Preoperative Rather Than Postoperative Intra-Articular Cartilage Degeneration Affects Long-Term Survivorship of Periacetabular Osteotomy
Preoperative Rather Than Postoperative Intra-Articular Cartilage Degeneration Affects Long-Term Survivorship of Periacetabular Osteotomy
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术前而不是术后关节内软骨退变影响髋臼周围截骨术的长期生存
DOI：
10.1016/j.arthro.2021.01.060
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Noguchi Yasuo
中科院分区：
文献类型：
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作者：
Fujii Masanori;Nakashima Yasuharu;Kitamura Kenji;Motomura Goro;Hamai Satoshi;Ikemura Satoshi;Noguchi Yasuo
目的探讨髋臼周围截骨术（PAO）术后短期随访中关节内病变是否发生改变，以及关节内病变的改变是否影响PAO的长期生存。方法回顾1990年至2001年间，通过关节镜观察行PAO手术的髋关节发育不良患者。接受二次关节镜检查的患者也包括在内。分析bbb10年随访患者关节内病变改变与PAO远期预后的相关性。可能的危险因素包括人口统计学因素（年龄、性别和体重指数）、影像学因素（Tönnis分级、外侧中缘角、Tönnis角、髋臼头指数、交叉征、后壁征和关节一致性）和关节镜检查结果（PAO时全层病变和二次关节镜检查时病变变化）。结果共研究64例患者（72髋）。PAO术后中位1.4年进行二次关节镜检查。关节内病变分别发生在髋臼93%，股骨头81%，唇部97%。74%的髋臼、76%的股骨头和79%的唇部病变不变。髋臼和股骨头软骨修复分别占24%和17%。10%的患者出现唇部修复。关节内病变改变不是失败的预测因子。多因素分析表明，国际软骨修复学会评定的股骨头4级病变是手术失败的独立危险因素。结论PAO可防止轻度软骨病变的进一步恶化，并在短期内修复部分晚期软骨变性患者的软骨。然而，这些术后变化与长期生存率无关。因此，基于术前关节内软骨退变的适当手术指征对于PAO的长期成功至关重要。证据水平：IV级，治疗性研究。
PurposeTo determine whether intra-articular lesions changed in short-term follow-up after periacetabular osteotomy (PAO) and whether the intra-articular lesion changes impacted the long-term survivorship of PAO.MethodsWe reviewed patients with hip dysplasia who underwent PAO with arthroscopic observation between 1990 and 2001. Patients who underwent second-look arthroscopy were included. The correlations between the intra-articular lesion changes and the long-term outcome of PAO were analyzed for patients with >10 years of follow-up. The possible risk factors included demographic factors (age, sex, and body mass index), radiographic factors (Tönnis grade, lateral center-edge angle, Tönnis angle, acetabular head index, crossover sign, posterior wall sign, and joint congruity), and arthroscopic findings (full-thickness lesions at the time of PAO and lesions changes at the time of second-look arthroscopy).ResultsA total of 64 patients (72 hips) were studied. Second-look arthroscopy was performed at a median of 1.4 years after PAO. Intra-articular lesions were observed in 93% in the acetabulum, 81% in the femoral head, and 97% in the labrum, respectively. These lesions unchanged in 74% in the acetabulum, 76% in the femoral head, and 79% in the labrum, respectively. Cartilage repair was observed in the acetabulum and the femoral head in 24% and 17% of hips, respectively. Labral repair occurred in 10%. Intra-articular lesion changes were not a predictor of failure. Multivariate analysis identified International Cartilage Repair Society grade 4 lesion in the femoral head as an independent risk factor for failure.ConclusionsOur results suggest that PAO prevents further deterioration in mild cartilage lesions and results in cartilage repair in some cases with advanced cartilage degenerations in the short term. However, these postoperative changes were not associated with long-term survivorship. Thus, appropriate surgical indications based on the preoperative intra-articular cartilage degeneration is paramount to achieving long-term success in PAO.Level of EvidenceLevel IV, therapeutic study.