髋臼旋转截骨术及Chiari截骨术对发育性髋关节发育不良生物力学影响的比较研究_《中国修复重建外科杂志》

作者：

傅明 ¹ , 张志奇 ¹ , 向珊珊 ² , 刘进 ¹ , 黄广鑫 ¹

1 中山大学附属第一医院关节外科（广州，510080）;;
2 中山大学附属江门医院骨外科;

关键词：

发育性髋关节发育不良髋臼旋转截骨术 Chiari截骨术髋关节应力

DOI：

10.7507/1002-1892.20130142

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的通过生物力学测试，比较髋臼旋转截骨术及Chiari截骨术治疗成人发育性髋关节发育不良（developmental dysplasia of the hip，DDH）后对髋关节生物力学的影响。方法取8具成年女性骨盆标本，切除双侧髋关节髋臼后沿和上沿，使其股骨头中心点垂线与髋臼外侧边缘夹角 lt; 20°，制备DDH模型；然后于左侧行髋臼旋转截骨术，右侧行Chiari截骨术。分别对正常标本、DDH模型及两种截骨术后标本，于材料试验机上以5 mm/min速率加载至600 N测量髋关节应变值。结果正常标本左、右侧髋关节应变值分别为845.63 ± 533.91及955.94 ± 837.42；DDH模型应变值明显增加，左、右侧分别为1 439.03 ± 625.23及1 558.75 ± 1 009.46，约为正常标本的2倍。结合形态学、影像学检查，提示DDH模型制备成功。髋臼旋转截骨术后髋关节应变值为574.94 ± 430.88，较DDH模型明显下降，差异有统计学意义（t=4.176，P=0.004）。Chiari截骨术后髋关节应变值为1 614.81 ± 932.67，与DDH模型相似，差异无统计学意义（t=0.208，P=0.841）。髋臼旋转截骨术后髋关节应变值与术前应变值之差显著低于Chiari截骨术，差异有统计学意义（t= —2.548，P=0.023）。结论髋臼旋转截骨术缓解DDH髋关节病理性应力的效果优于Chiari截骨术。

引用本文： 傅明,张志奇,向珊珊,刘进,黄广鑫. 髋臼旋转截骨术及Chiari截骨术对发育性髋关节发育不良生物力学影响的比较研究. 中国修复重建外科杂志, 2013, 27(6): 641-644. doi: 10.7507/1002-1892.20130142 复制

1.	Maheshwari R, Madan SS. Pelvic osteotomy techniques and comparative effects on biomechanics of the hip: a kinematic study. Orthopedics, 2011, 34(12): e821-e826.
2.	Lee CB, Millis MB. Alternatives to periacetabular osteotomy for adult acetabular dysplasia. Instr Course Lect, 2013, 62: 287-295.
3.	Bittersohl B, Hosalkar HS, Wenger DR. Surgical treatment of hip dysplasia in children and adolescents. Orthop Clin North Am, 2012, 43(3): 301-315.
4.	Bergmann G, Deuretzbacher G, Heller M, et al. Hip contact forces and gait patterns from routine activities. J Biomech, 2001, 34(7): 859-871.
5.	Michaeli DA, Murphy SB, Hipp JA. Comparison of predicted and measured contact pressures in normal and dysplastic hips. Med Eng Phys, 1997, 19(2): 180-186.
6.	Zhang Z, Fu M, Kang Y, et al. Upward and inward displacements of the acetabular component increase stress on femoral head in single endoprothesis models. Int Orthop, 2010, 34(4): 479-483.
7.	Østbyhaug PO, Klaksvik J, Romundstad P, et al. An in vitro study of the strain distribution in human femora with anatomical and customised femoral stems. J Bone Joint Surg (Br), 2009, 91(5): 676-682.
8.	Giori NJ, Trousdale RT. Acetabular retroversion is associated with osteoarthritis of the hip. Clin Orthop Relat Res, 2003, (417): 263-269.
9.	Millis MB, Murphy SB, Poss R. Osteotomies about the hip for the prevention and treatment of osteoarthrosis. Instr Course Lect, 1996, 45: 209-226.
10.	Hartofilakidis G, Karachalios T, Stamos KG. Epidemiology, demographics, and natural history of congenital hip disease in adults. Orthopedics, 2000, 23(8): 823-827.
11.	Aldinger PR, Thomsen M, Mau H, et al. Cementless Spotorno tapered titanium stems: excellent 10-15-year survival in 141 young patients. Acta Orthop Scand, 2003, 74(3): 253-258.
12.	Hartofilakidis G, Karachalios T, Zacharakis N. Charnley low friction arthroplasty in young patients with osteoarthritis. A 12- to 24-year clinical and radiographic followup study of 84 cases. Clin Orthop Relat Res, 1997, (341): 51-54.
13.	Yasunaga Y, Ochi M, Shimogaki K, et al. Rotational acetabular osteotomy for hip dysplasia: 61 hips followed for 8-15 years. Acta Orthop Scand, 2004, 75(1): 10-15.
14.	Yasunaga Y, Takahashi K, Ochi M, et al. Rotational acetabular osteotomy in patients forty-six years of age or older: comparison with younger patients. J Bone Joint Surg (Am), 2003, 85-A(2): 266-272.
15.	Ito H, Tanino H, Yamanaka Y, et al. The Chiari pelvic osteotomy for patients with dysplastic hips and poor joint congruency: long-term follow-up. J Bone Joint Surg (Br), 2011, 93(6): 726-731.
16.	Vukasinovic Z, Spasovski D, Slavkovic N, et al. Chiari pelvic osteotomy in the treatment of adolescent hip disorders: possibilities, limitations and complications. Int Orthop, 2011, 35(8): 1203-1208.
17.	Kotz R, Chiari C, Hofstaetter JG, et al. Long-term experience with Chiari’s osteotomy. Clin Orthop Relat Res, 2009, 467(9): 2215-2220.
18.	Iliescu N, Pastrama SD, Gruionu LG, et al. Biomechanical changes of hip joint following different types of corrective osteotomy—photoelastic studies. Acta Bioeng Biomech, 2008, 10(3): 65-71.
19.	Karami M, Fitoussi F, Ilharreborde B, et al. The results of Chiari pelvic osteotomy in adolescents with a brief literature review. J Child Orthop, 2008, 2(1): 63-68.
20.	Li Z, Yu S, Hou C, et al. A comparison of biomechanical changes on femoral head following rotational acetabular osteotomy and eccentric rotational acetabular osteotomy in normal cadaveric hip. Eur J Orthop Surg Traumatol, 2013. [Epub ahead of print].
21.	Maruyama M, Wakabayashi S, Tensho K. Less invasive rotational acetabular osteotomy for hip dysplasia. Clin Orthop Relat Res, 2013, 471(4): 1263-1270.
22.	陈晓东, 崔一民, 沈超, 等. 髋臼周围截骨术治疗髋关节发育不良. 中华骨科杂志, 2010, 30(2): 143-147.
23.	廉永云, 刘雪峰, 逯代锋. 等. 髋臼周围旋转截骨术联合髋关节镜治疗中青年髋臼发育不良. 中国修复重建外科杂志, 2011, 25(7): 821-825.
24.	Nozawa M, Maezawa K, Matsuda K, et al. Rotational acetabular osteotomy for advanced osteoarthritis of the hip joint with acetabular dysplasia. Int Orthop, 2009, 33(6): 1549-1553.
25.	Nozawa M, Maezawa K, Matsuda K, et al. Rotational acetabular osteotomy for secondary osteoarthritis after surgery for developmental dysplasia of the hip. HSS J, 2009, 5(2): 137-142.
26.	Shimogaki K, Yasunaga Y, Ochi M. A histological study of articular cartilage after rotational acetabular osteotomy for hip dysplasia. J Bone Joint Surg (Br), 2005, 87(7): 1019-1023.

1. Maheshwari R, Madan SS. Pelvic osteotomy techniques and comparative effects on biomechanics of the hip: a kinematic study. Orthopedics, 2011, 34(12): e821-e826.
2. Lee CB, Millis MB. Alternatives to periacetabular osteotomy for adult acetabular dysplasia. Instr Course Lect, 2013, 62: 287-295.
3. Bittersohl B, Hosalkar HS, Wenger DR. Surgical treatment of hip dysplasia in children and adolescents. Orthop Clin North Am, 2012, 43(3): 301-315.
4. Bergmann G, Deuretzbacher G, Heller M, et al. Hip contact forces and gait patterns from routine activities. J Biomech, 2001, 34(7): 859-871.
5. Michaeli DA, Murphy SB, Hipp JA. Comparison of predicted and measured contact pressures in normal and dysplastic hips. Med Eng Phys, 1997, 19(2): 180-186.
6. Zhang Z, Fu M, Kang Y, et al. Upward and inward displacements of the acetabular component increase stress on femoral head in single endoprothesis models. Int Orthop, 2010, 34(4): 479-483.
7. Østbyhaug PO, Klaksvik J, Romundstad P, et al. An in vitro study of the strain distribution in human femora with anatomical and customised femoral stems. J Bone Joint Surg (Br), 2009, 91(5): 676-682.
8. Giori NJ, Trousdale RT. Acetabular retroversion is associated with osteoarthritis of the hip. Clin Orthop Relat Res, 2003, (417): 263-269.
9. Millis MB, Murphy SB, Poss R. Osteotomies about the hip for the prevention and treatment of osteoarthrosis. Instr Course Lect, 1996, 45: 209-226.
10. Hartofilakidis G, Karachalios T, Stamos KG. Epidemiology, demographics, and natural history of congenital hip disease in adults. Orthopedics, 2000, 23(8): 823-827.
11. Aldinger PR, Thomsen M, Mau H, et al. Cementless Spotorno tapered titanium stems: excellent 10-15-year survival in 141 young patients. Acta Orthop Scand, 2003, 74(3): 253-258.
12. Hartofilakidis G, Karachalios T, Zacharakis N. Charnley low friction arthroplasty in young patients with osteoarthritis. A 12- to 24-year clinical and radiographic followup study of 84 cases. Clin Orthop Relat Res, 1997, (341): 51-54.
13. Yasunaga Y, Ochi M, Shimogaki K, et al. Rotational acetabular osteotomy for hip dysplasia: 61 hips followed for 8-15 years. Acta Orthop Scand, 2004, 75(1): 10-15.
14. Yasunaga Y, Takahashi K, Ochi M, et al. Rotational acetabular osteotomy in patients forty-six years of age or older: comparison with younger patients. J Bone Joint Surg (Am), 2003, 85-A(2): 266-272.
15. Ito H, Tanino H, Yamanaka Y, et al. The Chiari pelvic osteotomy for patients with dysplastic hips and poor joint congruency: long-term follow-up. J Bone Joint Surg (Br), 2011, 93(6): 726-731.
16. Vukasinovic Z, Spasovski D, Slavkovic N, et al. Chiari pelvic osteotomy in the treatment of adolescent hip disorders: possibilities, limitations and complications. Int Orthop, 2011, 35(8): 1203-1208.
17. Kotz R, Chiari C, Hofstaetter JG, et al. Long-term experience with Chiari’s osteotomy. Clin Orthop Relat Res, 2009, 467(9): 2215-2220.
18. Iliescu N, Pastrama SD, Gruionu LG, et al. Biomechanical changes of hip joint following different types of corrective osteotomy—photoelastic studies. Acta Bioeng Biomech, 2008, 10(3): 65-71.
19. Karami M, Fitoussi F, Ilharreborde B, et al. The results of Chiari pelvic osteotomy in adolescents with a brief literature review. J Child Orthop, 2008, 2(1): 63-68.
20. Li Z, Yu S, Hou C, et al. A comparison of biomechanical changes on femoral head following rotational acetabular osteotomy and eccentric rotational acetabular osteotomy in normal cadaveric hip. Eur J Orthop Surg Traumatol, 2013. [Epub ahead of print].
21. Maruyama M, Wakabayashi S, Tensho K. Less invasive rotational acetabular osteotomy for hip dysplasia. Clin Orthop Relat Res, 2013, 471(4): 1263-1270.
22. 陈晓东, 崔一民, 沈超, 等. 髋臼周围截骨术治疗髋关节发育不良. 中华骨科杂志, 2010, 30(2): 143-147.
23. 廉永云, 刘雪峰, 逯代锋. 等. 髋臼周围旋转截骨术联合髋关节镜治疗中青年髋臼发育不良. 中国修复重建外科杂志, 2011, 25(7): 821-825.
24. Nozawa M, Maezawa K, Matsuda K, et al. Rotational acetabular osteotomy for advanced osteoarthritis of the hip joint with acetabular dysplasia. Int Orthop, 2009, 33(6): 1549-1553.
25. Nozawa M, Maezawa K, Matsuda K, et al. Rotational acetabular osteotomy for secondary osteoarthritis after surgery for developmental dysplasia of the hip. HSS J, 2009, 5(2): 137-142.
26. Shimogaki K, Yasunaga Y, Ochi M. A histological study of articular cartilage after rotational acetabular osteotomy for hip dysplasia. J Bone Joint Surg (Br), 2005, 87(7): 1019-1023.

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《中国修复重建外科杂志》

髋臼旋转截骨术及Chiari截骨术对发育性髋关节发育不良生物力学影响的比较研究

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