髋臼周围截骨术(PAO)中是否需要进行骨软骨成形术(OCP)通常依赖于术中对90°屈曲(IRF)内旋的评估。进行OCP有助于降低PAO减少导致医源性股骨髋臼撞击的风险。避免撞击有助于降低继发性骨关节炎的风险。对于预测PAO期间需要OCP的因素,文献有限。这项研究的目的是(1)定义需要并发OCP的患者的特征,并根据IRF和股骨版本提供OCP率,以及(2)确定预测因素(临床,射线照相)与PAO期间对OCP的需求相关。由于一些外科医生在术前确定需要OCP,预测因素将有助于决策。
■这是一个前瞻性队列,包括224髋(207名患者),因症状性髋臼发育不良而接受PAO治疗,其中154臀部(69%)在2013年至2017年期间接受了OCP。如果患者术中运动或撞击受到限制,则接受OCP。术前因素,如年龄,性别,BMI,记录和CT检查结果,并进行单变量和多变量分析.多变量分析发现了使用比值比和95%置信区间描述的预测因子。在分类分析中,IRF>30°和股骨版本10°-25°被用作参考组。P值≤0.05被认为是显著的。
■α角>55°(OR=2.20,CI:1.08-4.52,p=0.03),IRF≤20°(OR:9.52,CI:3.87-23.40,p<0.001),IRF>20°-30°(OR:2.68,CI:1.08-6.62,p=0.03),股骨版本<10°(OR:5.26,CI:1.09-25.30,p=0.04)与OCP的几率增加相关。在连续建模中,股骨形态降低(OR:1.07,CI:1.02-1.12,p=0.002)和IRF(OR:1.06,CI:1.03-1.09,p<0.001)与OCP发生几率增加相关。对于5°变化,OCP的机会增加了40%(OR:1.40,CI:1.13-1.73,p=0.002)和35%(OR:1.35,IC:1.16-1.57,p<0.001),分别。
■对于这些患者的围手术期计划,认识到OCP的需求可能是有价值的,特别是因为一些外科医生在PAO之前进行关节镜检查。与OCP机会增加相关的因素是α角>55°,IRF减少,股骨版本减少。未来更多的研究将有助于确定OCP如何影响患者的预后。证据等级:III。
UNASSIGNED: Determination of need for osteochondroplasty (OCP) during periacetabular osteotomy (PAO) commonly relies on intraoperative assessment of internal rotation at 90° flexion (IRF). Performing an OCP helps decrease the risk of iatrogenic femoroacetabular impingement from PAO reduction. Avoiding impingement helps decrease risks of accelerated secondary osteoarthritis. The literature is limited for factors that predict need for OCPs during PAOs. The purpose of this study was to (1) define the characteristics of patients needing concurrent OCP and provide OCP rate based on IRF and femoral version and (2) identify predictive factors (clinical, radiographic) associated with need for OCP during PAO. As some surgeons determine need for OCP pre-operatively, predictive factors would aid decision making.
UNASSIGNED: This was a prospective cohort of 224 hips (207 patients) who underwent PAO for symptomatic acetabular dysplasia, of which 154 hips (69%) underwent OCP between years 2013 and 2017. Patients underwent OCP if they had restrictions in motion or impingement intra-operatively. Pre-operative factors such as age, sex, BMI, and CT findings were recorded that underwent univariate and multivariable analyses. Multivariable analysis found predictors that were described using odds ratios and 95% confidence intervals. IRF>30° and femoral version 10°-25° were used as the reference groups during categorical analysis. P-values ≤0.05 were considered significant.
UNASSIGNED: Alpha angles >55° (OR= 2.20, CI: 1.08-4.52, p= 0.03), IRF≤20° (OR: 9.52, CI: 3.87-23.40, p<0.001), IRF >20°-30° (OR: 2.68, CI: 1.08-6.62, p=0.03), and femoral version <10° (OR: 5.26, CI: 1.09-25.30, p=0.04) were associated with increased odds of OCP. On continuous modeling, decreasing femoral version (OR: 1.07, CI: 1.02-1.12, p=0.002) and IRF (OR: 1.06, CI: 1.03-1.09, p<0.001) were associated with increased chance of OCP. For 5° changes, the chance of OCP increased by 40% (OR: 1.40, CI: 1.13-1.73, p=0.002) and 35% (OR: 1.35, IC: 1.16-1.57, p<0.001), respectively.
UNASSIGNED: Awareness of need for OCP may be valuable in peri-operative planning for these patients especially since some surgeons perform this technique arthroscopically before PAO. Factors associated with increased chances of OCP were alpha angles >55°, decreased IRF, and decreased femoral version. More studies in the future would help determine how OCP affects patient outcomes. Level of Evidence: III.