来源：304关节学术

译者：张利强

整理：骨科在线

近期《J Clin Med》杂志发表了一项关于髋臼周围截骨术（PAO）新入路的回顾性研究。PAO被认为是治疗年轻人髋关节发育不良手术的金标准，为了减少软组织损伤，研究人员设计了一种新的保留缝匠肌和股直肌的入路，并在髋臼旋转、并发症发生率和短期临床结果参数方面与传统的保留股直肌（RS）的方法进行比较。

研究人员回顾性评估了2016年至2019年间由一名外科医生实施的所有PAO手术（217名患者中n=239髋）。采用新RASS技术的病例（n=48）与RS病例在髋臼旋转参数、手术时间、围手术期血红蛋白降低水平、住院时间（LOHS）等方面进行比较。纳入标准为外侧中心边缘角（LCEA）<25°，骨关节炎Tönnis分级≤1。排除髋臼后倾或同时行股骨截骨的患者。

患者平均手术年龄29岁（14～50岁，标准差±8.5）。女性占79.5%。RASS组和RS组术前平均LCEA分别为16°（7~24°，SD±4.4）和15°（0~23°，SD±6）（p=0.96）。术前平均髋臼指数（AI）分别为14°（2~25°，SD±4）和14°（7~29°，SD±4.3）（p=0.67）。术后LCEA平均值分别为31°（25～37°，SD±3.5，p<0.001）和30.2°（20～38°，SD±4，p<0.001）。术后平均AI角分别为2.8°（−3～13°，SD±3.3，p<0.001）和3°（−2～15°，SD±3.3，p<0.001）。

RASS组和RS组在手术时间、围手术期血红蛋白水平降低和LOHS方面无显著差异。两组围手术期均无需输血。两组均未发生重大围手术期并发症。我们观察到RS组有一例手术部位感染（SSI）需要浅表清创。与RS入路相比，RASS入路治疗PAO是一种安全的手术方式，髋臼旋转和临床转归参数相当。此外，RASS入路患者术后在活动方面的限制较少。

图1.“比基尼”皮肤切口和股外侧皮神经的识别（箭头标记）。

图2.小心游离腹肌，显露髂腹股沟入路

图3. a.打开第二个入路，向内侧拉开缝匠肌（1）向外侧拉开阔筋膜张肌（2）b.股直肌筋膜通过第一个入路暴露。

原文摘要

A New Rectus and Sartorius Sparing Approach for Periacetabular Osteotomy in Patients with Developmental Dysplasia of the Hip

Background: periacetabular osteotomy (PAO) is known as the gold standard surgical treatment in young adults with symptomatic hip dysplasia. With the aim of reducing soft tissue trauma, we developed a new rectus and sartorius sparing (RASS) approach. We hypothesized that this new PAO technique was equal regarding acetabular reorientation, complication rate, and short-term clinical outcome parameters, compared to our conventional, rectus sparing (RS) approach.

Patients and Methods: we retrospectively assessed all PAO procedures performed by a single surgeon between 2016 and 2019 (n = 239 hips in 217 patients). The cases in which the new RASS technique were used (n = 48) were compared to the RS cases for acetabular orientation parameters, surgical time, perioperative reduction of hemoglobin level, and length of hospital stay (LOHS). Inclusion criteria were a lateral center-edge angle (LCEA) <25°and osteoarthritis Tönnis grade ≤1. Patients with acetabular retroversion or additional femoral osteotomy were excluded.

Results: the mean patient age at the time of surgery was 29 years (14 to 50, SD ± 8.5). Females accounted for 79.5% in this series. The mean preoperative LCEA were 16°(7 to 24°, SD ± 4.4) and 15°(0° to 23°, SD ± 6) in the RASS and the RS group, respectively (p = 0.96). The mean preoperative acetabular index (AI) angles were 14°(2° to 25°, SD ± 4) and 14° (7° to 29°, SD ± 4.3), respectively (p = 0.67). The mean postoperative LCEA were significantly improved to 31° (25° to 37°, SD ± 3.5, p < 0.001) and 30.2° (20° to 38°, SD ± 4, p < 0.001), respectively. The mean postoperative AI angles improved to 2.8°(−3° to 13°, SD ± 3.3, p < 0.001) and 3° (−2° to 15°, SD ± 3.3, p < 0.001), respectively. There were no significant differences between the RASS and the RS group for surgical time, perioperative reduction in hemoglobin level, and LOHS. No blood transfusions were necessary perioperatively in either group. No major perioperative complication occurred in either group. We observed one surgical site infection (SSI) requiring superficial debridement in the RS group.

Conclusion: the RASS approach for PAO showed to be a safe procedure with equivalent acetabular reorientation and equivalent clinical outcome parameters compared to the RS approach. Additionally, patients have fewer postoperative restrictions in mobilization with the RASS approach.

文献出处

Löchel J, Janz V, Perka C, Hofer A, Zimmerer A, Wassilew GI. A New Rectus and Sartorius Sparing Approach for Periacetabular Osteotomy in Patients with Developmental Dysplasia of the Hip. J Clin Med. 2021 Feb 5;10(4):601. doi: 10.3390/jcm10040601. PMID: 33562732; PMCID: PMC7915261.