Dynamic hip kinematics before and after periacetabular osteotomy in patients with dysplasia
Dynamic hip kinematics before and after periacetabular osteotomy in patients with dysplasia
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DOI：
10.1016/j.jos.2019.03.019
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发表时间：
2020-03-01
影响因子：
1.7
通讯作者：
Nakashima，Yasuharu
中科院分区：
文献类型：
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作者：
Yoshimoto，Kensei;Hamai，Satoshi;Nakashima，Yasuharu
背景资料：我们前瞻性分析了髋关节发育不良（DDH）患者髋臼周围截骨术（PAO）前后的髋关节运动学以及健康受试者蹲位时的髋关节运动学，以确定股骨头覆盖对髋关节运动学的影响。方法：DDH患者14例14髋，健康志愿者10例10髋。获得蹲位时的连续X线片和计算机断层扫描图像，以使用基于密度的3D到2D模型到图像配准技术评估髋关节的体内运动学和边缘-颈部距离。结果：PAO前后的最大髋关节屈曲角分别为100.4和94.9（p <$0.0863）。PAO后的最大髋关节屈曲角与正常髋关节的最大髋关节屈曲角无显著差异（102.2; p <0.2552）。PAO前后最大髋关节屈曲时的髋关节外展角分别为31.7和26.2（p <$0.1256）。边缘-颈部距离从平均12.2 mm e8降低。PAO后9 mm（p ¼ 0.0044）。外侧中心边缘角（LCEA）和前中心边缘角（ACEA）显著改善14.7 e42。4和50.4 e54。PAO后ACEA分别为0（p< 0.0001，p <0.0347）;特别是，PAO后ACEA与正常髋关节无显著差异（p <0.1917）。ACEA与髋关节屈曲或股骨颈边缘距离无关（p <0.9601，0.8764）。LCEA也与髋关节外展无关（p <0.1683）。结论：PAO后患者在蹲位时的最大髋关节屈曲度与PAO前和正常髋关节相比无显著差异。水平负重髋臼和标准化ACEA可以充分矫正髋臼碎片，以恢复髋关节RoM，而不会导致PAO后无法进行下蹲的髋痛。
Background: We prospectively analyzed the hip kinematics in patients with developmental dysplasia of the hip (DDH) before and after periacetabular osteotomy (PAO) and in healthy subjects while squatting to determine the influence of coverage of the femoral head on hip kinematics. Methods: 14 hips in 14 patients with DDH and 10 hips in 10 volunteers were included. Continuous radiographs while squatting and computed tomography images were obtained to assess the in vivo kinematics of the hip and the rim-neck distance using density-based 3D-to-2D model-to-image registration techniques.Results: The maximum hip flexion angles were 100.4 and 94.9 before and after PAO (p ¼ 0.0863), respectively. The maximum hip flexion angles after PAO did not significantly differ from those of normal hips (102.2; p ¼ 0.2552). The hip abduction angles at maximum hip flexion were 31.7 and 26.2 before and after PAO (p ¼ 0.1256), respectively. The rim-neck distance decreased from averaged 12.2 mm e8. 9 mm (p ¼ 0.0044) after PAO. The lateral center edge angle (LCEA) and anterior center edge angle (ACEA) significantly improved 14.7 e42. 4 and 50.4 e54. 0 after PAO (p< 0.0001, p ¼ 0.0347), respectively; in particular, the ACEA after PAO did not significantly differ from that in the normal hips (p ¼ 0.1917). The ACEA was not correlated with hip flexion, or the rim-neck distance (p ¼ 0.9601, 0.8764). The LCEA was also not correlated with hip abduction (p ¼ 0.1683). Conclusion: Patients after PAO showed no significant difference in maximum hip flexion while squatting compared to before PAO and normal hips. Horizontalized weight-bearing acetabulum with normalized ACEA could be adequate correction of the acetabular fragment to restore hip RoM without coxalgia that induce the inability to perform squats after PAO.