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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Early Clinical and Radiographic Outcomes of Combined Hip Arthroscopy and Periacetabular Osteotomy
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Early Clinical and Radiographic Outcomes of Combined Hip Arthroscopy and Periacetabular Osteotomy

机译：髋关节镜和髋臼周围截骨术联合的早期临床和影像学结果

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Objectives: Modern treatment of hip dysplasia has focused on the correction of the structural deformity with the periacetabular osteotomy (PAO), which addresses the deformity by redirecting the acetabulum into an improved mechanical position. Hip arthroscopy has allowed an increased awareness of the intra-articular pathology associated with acetabular dysplasia. The combination of hip arthroscopy with periacetabular osteotomy allows for treatment of both intra-articular and structural abnormalities associated with hip dysplasia. However, there is limited information regarding this combined approach for treating symptomatic acetabular dysplasia. The purpose of this study was to report the early clinical and radiographic outcomes of combining hip arthroscopy with PAO compared to PAO alone. Methods: We retrospectively reviewed 48 hips (46 patients) who underwent hip arthroscopy combined with periacetabular osteotomy (HS-PAO) and compared them to a control group of 62 hips (54 patients) who underwent PAO alone. The minimum clinical follow-up of the HS-PAO group was 12 months (mean, 31.4 months; range, 12-79 months), which was not significantly different from the control group (mean, 28.7 months; range, 12-71 months; p = 0.39). Pre-operative and post-operative standardized radiographs were analyzed for findings of acetabular dysplasia, including lateral center-edge angle (LCEA), acetabular inclination, anterior-center edge angle (ACEA), and T?nnis osteoarthritis grade. Clinical outcomes were evaluated with the UCLA activity score, modified Harris hip score (mHHS), short form-12 (SF-12), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Perioperative complications were graded and compared between the two groups. Results: The mean age of the patients in the HS-PAO group was 28.0 years (range, 12 to 47 years), which was not significantly different from the control group (p = 0.35). Forty-four hips (91.7%) were in female patients, and 58% were right-sided. There was significant change in the mean LCEA (15.1 ° vs. 29.7 ° ; p < 0.0001), acetabular inclination (15.0 ° vs. 2.8 ° ; p < 0.0001), and ACEA (16.5 ° vs. 33.7 ° ; p 0.3). The PAO-HS group, however, experienced a 0.9 improvement in the UCLA score, which was significantly different from the control group (-0.2; p = 0.03). The PAO-HS group also experienced a significantly greater improvement in the total WOMAC score (27.0 vs. 17.8; p = 0.03). There were no significant differences in the complication between the groups. Within the PAO-HS group, there were 16 lateral femoral cutaneous nerve palsies (33.3%) that resolved with outpatient management. There was 1 posterior column fracture that was treated nonoperatively. Conclusion: At short-term follow-up, hip arthroscopy with PAO shows equal to improved clinical outcomes with similar radiographic changes when compared to PAO alone without an increase in major complications. Patients that underwent hip arthroscopy combined with PAO also experienced a larger increase in activity level when compared to PAO alone.
机译：目的：髋关节发育不良的现代治疗方法集中在通过髋臼周围截骨术（PAO）纠正结构畸形，该技术通过将髋臼重新定位到改善的机械位置来解决畸形。髋关节镜检查使人们对与髋臼发育不良相关的关节内病理学的认识有所提高。髋关节镜与髋臼周围截骨术相结合，可治疗与髋关节发育不良相关的关节内和结构异常。但是，关于这种联合治疗症状性髋臼发育不良的方法的信息有限。这项研究的目的是报告与单独使用PAO相比，将髋关节镜与PAO相结合的早期临床和影像学结果。方法：我们回顾性分析了48例行髋关节镜联合髋臼周围截骨术（HS-PAO）的髋部（46例），并将它们与仅接受PAO的62例髋关节（54例）进行了比较。 HS-PAO组的最低临床随访时间为12个月（平均31.4个月;范围12-79个月），与对照组无明显差异（平均28.7个月;范围12-71个月）。 ; p ＝ 0.39）。术前和术后标准化X线照片分析了髋臼发育不良的发现，包括外侧中心边缘角（LCEA），髋臼倾斜度，前中心边缘角（ACEA）和T？nnis骨关节炎等级。临床结果通过UCLA活动评分，改良的Harris髋关节评分（mHHS），简短表格12（SF-12）以及西安大略和麦克马斯特大学关节炎指数（WOMAC）进行评估。围手术期并发症分级并在两组之间进行比较。结果：HS-PAO组患者的平均年龄为28.0岁（范围12至47岁），与对照组无显着差异（p = 0.35）。女性患者为四十四髋（占91.7％），右侧为58％。平均LCEA（15.1°vs. 29.7°; p <0.0001），髋臼倾角（15.0°vs. 2.8°; p <0.0001）和ACEA（16.5°vs. 33.7°; p 0.3）有显着变化。但是，PAO-HS组的UCLA评分提高了0.9，与对照组相比有显着差异（-0.2; p = 0.03）。 PAO-HS组的WOMAC总评分也有了显着提高（27.0比17.8; p = 0.03）。两组之间的并发症没有显着差异。在PAO-HS组中，有16例股外侧皮神经麻痹经门诊治疗后得以缓解。 1例后柱骨折未经手术治疗。结论：在短期随访中，与单独的PAO相比，PAO的髋关节镜检查显示的临床效果改善，且影像学改变相似，而主要并发症没有增加。与单独使用PAO相比，接受髋关节镜检查结合PAO的患者的活动水平也有较大的提高。

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