Impingement Adversely Affects 10-year Survivorship After Periacetabular Osteotomy for DDH
Impingement Adversely Affects 10-year Survivorship After Periacetabular Osteotomy for DDH
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DOI：
10.1007/s11999-013-2799-8
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发表时间：
2013-05-01
影响因子：
4.2
通讯作者：
Siebenrock, Klaus A.
中科院分区：
文献类型：
--
作者：
Albers, Christoph E.;Steppacher, Simon D.;Siebenrock, Klaus A.
虽然髋臼周围截骨术（PAO）治疗髋关节发育不良（DDH）与其他截骨术相比具有概念上的优势，并且据报道20年时关节存活率为60%，但髋臼适当重新定向伴关节切开术和股骨头颈偏心距对10年髋关节存活率的有益影响仍不清楚。我们提出了以下问题：（1）通过适当的髋臼重新定向和球形股骨头，PAO后髋关节的10年生存率是否得到改善;（2）Merle d 'Aubign，-Postel评分是否得到改善;（3）骨关节炎（OA）的进展是否可以减缓;（4）哪些因素可以预测转为THA、OA进展或Merle d' Aubign，-Postel评分低于15分？我们回顾性分析了147例接受165例PAO治疗DDH的患者，分为两组：组I（正确重新定向和球形股骨头）和组II（不正确重新定向和非球形股骨头）。我们比较了两组的Kaplan-Meier生存率、Merle d 'Aubign、-Postel评分和OA进展。进行考克斯回归分析（终点：THA、OA进展或Merle d 'Aubign，-Postel评分小于15），以检测预测失败的因素。最短随访时间为10年（中位数为11年，范围为10-14年）。Merle d 'Aubign-Postel评分无差异。组I中OA的进展慢于组II。预测失败的因素包括年龄较大、术前Merle d 'Aubign-Postel评分较低、Trendelenburg征、非球面股骨头、OA、半脱位、术后髋臼后倾、髋臼过度前倾和覆盖不足。适当的髋臼重新定向和球形股骨头的形成可提高DDH患者的长期生存率并减缓OA进展。III级，治疗研究。有关证据等级的完整描述，请参见作者指南。
Although periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH) provides conceptual advantages compared with other osteotomies and reportedly is associated with joint survivorship of 60% at 20 years, the beneficial effect of proper acetabular reorientation with concomitant arthrotomy and creation of femoral head-neck offset on 10-year hip survivorship remains unclear.We asked the following questions: (1) Does the 10-year survivorship of the hip after PAO improve with proper acetabular reorientation and a spherical femoral head; (2) does the Merle d'Aubign,-Postel score improve; (3) can the progression of osteoarthritis (OA) be slowed; and (4) what factors predict conversion to THA, progression of OA, or a Merle d'Aubign,-Postel score less than 15 points?We retrospectively reviewed 147 patients who underwent 165 PAOs for DDH with two matched groups: Group I (proper reorientation and spherical femoral head) and Group II (improper reorientation and aspherical femoral head). We compared the Kaplan-Meier survivorship, Merle d'Aubign,-Postel scores, and progression of OA in both groups. A Cox regression analysis (end points: THA, OA progression, or Merle d'Aubign,-Postel score less than 15) was performed to detect factors predicting failure. The minimum followup was 10 years (median, 11 years; range, 10-14 years).An increased survivorship was found in Group I. The Merle d'Aubign,-Postel score did not differ. Progression of OA in Group I was slower than in Group II. Factors predicting failure included greater age, lower preoperative Merle d'Aubign,-Postel score, and the presence of a Trendelenburg sign, aspherical head, OA, subluxation, postoperative acetabular retroversion, excessive acetabular anteversion, and undercoverage.Proper acetabular reorientation and the creation of a spherical femoral head improve long-term survivorship and decelerate OA progression in patients with DDH.Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.