髋臼周围截骨术后患者报告结果与股骨头覆盖率和髋臼方向的相关性
Correlation of Patient-Reported Outcomes After Periacetabular Osteotomy With Femoral Head Coverage and Acetabular Orientation: A Single-Center Cohort Study
Background: Gaining a better understanding of the underlying pattern of acetabular dysplasia 3-dimensionally can help better guide treatment and optimize clinical outcomes after periacetabular osteotomy (PAO).
Purpose: (1) To examine the relationship between femoral head coverage before and after PAO for dysplasia and patient-reported outcome measure (PROM) scores and (2) to assess if the direction/orientation of correction of the acetabulum can be predicted based on the Ottawa classification.
Study Design: Cohort study; Level of evidence, 3.
Methods: A retrospective analysis of a prospectively collected database from a single-center institutional registry of PAO was conducted, and PROM scores at a minimum of 2 years were analyzed. A total of 79 hips (67 patients [56 female]; mean age at surgery, 27.5 years [range, 15.8-53.7 years]) were available for inclusion. According to the Ottawa classification, 54 hips (68.4%) had global deficiency, 15 hips (18.9%) had posterior deficiency, and 10 hips (12.7%) had anterior deficiency. Hip2Norm software was used to analyze the 3-dimensional coverage of the femoral head. Statistical analysis was conducted to look at significant predictors of improvements in PROMs using the minimal clinically important difference (MCID) for the Hip disability and Osteoarthritis Outcome Score (HOOS) Activities of Daily Living subscale.
Results: At a mean follow-up of 3.1 years (range, 2.0-7.4 years), all functional outcome scores improved significantly. A postoperative total femoral coverage < 75.7%, posterior coverage (PC) <45.2%, and femoral head extrusion index > 15.5% were all associated with not reaching the MCID for the HOOS Activities of Daily Living subscale. Multivariate analysis showed that PC was the single most important significant modifier influencing functional outcomes after PAO for the treatment of acetabular dysplasia, with an odds ratio of 6.0 (95% CI, 1.8-20.4; P = .004). One-way analysis of variance showed a significant difference comparing the mean change in radiographic measurements, that is, anterior coverage, PC, and total femoral coverage, per the Ottawa classification (P <.001).
Conclusion: Our study demonstrated that postoperative femoral head coverage and acetabular orientation were significant predictors of PROM scores. Classifying acetabular dysplasia into 3 groups based on the plane of instability could optimize the planning of PAO by giving a better understanding of the 3-dimensional deformity.
髋臼周围截骨术后患者报告结果与股骨头覆盖率和
髋臼方向的相关性：单中心队列研究
译者：张利强
背景：更好地了解髋臼发育不良的三维基本模式将有助于更好地指导治疗和优化髋臼周围截骨术（PAO）后的临床结果。
目的：（1）探讨髋臼发育不良行PAO治疗前后股骨头覆盖率与患者报告的预后评分（PROM）之间的关系；（2）评估根据渥太华分类是否可以预测髋臼矫正的方向。
研究设计：队列研究；证据水平，3。
方法：回顾性分析单中心机构注册数据库前瞻性收集的PAO资料，分析至少2年的PROM评分。共有79髋（67名患者[56名女性]；平均手术年龄27.5岁[范围15.8-53.7岁]）符合纳入标准。根据渥太华分类，54髋（68.4%）有全髋关节发育不良，15髋（18.9%）有髋关节后方发育不良，10髋（12.7%）有髋关节前方发育不良。应用Hip2Norm软件分析股骨头三维覆盖情况。采用髋关节残疾和骨关节炎结局评分（HOOS）日常生活活动量表的最小临床重要差异（MCID）对PROMs改善的显著预测因子进行统计分析。
结果：平均随访3.1年（2.0-7.4年），所有功能结果评分均明显改善。术后股骨头总覆盖率＜75.7%，后方覆盖率＜45.2%，股骨头外移指数＞15.5%，均与HOOS日常生活活动量表未达到MCID有关。多变量分析显示PC是影响PAO治疗髋臼发育不良后功能结果的唯一最重要因素，优势比为6.0（95%CI，1.8-20.4；P=0.004）。单因素方差分析显示，根据渥太华分类（P<0.001），与X线测量的平均变化相比，前覆盖率、后覆盖率和股骨总覆盖率存在显著差异。
结论：我们的研究表明，术后股骨头覆盖率和髋臼方向是PROM的重要预测因素。根据不稳定平面将髋臼发育不良分为3组，可以更好地了解三维畸形，从而优化PAO的规划。
（A） 一位22岁女性患者的术前骨盆正位（AP）平片显示，右髋臼为全髋发育不良（根据渥太华分类为G级），图示外移指数，未覆盖股骨头（a）与总水平股骨头直径（a + b）的比率为27%，术后降至8%（插图）。（B）髋臼周围截骨术后在骨盆平片上利用Hip2Norm手动标识，包括骶尾关节（上蓝十字）和耻骨联合上缘（下蓝十字），用于矢状面参照；泪滴的下缘（红十字），用于水平面参照；股骨头（粉红十字）和髋臼（绿十字）的中心；髋臼前缘（蓝线）和后缘（红线）的投影。利用前后视图（插图a）和上下视图（插图b）分析右髋。（C） 髋臼三维重建前后，在前后位上计算前覆盖率，后覆盖率，计算髋臼在上下方向（蓝色箭头）的总股骨覆盖率（Hip2Norm软件的插图显示了髋臼在上下方向的前（蓝线）和后（红线）的股骨头覆盖率）。髋臼硬化带由粗黑线表示。
（A） 前覆盖率（蓝色斑块）：髋臼前缘（实线）在前后方向覆盖的股骨头百分比。（B） 后覆盖率（红色斑块）：股骨头在后向前方向上被髋臼后缘（虚线）覆盖的百分比。（C） 股骨总覆盖率：髋臼在上下方向（蓝色箭头）覆盖股骨头的百分比，即上下覆盖率。（D） 外侧中心边缘角：骨盆纵轴与连接股骨头中心与髋臼外侧边缘的线（粗黑线）之间的角度。（E） 髋臼指数：骨盆水平轴与连接髋臼顶部硬化区最内侧和外侧点的线（粗黑线）之间的角度。（F） 外移指数：未覆盖股骨头（a）与总水平头直径（a + b）的比值。（G）后壁征：髋臼后缘（虚线）向股骨头中心内侧突出（黑点）。交叉征：突出的前壁与后壁交叉。髋臼后倾指数：后倾的髋臼开口长度（a）与髋臼外侧开口全长（b）的比值。
文献出处：Ibrahim MM, Smit K, Poitras S, Grammatopoulos G, Beaulé PE. Correlation of Patient-Reported Outcomes After Periacetabular Osteotomy With Femoral Head Coverage and Acetabular Orientation: A Single-Center Cohort Study. Am J Sports Med. 2021 Mar 4:363546521992108. doi: 10.1177/0363546521992108. Epub ahead of print. PMID: 33661717.