骨盆三联截骨术治疗髋关节发育不良：采用改良Stoppa入路的Akbulut-Coskun技术
zzf1056 已点赞背景：已报道许多成功的截骨术用于治疗髋臼发育不良。然而，三联骨盆截骨术仍然是一种技术上具有挑战性的手术，有可能出现严重的并发症。本文研究了用于治疗青少年髋臼发育不良的经改良Stoppa入路进行的Tönnis髋臼周围截骨术（TPAO）。
目的：描述经改良Stoppa入路行TPAO治疗青少年髋臼发育不良的影像学结果、并发症和早期功能结果。
方法：本研究纳入16名患者（20髋），他们使用改良Stoppa入路行TPAO治疗有症状的髋臼发育不良。讨论了患者特点和手术方法。使用外侧中心边缘（CE）角和Tönnis臼顶角评估放射学结果。记录围手术期数据包括手术时间、失血量和并发症。并讨论了并发症。
结果：患者的平均年龄为11.5±1.1（10~13）岁。术前平均外侧CE角为14.7±3度（7至19度），术后平均外侧CE角为35.7±3.1度（30至42度；P<0.001）。术前平均Sharp角为55.9±5.4度（48至65度），术后平均Sharp角为33±5度（24至40度；P<0.001）。截骨术前后的平均Tönnis角分别为23.3±7.1度（17至36度）和7.1±2度（4至10度）（P<0.001）。平均手术时间为42.2±10.3分钟，平均失血量为167.7±50.3毫升。一名患者的主要并发症是膀胱损伤。
结论：经改良Stoppa入路行TPAO治疗髋关节发育不良具有单切口、同一入路可进入2个髋关节、体位优势和保护外展功能的优点。早期结果令人满意且安全。
证据等级：四级。
关键词：髋关节发育不良、改良Stoppa入路、髋臼周围截骨术
显露四边体表面：骨膜下显露四边体。将钝性Hohmann拉钩插入坐骨切迹中。显露闭孔后，插入钝性Hohmann拉钩。坐骨支截骨从坐骨上切迹开始，于坐骨棘上方1厘米延伸至闭孔。
在C臂透视下使用克氏针来确定髋臼上截骨线。髋臼上截骨线从标记线开始，一直延伸到坐骨上切迹的中点
耻骨截骨是倾斜进行的，在泪滴的内侧
手术入路：患者取仰卧位，耻骨联合上方2cm处，沿正中线作8cm（双侧10cm）横切口。
显露：识别白线和腹直肌之间的肌间隙。腹直肌从其在耻骨联合处的附着处作为皮瓣翻起。
移动截骨块；将5毫米Schanz钉平行于髋臼上方置入，在透视下进行调整
在透视下将截骨块固定到术前设计位置
固定：髋臼上方使用两枚6毫米空心螺钉固定，在耻骨支使用一枚4毫米空心螺钉固定
双侧髋关节发育不良患者(A)、手术后立即(B)和愈合后(C)的X线图像。
Triple Pelvic Osteotomy for Hip Dysplasia: The Akbulut-Coskun Technique Using a Modified Stoppa Approach
Background: Many successful osteotomies have been reported for the treatment of acetabular dysplasia. However, triple pelvic osteotomy remains a technically challenging procedure with potential for significant complications. This study examined a series of Tönnis periacetabular osteotomy (TPAO) procedures performed using the modified Stoppa approach to treat acetabular dysplasia in adolescents.
Objective: To describe the radiographic outcomes, complications, and early functional results of TPAO using the modified Stoppa approach for acetabular dysplasia in adolescents.
Methods: This study included 16 patients (20 hips) who underwent TPAO using the modified Stoppa approach for symptomatic acetabular dysplasia. The characteristics of the patients and the surgical procedure were discussed. The radiologic outcome was evaluated using the lateral center-edge (CE) and Tönnis roof angles. Perioperative data including surgery duration, blood loss, and complications were recorded. Complications were also discussed.
Results: The mean age of the patients was 11.5±1.1 (10 to 13) years. The mean preoperative anteroposterior CE angle was 14.7±3 degrees (7 to 19 degrees), and the mean postoperative angle was 35.7±3.1 degrees (30 to 42 degrees; P<0.001). The mean preoperative Sharp’s angle was 55.9±5.4 degrees (48 to 65 degrees), and the postoperative mean was 33±5 degrees (24 to 40 degrees; P<0.001). The mean Tönnis angle before and after osteotomy was 23.3±7.1 degrees (17 to 36 degrees) and 7.1±2 degrees (4 to 10 degrees), respectively (P<0.001). The mean operative time was 42.2±10.3 minutes with a mean blood loss of 167.7±50.3 mL. One patient sustained a bladder injury as a major complication.
Conclusions: The use of TPAO with the intrapelvic modified Stoppa approach in the treatment of hip dysplasia provides the benefits of a single incision, access to 2 hips in the same session, positional advantage, and abductor function preservation. Early results are satisfactory and safe.
Level of Evidence: Level IV.
Key Words: hip dysplasia, modified Stoppa approach, periacetabular osteotomy
文献出处：Akbulut D, Coşkun M, Aydin A, Arslanoğlu F, Sevencan A, Çamurcu Y. Triple Pelvic Osteotomy for Hip Dysplasia: The Akbulut-Coskun Technique Using a Modified Stoppa Approach. J Pediatr Orthop. 2024 Nov 8. doi: 10.1097/BPO.0000000000002851. Epub ahead of print. PMID: 39513523.
最后编辑于 2024-11-30 · 浏览 761
