non-terminal developmental dysplasia of hip in adolescents and adults.Pelvic inclination plays an important role in biomechanics of hip joint,which determines the stress direction of hip joint.In hip joint diseases,pelvic compensatory tilt can occur to minimize the abnormal stress of hip joint.OBJECTIVE:To observe whether periacetabular osteotomy changes pelvic sagittal tilt in patients with developmental dysplasia of hip,and to investigate the effect of acetabular covering on pelvic sagittal tilt.METHODS:A retrospective analysis was performed on 29 patients who underwent periacetabular osteotomy due to developmental dysplasia of hip in West China Hospital of Sichuan University from August 2019 to June 2022.Anteroposterior X-rays of the standing pelvis were collected before and 6 months after surgery.The pelvic tilt parameters,including the lateral center-edge angle,pubic symphysis to sacroiliac joint distance,pubic symphysis to sacroiliac joint midline distance,sacrofemoral-pubic angle,and pelvic tilt,were measured.Hip functions of all patients were assessed by hip disability and osteoarthritis score and Harris score before and 6 months after surgery.RESULTS AND CONCLUSION:(1)The lateral center-edge angle,pubic symphysis to sacroiliac joint midline distance,and sacrofemoral-pubic angle were significantly increased 6 months postoperatively compared to preoperative values(P<0.05).Tonnis angle and pelvic tilt were significantly decreased(P<0.05).There was no significant difference in pubic symphysis to sacroiliac joint distance between preoperative and postoperative measurements(P>0.05).(2)The hip disability and osteoarthritis scores and Harris scores were significantly increased 6 months after operation(P<0.01).(3)It is indicated that periacetabular osteotomy surgery can significantly improve acetabular coverage and the pelvis showed significant anteversion changes in patients with developmental dysplasia of hip.