背景:发育性髋关节发育不良患者可能需要进行骨盆截骨术以提高髋臼覆盖率。这项研究的目的是比较髋臼版本的变化,倾斜,和圣地亚哥髋臼成形术(SDA)后的区域覆盖角,改良的圣地亚哥髋臼成形术(mSDA),和Pemberton髋臼成形术(PA)。
方法:确定了14例发育性髋关节发育不良和计算机断层扫描(CT)成像患者。从CT图像,为每位患者三维打印2个相同的骨盆。骨头是用刚性材料印刷的,和软骨与柔性材料。对于每个模型对,在一个上进行SDA,在另一个上进行PA。在髋臼成形术前后进行CT扫描。接下来,SDA模型中的骨移植物向前移动,代表mSDA,模型被重新扫描了。髋臼版,倾斜,和覆盖角(后,上-后,上级,上前,和前)进行了计算。术前与术后的差异进行比较(反复测量方差分析或Wilcoxon符号秩检验)。显著性设定为P<0.05。
结果:CT时的平均年龄为5.8±1.2岁(范围:3.9至7.5岁)。所有3个程序(SDA,mSDA,和PA)显著增加髋臼倾斜;P<0.045),所有3个都观察到相似的变化(P=0.868)。PA是唯一显着降低相对髋臼版本(6.5±6.5度,术前:12.9±5.3度;P=0.004)。SDA和mSDA程序均显着增加了上后角的覆盖率(SDA:92.6±9.3度,mSDA:92.3±9.8度,术前:81.9±9.5度;P<0.02),2之间的百分比变化相似(P=1.0)。所有3种手术均显着提高了覆盖率(P<0.04);3种手术中的增加相似(P=0.205)。PA是唯一在前八分区(91.0±16.7度,术前:74.0±12.1度;P=0.005)或前角(50.7±11.7度,术前:45.8±8.9度;P=0.012)。
结论:SDA和mSDA手术产生了相似的术后变化,主要在上和上-后髋臼八分体。在mSDA中,将移植物放置在更前面并没有增加前部覆盖率,只有PA增加了上前髋臼八分体和上前髋臼八分体的覆盖率。
BACKGROUND: Patients with developmental dysplasia of the hip may require pelvic osteotomies to improve acetabular coverage. The purpose of this study was to compare the changes in acetabular version, tilt, and regional coverage angles following the San Diego
acetabuloplasty (SDA), the modified San Diego
acetabuloplasty (mSDA), and the Pemberton
acetabuloplasty (PA).
METHODS: Fourteen patients with developmental dysplasia of the hip and computed tomography (CT) imaging were identified. From CT images, 2 identical pelvises were 3-dimensional-printed for each patient. Bone was printed with rigid material, and cartilage with flexible material. For each model pair, the SDA was performed on one and the PA was performed on the other. CT scans were obtained before and after acetabuloplasties. Next, the bone graft in the SDA model was moved anteriorly, representing the mSDA, and the model was rescanned. Acetabular version, tilt, and coverage angles (posterior, superior-posterior, superior, superior-anterior, and anterior) were calculated. Preoperative to postoperative differences were compared (repeated measures analysis of variance or Wilcoxon signed rank test). The significance was set to P <0.05.
RESULTS: The mean age at CT was 5.8±1.2 years (range: 3.9 to 7.5 y). All 3 procedures (SDA, mSDA, and PA) significantly increased acetabular tilt; P <0.045), with a similar change observed for all 3 ( P =0.868). PA was the only procedure to significantly decrease relative acetabular version (6.5±6.5 degrees, preoperative: 12.9±5.3 degrees; P =0.004). Both the SDA and mSDA procedures significantly increased coverage in the superior-posterior octant (SDA: 92.6±9.3 degrees, mSDA: 92.3±9.8 degrees, preoperative: 81.9±9.5 degrees; P <0.02), with a similar percent change among the 2 ( P =1.0). All 3 procedures significantly increased superior coverage ( P <0.04); the increase was similar among the 3 ( P =0.205). The PA was the only procedure to produce a significant increase in coverage in the superior-anterior octant (91.0±16.7 degrees, preoperative: 74.0±12.1 degrees; P =0.005) or the anterior octant (50.7±11.7 degrees, preoperative: 45.8±8.9 degrees; P =0.012).
CONCLUSIONS: The SDA and mSDA procedures produced similar postoperative changes, primarily in the superior and superior-posterior acetabular octants. Placing the graft more anteriorly did not increase anterior coverage in the mSDA, and only the PA increased coverage in the superior and superior-anterior acetabular octants.