Травматология и ортопедия России. 2021; 27: 131-142
Периацетабулярная остеотомия таза при лечении пациентов с дисплазией тазобедренного сустава
https://doi.org/10.21823/2311-2905-2021-27-1-131-142Аннотация
Актуальность. При наличии дисплазии тазобедренного сустава (ТБС) I типа по классификации Crowe или типа А по Hartofilakidis и отсутствии тяжелых дегенеративных изменений методом лечения молодых активных пациентов все чаще становятся остеотомии таза. На сегодняшний день периацетабулярная остеотомия (ПАО) таза по Ganz является наиболее частым выбором хирургов при лечении подобных пациентов.
Целью исследования явилась оценка рентгенологических и функциональных результатов лечения пациентов с дисплазией ТБС, которым выполнялась ПАО таза по Ganz.
Материал и методы. Был проведен одноцентровый ретроспективный анализ 49 ПАО по Ganz у 43 пациентов в возрасте 36±9 лет. Рентгенологическими критериями оценки были углы Wiberg (AW), Lequesne (AL), Tonnis (AT), медиализация сустава. Результаты лечения оценивали с использованием шкалы Харриса, iHOT-12 и ВАШ до лечения и через 1 год после, отслеживали наличие осложнений.
Результаты. Средний срок наблюдения составил 35±15 мес. (от 1,0 года до 6,9 лет). Рентгенологические параметры улучшились после операции по сравнению с предоперационными: AW +19,9° (17,1° против 37,0°), AT -11,5° (19,9° против 8,4°), AL +14,1° (25,1° против 39,2°), медиализация сустава -5,5 мм (14,3 мм против 8,8 мм) (р<0,001). Функциональные результаты и качество жизни пациентов также улучшились: шкала Харриса +35,6 баллов (47 против 83 баллов), iHOT-12 +40,9 баллов (44 против 85 баллов), уровень боли -2,8 балла (5 против 2 баллов) (р<0,001). Различные осложнения развились в 20 случаях из 49 (40,8%). Неврологические осложнения были разрешены консервативно-восстановительным путем (22,4%). Была установлена прямая корреляционная взаимосвязь между наличием в анамнезе оперативного лечения дисплазии в детском возрасте и развитием неврологических осложнений после ПАО (R = 0,76; р<0,001). В 9 случаях из 49 (18,4%) потребовалось повторное вмешательство: в 3 — тотальное эндопротезирование, в 2 — переориентация вертлужной впадины, в 4 — артроскопическая фиксация передней суставной губы. В 93,9% случаев удалось сохранить собственный сустав.
Заключение. ПАО таза по Ganz обладает хорошими реконструктивными возможностями и достаточной эффективностью. Операция позволяет восстановить покрытие головки бедренной кости вертлужной впадиной, отсрочить эндопротезирование ТБС и обеспечивает улучшение функциональных результатов.
Список литературы
1. Gala L., Clohisy J.C., Beaule P.E. Hip dysplasia in the young adult. J Bone Joint Surg Am. 2016;98(1):63-73. doi: 10.2106/jbjs.o.00109.
2. Shibata K.R, Matsuda S., Safran M.R. Open treatment of dysplasia – other than PAO: does it have to be a PAO? J Hip Preserv Surg. 2015;4(2):131-144. doi: 10.1093/jhps/hnv028.
3. Ramirez-Nunez L., Payo-Ollero J., Comas M., Cardenas C., Bellotti V., Astarita E., Chacon-Cascio G., Ribas M. Osteotomia periacetabular en el tratamiento de displasia de cadera mediante tecnica mini-invasiva. Nuestros resultados a medio plazo en 131 casos. Rev Esp Cir Ortop Traumatol. 2020;64(3):151-159. doi: 10.1016/j.recot.2020.01.003.
4. Герасимов С.А., Корыткин А.А., Герасимов Е.А., Ковалдов К.А., Новикова Я.С. Остеотомии таза как метод лечения дисплазии тазобедренного сустава. Современное состояние вопроса. Современные проблемы науки и образования. 2018;(4):160. Режим доступа: http://science-education.ru/ru/article/view?id=27765.
5. Gerasimov S.A., Korytkin A.A., Gerasimov E.A., Kovaldov K.A., Novikova Ya.S. [Pelvic osteotomies as a treatment option for development dysplasia of the hip. current concepts]. Sovremennyye problemy nauki i obrazovaniya [Modern Problems of Science and Education]. 2018;(4):160. (In Russ.). Available from: http://science-education.ru/ru/article/view?id=27765.
6. Steppacher S.D., Tannast M., Ganz R., Siebenrock K.A. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. 2008;466(7):1633-1644. doi: 10.1007/s11999-008-0242-3.
7. Alcobia Diaz B., Luque Perez R., Garcia Bullon I., Moro Rodriguez L.E., Lopez-Duran Stern L. Long-term clinical and radiological outcomes in a series of 26 cases of symptomatic adult developmental dysplasia of the hip managed with Bernese periacetabular osteotomy. Rev Esp Cir Ortop Traumatol. 2015;59(6):421-428. doi: 10.1016/j.recot.2015.04.001.
8. Ganz R., Klaue K., Vinh T.S., Mast J.W. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res. 1988;232:26-36. doi: 10.1097/00003086-198807000-00006.
9. Kamath A.F. Bernese periacetabular osteotomy for hip dysplasia: surgical technique and indications. World J Orthop. 2016;7(5):280-286. doi: 10.5312/wjo.v7.i5.280.
10. Руководство по хирургии тазобедренного сустава. Под ред. Р.М. Тихилова, И.И. Шубнякова. СПб.: РНИИТО им. Р.Р. Вредена, 2014. Т.1. С. 47-61.
11. Guide to hip surgery. Ed. by R.M. Tikhilov, I.I. Shubnyakov. SPb.: RNIITO im. R.R. Vredena, 2014. Vol.1. P. 47-61. (In Russ.).
12. The adult hip – hip preservation surgery. Ed. by J. Clohisy, P. Beaule, C. Della Valle, J. Callaghan, A. Rosenberg, H. Rubash. Wolters Kluwer, 2015. 762 p.
13. Matheney T., Kim Y.J., Zurakowski D., Matero C., Millis M. Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Am. 2010;92(Suppl. 1):115-129. doi: 10.2106/jbjs.j.00646.
14. Gray B.L., Stambough J.B., Baca G.R., Schoenecker P.L., Clohisy J.C. Comparison of contemporary periacetabular osteotomy for hip dysplasia with total hip arthroplasty for hip osteoarthritis. Bone Joint J. 2015;97-B(10):1322-1327. doi: 10.1302/0301-620X.97B10.35741.
15. Kalore N.V., Cheppalli S.P.R., Daner W.E., Jiranek W.A. Acetabular dysplasia in middle-aged patients: periacetabular osteotomy or total hip arthroplasty? J Arthroplasty. 2016;31(9):1894-1898. doi: 10.1016/j.arth.2016.02.032.
16. Pascual-Garrido C., Harris M.D., Clohisy J.C. Innovations in joint preservation procedures for the dysplastic hip «the periacetabular osteotomy». J Arthroplasty. 2017;32(9):S32-S37. doi: 10.1016/j.arth.2017.02.015.
17. The hip: preservation, replacement, and revision. Ed. by J. Cashman, N. Goyal, J. Parvizi. Brooklandville, 2015. Vol. 1. 770 p.
18. Rudin D., Manestar M., Ullrich O., Erhardt J., Grob K. The anatomical course of the lateral femoral cutaneous nerve with special attention to the anterior approach to the hip joint. J Bone Joint Surg Am. 2016;98(7):561-567. doi: 10.2106/jbjs.15.01022.
19. Khan O.H., Malviya A., Subramanian P., Agolley D., Witt J.D. Minimally invasive periacetabular osteotomy using a modified Smith-Petersen approach: technique and early outcomes. Bone Joint J. 2017;99-B(1):22-28. doi: 10.1302/0301-620x.99b1.bjj-2016-0439.r1.
20. Luo D., Zhang H., Zhang W. Comparison of three approaches of Bernese periacetabular osteotomy. Ther Clin Risk Manag. 2016;67. doi: 10.2147/tcrm.s81914.
21. Ali M., Malviya A. Complications and outcome after periacetabular osteotomy – influence of surgical approach. Hip Int. 2019;30(1):4-15. doi: 10.1177/1120700019871195.
22. Гахраманов А.Г. Осложнения после периацетабулярной остеотомии. Казанский медицинский журнал. 2016;97(5):696-700. doi: 10.17750/KMJ2016-696.
23. Gakhramanov A.G. [Complications after periacetabular osteotomy]. Kazanskii meditsinskii zhurnal [Kazan medical journal]. 2016;97(5):696-700. doi: 10.17750/KMJ2016-696. (In Russ.).
24. Samuel L.T., Munim M., Acuna A.J., Sultan A.A., Kamath A.F. Modified iliac spine wafer osteotomy for exposure during Bernese periacetabular osteotomy. J Hip Preserv Surg. 2019;6(4):421-425. doi: 10.1093/jhps/hnz061.
25. Clohisy J.C., Ackerman J., Baca G., Baty J., Beaule P.E., Kim Y.J. et al. Patient-reported outcomes of periacetabular osteotomyfrom the prospective ANCHOR cohort study. J Bone Joint Surg Am. 2017;99(1):33-41. doi: 10.2106/jbjs.15.00798.
26. Ziebarth K., Balakumar J., Domayer S., Kim Y.J., Millis M.B. Bernese periacetabular osteotomy in males: is there an increased risk of femoroacetabular impingement (FAI) after Bernese periacetabular osteotomy? Clin Orthop Relat Res. 2010;469(2):447-453. doi: 10.1007/s11999-010-1544-9.
27. Duncan S.T., Bogunovic L., Baca G., Schoenecker P.L., Clohisy J.C. Are there sexdependent differences in acetabular dysplasia characteristics? Clin Orthop Relat Res. 2015;473(4):1432-1439. doi: 10.1007/s11999-015-4155-7.
28. Novais E.N., Potter G.D., Clohisy J.C., Millis M.B., Kim Y.J., Trousdale R.T., Carry P.M., Sierra R.J. Obesity is a major risk factor for the development of complications after periacetabular osteotomy. Bone Joint J. 2015;97-B(1):29-34. doi: 10.1302/0301-620x.97b1.34014.
29. Shang J., Zhang Z., Luo D., Cheng H., Zhang H. Effectiveness of multi‐modal blood management in Bernese periacetabular osteotomy and periacetabular osteotomy with proximal femoral osteotomy. Orthop Surg. 2020;9999:1-5. doi: 10.1111/os.12794.
30. Clohisy J.C., Schutz A.L., St. John L., Schoenecker P.L., Wright R.W. Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res. 2009;467(8):2041-2052. doi: 10.1007/s11999-009-0842-6.
31. Swarup I., Ricciardi B.F., Sink E.L. Avoiding complications in periacetabular osteotomy. JBJS Rev. 2015; 3(11):1-9. doi: 10.2106/jbjs.rvw.o.00023.
32. Novais E.N., Carry P.M., Kestel L.A., Ketterman B., Brusalis C.M., Sankar W.N. Does surgeon experience impact the risk of complications after Bernese periacetabular osteotomy? Clin Orthop Relat Res. 2016;475(4):1110-1117. doi: 10.1007/s11999-016-5010-1.
33. Ricciardi B.F., Fields K.G., Wentzel C., Nawabi D.H., Kelly B.T., Sink E.L. Complications and short-term patient outcomes of periacetabular osteotomy for symptomatic mild hip dysplasia. Hip Int. 2016;27(1):42-48. doi: 10.5301/hipint.5000420.
34. Malviya A., Dandachli W., Beech Z., Bankes M.J., Witt J.D. The incidence of stress fracture following peri-acetabular osteotomy: an underreported complication. Bone Joint J. 2015;97-B(1):24-28. doi: 10.1302/0301-620x.97b1.34525.
Traumatology and Orthopedics of Russia. 2021; 27: 131-142
Periacetabular Pelvic Osteotomy in Treatment of Patients with Developmental Dysplasia of the Hip
https://doi.org/10.21823/2311-2905-2021-27-1-131-142Abstract
Background. Pelvic osteotomies are widely used for treatment of young active patients with developmental dysplasia of the hip (DDH) Type I according to the Crowe or type A according to Hartofilakidis classifications and the absence of severe degenerative cartilage lesions. Nowadays, Ganz periacetabular osteotomy (PAO) is the most common choice of surgeons around the world in treatment of such patients.
The aim of the study was to evaluate the radiological and functional results of Ganz periacetabular osteotomy in patients with DDH.
Material and Methods. A single-center retrospective analysis of 49 Ganz PAO was performed in 43 patients aged 36±9 years. The radiological evaluation criteria were Wiberg (AW), Lequesne (AL), Tonnis (AT) angles, and joint medialization. The results of treatment were evaluated using the Harris scale, iHOT-12, and VAS before treatment and 1 year after, the presence of complications was also monitored.
Results. The average follow-up period was 35±15 months (from 1.0 to 6.9 years). Radiological parameters improved after surgery compared to preoperative ones: AW +19.9° (17.1° vs. 37.0°), AT -11.5° (19.9° vs. 8.4°), AL +14.1° (25.1° vs. 39.2°), joint medialization -5.5 mm (14.3 mm vs. 8.8 mm) (p<0.001). Functional results and quality of life of patients also improved: the Harris scale +35.6 points (47 vs 83 points), iHOT-12 +40.9 points (44 vs 85 points), pain level -2.8 points (5 vs 2 points) (p<0.001). Various complications developed in 20 out of 49 cases (40.8%). Neurological complications were resolved conservatively (22.4%). A direct correlation was evaluated between the surgical treatment of DDH in childhood and the development of neurological complications after PAO (R = 0.76; p<0.001). In 9 cases out of 49 (18.4%), revision surgery was required: in 3 — total hip replacement, in 2 — reorientation of the acetabulum, in 4 — arthroscopic fixation of the anterior articular lip. In 93.9% of cases native hip joint surfaces were preserved.
Conclusion. Ganz PAO has good reconstructive capabilities and sufficient efficiency. The operation allows to restore the coverage of the femoral head with the acetabulum, delays total hip replacement and provides improved functional results.
References
1. Gala L., Clohisy J.C., Beaule P.E. Hip dysplasia in the young adult. J Bone Joint Surg Am. 2016;98(1):63-73. doi: 10.2106/jbjs.o.00109.
2. Shibata K.R, Matsuda S., Safran M.R. Open treatment of dysplasia – other than PAO: does it have to be a PAO? J Hip Preserv Surg. 2015;4(2):131-144. doi: 10.1093/jhps/hnv028.
3. Ramirez-Nunez L., Payo-Ollero J., Comas M., Cardenas C., Bellotti V., Astarita E., Chacon-Cascio G., Ribas M. Osteotomia periacetabular en el tratamiento de displasia de cadera mediante tecnica mini-invasiva. Nuestros resultados a medio plazo en 131 casos. Rev Esp Cir Ortop Traumatol. 2020;64(3):151-159. doi: 10.1016/j.recot.2020.01.003.
4. Gerasimov S.A., Korytkin A.A., Gerasimov E.A., Kovaldov K.A., Novikova Ya.S. Osteotomii taza kak metod lecheniya displazii tazobedrennogo sustava. Sovremennoe sostoyanie voprosa. Sovremennye problemy nauki i obrazovaniya. 2018;(4):160. Rezhim dostupa: http://science-education.ru/ru/article/view?id=27765.
5. Gerasimov S.A., Korytkin A.A., Gerasimov E.A., Kovaldov K.A., Novikova Ya.S. [Pelvic osteotomies as a treatment option for development dysplasia of the hip. current concepts]. Sovremennyye problemy nauki i obrazovaniya [Modern Problems of Science and Education]. 2018;(4):160. (In Russ.). Available from: http://science-education.ru/ru/article/view?id=27765.
6. Steppacher S.D., Tannast M., Ganz R., Siebenrock K.A. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. 2008;466(7):1633-1644. doi: 10.1007/s11999-008-0242-3.
7. Alcobia Diaz B., Luque Perez R., Garcia Bullon I., Moro Rodriguez L.E., Lopez-Duran Stern L. Long-term clinical and radiological outcomes in a series of 26 cases of symptomatic adult developmental dysplasia of the hip managed with Bernese periacetabular osteotomy. Rev Esp Cir Ortop Traumatol. 2015;59(6):421-428. doi: 10.1016/j.recot.2015.04.001.
8. Ganz R., Klaue K., Vinh T.S., Mast J.W. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res. 1988;232:26-36. doi: 10.1097/00003086-198807000-00006.
9. Kamath A.F. Bernese periacetabular osteotomy for hip dysplasia: surgical technique and indications. World J Orthop. 2016;7(5):280-286. doi: 10.5312/wjo.v7.i5.280.
10. Rukovodstvo po khirurgii tazobedrennogo sustava. Pod red. R.M. Tikhilova, I.I. Shubnyakova. SPb.: RNIITO im. R.R. Vredena, 2014. T.1. S. 47-61.
11. Guide to hip surgery. Ed. by R.M. Tikhilov, I.I. Shubnyakov. SPb.: RNIITO im. R.R. Vredena, 2014. Vol.1. P. 47-61. (In Russ.).
12. The adult hip – hip preservation surgery. Ed. by J. Clohisy, P. Beaule, C. Della Valle, J. Callaghan, A. Rosenberg, H. Rubash. Wolters Kluwer, 2015. 762 p.
13. Matheney T., Kim Y.J., Zurakowski D., Matero C., Millis M. Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Am. 2010;92(Suppl. 1):115-129. doi: 10.2106/jbjs.j.00646.
14. Gray B.L., Stambough J.B., Baca G.R., Schoenecker P.L., Clohisy J.C. Comparison of contemporary periacetabular osteotomy for hip dysplasia with total hip arthroplasty for hip osteoarthritis. Bone Joint J. 2015;97-B(10):1322-1327. doi: 10.1302/0301-620X.97B10.35741.
15. Kalore N.V., Cheppalli S.P.R., Daner W.E., Jiranek W.A. Acetabular dysplasia in middle-aged patients: periacetabular osteotomy or total hip arthroplasty? J Arthroplasty. 2016;31(9):1894-1898. doi: 10.1016/j.arth.2016.02.032.
16. Pascual-Garrido C., Harris M.D., Clohisy J.C. Innovations in joint preservation procedures for the dysplastic hip «the periacetabular osteotomy». J Arthroplasty. 2017;32(9):S32-S37. doi: 10.1016/j.arth.2017.02.015.
17. The hip: preservation, replacement, and revision. Ed. by J. Cashman, N. Goyal, J. Parvizi. Brooklandville, 2015. Vol. 1. 770 p.
18. Rudin D., Manestar M., Ullrich O., Erhardt J., Grob K. The anatomical course of the lateral femoral cutaneous nerve with special attention to the anterior approach to the hip joint. J Bone Joint Surg Am. 2016;98(7):561-567. doi: 10.2106/jbjs.15.01022.
19. Khan O.H., Malviya A., Subramanian P., Agolley D., Witt J.D. Minimally invasive periacetabular osteotomy using a modified Smith-Petersen approach: technique and early outcomes. Bone Joint J. 2017;99-B(1):22-28. doi: 10.1302/0301-620x.99b1.bjj-2016-0439.r1.
20. Luo D., Zhang H., Zhang W. Comparison of three approaches of Bernese periacetabular osteotomy. Ther Clin Risk Manag. 2016;67. doi: 10.2147/tcrm.s81914.
21. Ali M., Malviya A. Complications and outcome after periacetabular osteotomy – influence of surgical approach. Hip Int. 2019;30(1):4-15. doi: 10.1177/1120700019871195.
22. Gakhramanov A.G. Oslozhneniya posle periatsetabulyarnoi osteotomii. Kazanskii meditsinskii zhurnal. 2016;97(5):696-700. doi: 10.17750/KMJ2016-696.
23. Gakhramanov A.G. [Complications after periacetabular osteotomy]. Kazanskii meditsinskii zhurnal [Kazan medical journal]. 2016;97(5):696-700. doi: 10.17750/KMJ2016-696. (In Russ.).
24. Samuel L.T., Munim M., Acuna A.J., Sultan A.A., Kamath A.F. Modified iliac spine wafer osteotomy for exposure during Bernese periacetabular osteotomy. J Hip Preserv Surg. 2019;6(4):421-425. doi: 10.1093/jhps/hnz061.
25. Clohisy J.C., Ackerman J., Baca G., Baty J., Beaule P.E., Kim Y.J. et al. Patient-reported outcomes of periacetabular osteotomyfrom the prospective ANCHOR cohort study. J Bone Joint Surg Am. 2017;99(1):33-41. doi: 10.2106/jbjs.15.00798.
26. Ziebarth K., Balakumar J., Domayer S., Kim Y.J., Millis M.B. Bernese periacetabular osteotomy in males: is there an increased risk of femoroacetabular impingement (FAI) after Bernese periacetabular osteotomy? Clin Orthop Relat Res. 2010;469(2):447-453. doi: 10.1007/s11999-010-1544-9.
27. Duncan S.T., Bogunovic L., Baca G., Schoenecker P.L., Clohisy J.C. Are there sexdependent differences in acetabular dysplasia characteristics? Clin Orthop Relat Res. 2015;473(4):1432-1439. doi: 10.1007/s11999-015-4155-7.
28. Novais E.N., Potter G.D., Clohisy J.C., Millis M.B., Kim Y.J., Trousdale R.T., Carry P.M., Sierra R.J. Obesity is a major risk factor for the development of complications after periacetabular osteotomy. Bone Joint J. 2015;97-B(1):29-34. doi: 10.1302/0301-620x.97b1.34014.
29. Shang J., Zhang Z., Luo D., Cheng H., Zhang H. Effectiveness of multi‐modal blood management in Bernese periacetabular osteotomy and periacetabular osteotomy with proximal femoral osteotomy. Orthop Surg. 2020;9999:1-5. doi: 10.1111/os.12794.
30. Clohisy J.C., Schutz A.L., St. John L., Schoenecker P.L., Wright R.W. Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res. 2009;467(8):2041-2052. doi: 10.1007/s11999-009-0842-6.
31. Swarup I., Ricciardi B.F., Sink E.L. Avoiding complications in periacetabular osteotomy. JBJS Rev. 2015; 3(11):1-9. doi: 10.2106/jbjs.rvw.o.00023.
32. Novais E.N., Carry P.M., Kestel L.A., Ketterman B., Brusalis C.M., Sankar W.N. Does surgeon experience impact the risk of complications after Bernese periacetabular osteotomy? Clin Orthop Relat Res. 2016;475(4):1110-1117. doi: 10.1007/s11999-016-5010-1.
33. Ricciardi B.F., Fields K.G., Wentzel C., Nawabi D.H., Kelly B.T., Sink E.L. Complications and short-term patient outcomes of periacetabular osteotomy for symptomatic mild hip dysplasia. Hip Int. 2016;27(1):42-48. doi: 10.5301/hipint.5000420.
34. Malviya A., Dandachli W., Beech Z., Bankes M.J., Witt J.D. The incidence of stress fracture following peri-acetabular osteotomy: an underreported complication. Bone Joint J. 2015;97-B(1):24-28. doi: 10.1302/0301-620x.97b1.34525.
