髖臼旋轉截骨術及Chiari截骨術對發育性髖關節發育不良生物力學影響的比較研究_《中國修復重建外科雜志》

作者：

傅明 ¹ , 張志奇 ¹ , 向珊珊 ² , 劉進 ¹ , 黃廣鑫 ¹

1 中山大學附屬第一醫院關節外科（廣州，510080）;;
2 中山大學附屬江門醫院骨外科;

關鍵詞：

發育性髖關節發育不良髖臼旋轉截骨術 Chiari截骨術髖關節應力

DOI：

10.7507/1002-1892.20130142

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目的通過生物力學測試，比較髖臼旋轉截骨術及Chiari截骨術治療成人發育性髖關節發育不良（developmental dysplasia of the hip，DDH）后對髖關節生物力學的影響。方法取8具成年女性骨盆標本，切除雙側髖關節髖臼后沿和上沿，使其股骨頭中心點垂線與髖臼外側邊緣夾角 lt; 20°，制備DDH模型；然后于左側行髖臼旋轉截骨術，右側行Chiari截骨術。分別對正常標本、DDH模型及兩種截骨術后標本，于材料試驗機上以5 mm/min速率加載至600 N測量髖關節應變值。結果正常標本左、右側髖關節應變值分別為845.63 ± 533.91及955.94 ± 837.42；DDH模型應變值明顯增加，左、右側分別為1 439.03 ± 625.23及1 558.75 ± 1 009.46，約為正常標本的2倍。結合形態學、影像學檢查，提示DDH模型制備成功。髖臼旋轉截骨術后髖關節應變值為574.94 ± 430.88，較DDH模型明顯下降，差異有統計學意義（t=4.176，P=0.004）。Chiari截骨術后髖關節應變值為1 614.81 ± 932.67，與DDH模型相似，差異無統計學意義（t=0.208，P=0.841）。髖臼旋轉截骨術后髖關節應變值與術前應變值之差顯著低于Chiari截骨術，差異有統計學意義（t= —2.548，P=0.023）。結論髖臼旋轉截骨術緩解DDH髖關節病理性應力的效果優于Chiari截骨術。

引用本文： 傅明,張志奇,向珊珊,劉進,黃廣鑫. 髖臼旋轉截骨術及Chiari截骨術對發育性髖關節發育不良生物力學影響的比較研究. 中國修復重建外科雜志, 2013, 27(6): 641-644. doi: 10.7507/1002-1892.20130142 復制

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.	?stbyhaug 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.	陳曉東, 崔一民, 沈超, 等. 髖臼周圍截骨術治療髖關節發育不良. 中華骨科雜志, 2010, 30(2): 143-147.
23.	廉永云, 劉雪峰, 逯代鋒. 等. 髖臼周圍旋轉截骨術聯合髖關節鏡治療中青年髖臼發育不良. 中國修復重建外科雜志, 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. ?stbyhaug 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. 陳曉東, 崔一民, 沈超, 等. 髖臼周圍截骨術治療髖關節發育不良. 中華骨科雜志, 2010, 30(2): 143-147.
23. 廉永云, 劉雪峰, 逯代鋒. 等. 髖臼周圍旋轉截骨術聯合髖關節鏡治療中青年髖臼發育不良. 中國修復重建外科雜志, 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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髖臼旋轉截骨術及Chiari截骨術對發育性髖關節發育不良生物力學影響的比較研究

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