PDF(Pubmed)
Abstract：
UNASSIGNED: Relative femoral neck lengthening (RNL) is a newer technique to correct coxa breva and coxa vara to relieve a femoro-acetabular impingement and improve hip abductor function without changing the position of the head on the shaft. Proximal femoral osteotomy (PFO) changes the position of the femoral head relative to the shaft. We studied the short-term complications of procedures that combined RNL with PFO.
UNASSIGNED: All hips that underwent RNL and PFO using a surgical dislocation and extended retinacular flap development were included. Hips that were treated only with intra-articular femoral osteotomies (IAFO) were excluded. Hips that underwent RNL and PFO, with IAFO and/or acetabular procedures were included. Intra-operative evaluation of the femoral head blood flow was performed with the drill hole technique. Clinical evaluation and hip radiographs were obtained at 1 week, 6 weeks, 3 months, 6 months, 12 months and 24 months.
UNASSIGNED: Seventy two patients (31 males, 41 females, 6-52 years of age) underwent 79 combined RNL and PFO. 22 hips underwent additional procedures like head reduction osteotomy, femoral neck osteotomy, and acetabular osteotomies. There were 6 major and 5 minor complications noted. Two hips developed non-unions, both with basicervical varus-producing osteotomies. Four hips developed femoral head ischemia. Two of these hips avoided collapse with early intervention. One hip had persistent abductor weakness requiring hardware removal and three hips, all in boys developed symptomatic widening of the hip on the operated side from varus-producing osteotomy. One hip had asymptomatic trochanteric non-union.
UNASSIGNED: RNL is routinely performed by releasing the short external rotator muscle tendon insertion from the proximal femur to raise the posterior retinacular flap. Though this technique protects the blood supply from direct injury, it seems to stretch the vessels with major corrections in the proximal femur. We recommend evaluating the blood flow intraoperatively and postoperatively and taking necessary steps early to decrease the stretch on the flap. It may be safer to avoid raising the flap for major extra-articular proximal femur corrections.
UNASSIGNED: The results of this study suggest ways to improve the safety of procedures that combine RNL and PFO.
UNASSIGNED: All hips that underwent RNL and PFO using a surgical dislocation and extended retinacular flap development were included. Hips that were treated only with intra-articular femoral osteotomies (IAFO) were excluded. Hips that underwent RNL and PFO, with IAFO and/or acetabular procedures were included. Intra-operative evaluation of the femoral head blood flow was performed with the drill hole technique. Clinical evaluation and hip radiographs were obtained at 1 week, 6 weeks, 3 months, 6 months, 12 months and 24 months.
UNASSIGNED: Seventy two patients (31 males, 41 females, 6-52 years of age) underwent 79 combined RNL and PFO. 22 hips underwent additional procedures like head reduction osteotomy, femoral neck osteotomy, and acetabular osteotomies. There were 6 major and 5 minor complications noted. Two hips developed non-unions, both with basicervical varus-producing osteotomies. Four hips developed femoral head ischemia. Two of these hips avoided collapse with early intervention. One hip had persistent abductor weakness requiring hardware removal and three hips, all in boys developed symptomatic widening of the hip on the operated side from varus-producing osteotomy. One hip had asymptomatic trochanteric non-union.
UNASSIGNED: RNL is routinely performed by releasing the short external rotator muscle tendon insertion from the proximal femur to raise the posterior retinacular flap. Though this technique protects the blood supply from direct injury, it seems to stretch the vessels with major corrections in the proximal femur. We recommend evaluating the blood flow intraoperatively and postoperatively and taking necessary steps early to decrease the stretch on the flap. It may be safer to avoid raising the flap for major extra-articular proximal femur corrections.
UNASSIGNED: The results of this study suggest ways to improve the safety of procedures that combine RNL and PFO.
摘要：
■相对股骨颈延长术（RNL）是一种较新的技术，可以纠正髋臼和髋内翻，以减轻股骨髋臼撞击并改善髋关节外展器功能，而无需改变头部在轴上的位置。股骨近端截骨术（PFO）改变了股骨头相对于轴的位置。我们研究了RNL与PFO联合手术的短期并发症。
■包括所有使用手术脱位和扩展的视网膜皮瓣进行RNL和PFO的臀部。排除仅用关节内股骨截骨术（IAFO）治疗的髋关节。接受RNL和PFO的臀部，包括IAFO和/或髋臼手术。使用钻孔技术进行股骨头血流的术中评估。在1周时获得临床评估和髋部X光片，6周,3个月,6个月,12个月和24个月。
■72名患者（31名男性，41名女性,6-52岁）接受了79联合RNL和PFO。22髋接受了额外的手术，如头部复位截骨术，股骨颈截骨术,髋臼截骨术.有6个主要和5个次要并发症。两个臀部出现了不结合，两者都有基底颈内翻产生截骨术。四髋发生股骨头缺血。这些臀部中的两个避免了早期干预的塌陷。一个臀部有持续的外展肌无力，需要去除硬件和三个臀部，所有男孩都因产生内翻的截骨术而在手术侧出现有症状的髋关节加宽。一个髋关节无症状股骨转子不愈合。
■RNL通常通过从股骨近端释放短的外部旋转肌腱插入以升高后部视网膜瓣进行。虽然这种技术可以保护血液供应免受直接伤害，似乎在股骨近端进行了重大矫正，使血管伸展。我们建议在术中和术后评估血流，并尽早采取必要步骤以减少皮瓣的拉伸。避免抬高皮瓣进行主要的关节外股骨近端矫正可能更安全。
■这项研究的结果提出了提高RNL和PFO相结合的程序安全性的方法。
■包括所有使用手术脱位和扩展的视网膜皮瓣进行RNL和PFO的臀部。排除仅用关节内股骨截骨术（IAFO）治疗的髋关节。接受RNL和PFO的臀部，包括IAFO和/或髋臼手术。使用钻孔技术进行股骨头血流的术中评估。在1周时获得临床评估和髋部X光片，6周,3个月,6个月,12个月和24个月。
■72名患者（31名男性，41名女性,6-52岁）接受了79联合RNL和PFO。22髋接受了额外的手术，如头部复位截骨术，股骨颈截骨术,髋臼截骨术.有6个主要和5个次要并发症。两个臀部出现了不结合，两者都有基底颈内翻产生截骨术。四髋发生股骨头缺血。这些臀部中的两个避免了早期干预的塌陷。一个臀部有持续的外展肌无力，需要去除硬件和三个臀部，所有男孩都因产生内翻的截骨术而在手术侧出现有症状的髋关节加宽。一个髋关节无症状股骨转子不愈合。
■RNL通常通过从股骨近端释放短的外部旋转肌腱插入以升高后部视网膜瓣进行。虽然这种技术可以保护血液供应免受直接伤害，似乎在股骨近端进行了重大矫正，使血管伸展。我们建议在术中和术后评估血流，并尽早采取必要步骤以减少皮瓣的拉伸。避免抬高皮瓣进行主要的关节外股骨近端矫正可能更安全。
■这项研究的结果提出了提高RNL和PFO相结合的程序安全性的方法。
