Bernese髋臼周围截骨术(Bernese periacetabular osteotomy,PAO)治疗发育性髋关节发育不良(develop-mental dysplasia of the hip,DDH)的效果较好.PAO治疗DDH效果的影响因素主要有术前影像学参数、术后影像学参数、一般资料及手术并发症.影响PAO治疗效果的术前影像学参数主要有外侧中心边缘角、关节间隙宽度及骨性关节炎的Tonnis分级、头臼匹配度、非球形股骨头、髋臼前倾角、股骨颈前倾角、股骨头超出指数、α角、髋臼倾斜度.影响PAO治疗效果的术后影像学参数主要有外侧中心边缘角、前方中心边缘角、髋臼倾斜度、股骨头超出指数、髋关节中心内移程度、髋臼前倾角、关节间隙宽度、α角.除此之外,年龄、体质量指数等一般资料,以及神经损伤、骨不连、截骨进入关节、应力性骨折等并发症可能会影响PAO的治疗效果.

Objective:To explore the influencing factors of postoperative functional recovery of Bernese periacetabular osteotomy(PAO) and influencing factors of pain degree.Methods:A retrospective study was conducted on the patients with developmental dysplasia of the hip (DDH) who underwent Bernese periacetabular osteotomy with a modified Smith-Peterson approach between January 2017 and November 2019. The inclusion criteria was all the DDH patients who received PAO during this period. Exclusion criteria: history of hip joint trauma, existing diseases of nerve, muscle or connective tissue, history of hip surgery, incomplete image data, acetabular retroversion (positive cross sign), the iliac-inguinal approach patients, and the patients who were lost during the follow-up. The preoperative and postoperative imaging indicators were measured. The acetabular top tilt angle, lateral central edge angle, acetabular abduction angle, femoral head extrusion index, sphericity index of femoral head, Shenton line, Tonnis grade of osteoarthritis, joint congruency, p/a ratio, acetabular anteversion angle, Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain score and modified Harris hip score (MHHS) were measured and recorded. Multiple regression analysis was applied to determine the preoperative pain degree and postoperative function influencing factors.Results:A total of 75 patients underwent Bernese PAO. Among them, 16 cases using the iliac-inguinal approach were excluded, five cases were lost during follow-up, eight cases had incomplete imaging data, and there were two cases of acetabular retroversion. Eventually the study was conducted on 44 patients. The follow-up time was (2.1±1.4) years on average. The MHHS increased from 70(55, 84) points before the surgery to 91(88, 91) points after the surgery (Z=-7.067, P <0.01), WOMAC pain score decreased from 4(1, 8) points before surgery to zero after the surgery (Z=-4.920, P<0.01). According to the logistic regression analysis, for every unit increased in the lateral center-edge angle, the postoperative modified Harris score was 1.2 times more likely to be classified as excellent[odds ratio(OR)=1.183, 95%confidence interval(CI)(1.077, 1.299), P<0.01]. For each increase of age by one unit, the probability of preoperative pain level increasing by one level was 1.1 times higher [OR=1.090, 95%CI(1.018, 1.157), P=0.012]. For each increase in body mass index by one unit, the probability of preoperative pain level increasing by one level was 1.2 times higher [OR=1.244, 95%CI(1.050, 1.474), P=0.011]. Regression analysis of other factors showed no significant correlation with preoperative pain and postoperative functional score.Conclusions:The overall function score of patients after Bernese periacetabular osteotomy is significantly improved, and the pain symptoms are significantly reduced. The patients with larger lateral center-edge angle may have better joint function after surgery, while the patients with elder age and lager body mass index may suffer more severe pain.

Objective:According to the digital anatomical characteristics of the hip joint, a calibrated femoral canal file, and corresponding femoral stem prosthesis and its measuring method are developed. To explore the effect of this technique on controlling the leg length in total hip arthroplasty (THA) and analyze the causes for the results obtained by this method.Methods:Retrospective cohort study. A total of 300 patients who underwent the first unilateral THA in Qianfoshan Hospital of Shandong Province from June 2017 to July 2020 were selected. Among them, there were 154 males and 146 females, aged 27-86 (59.5±11.3) years old. Patients were divided into groups according to the methods used of controlling their leg length discrepancy (LLD) during the operation: 134 patients with calibrated femoral canal files to control leg length were included in the observation group, meanwhile, 166 patients with unarmed methods were included in the control group. Observation indicators: (1) the baseline data of equal sex, height, preoperative LLD, and operation side were compared between the two groups. (2) the differences between LLD and the distribution of LLD were measured and compared between the two groups. (3) to compare the proportion of patients with LLD >10 mm in the two groups, and to analyze the causes of postoperative LLD >10 mm.Results:All patients completed their primary wound healing. (1) There was no significant difference found in gender, height, preoperative LLD, and operation side between the two groups (all P values >0.05). (2) The postoperative LLD of the observation group was 4.76 (2.98,7.18) mm, and that of the control group was 5.85 (3.78,8.38) mm, the difference was statistically significant ( Z=-2.84, P=0.004), and the distribution of the LLD of the observation group was better than that of the control group, and the difference was statistically significant ( Z=3.078, P=0.002). (3) In the observation group, 8 cases (5.97%, 8/134) had postoperative LLD >10 mm, and in 24 cases in the control group (14.46%, 24/166), the difference was statistically significant (χ 2=5.61, P=0.018). Cause analysis: It was related to the mismatch between the prosthesis and the patients (3 cases in the observation group and 4 cases in the control group; it was related to the lower orientation of Kirschner wire caused by obvious hyperplasia of osteophytes in the lower edge of the acetabulum (5 cases in the observation group and 3 cases in the control group). Conclusion:The use of calibrated femoral canal file in the THA can control postoperative LLD more effectively than the unarmed method, the mismatch of the prosthesis, and the lower orientation of Kirschner wire caused by hyperplasia of osteophytes in the lower edge of the acetabulum affect the control of LLD by this method.

Objectives To explore factors affecting the efficacy of Bernese periacetabular osteotomy for the treatment of hip dysplasia. Methods A retrospective study was conducted on 44 patients with hip dysplasia who underwent Bernese periacetabular osteotomy with a modified Smith‐Peterson approach between January 2017 and November 2019. Among them, 40 were women and four were men. The average age was 31.2 ± 9.4. Preoperative and postoperative imaging parameters were measured. The acetabular top tilt angle, lateral central edge angle, acetabular abduction angle, femoral head extrusion index, sphericity index of femoral head, Shenton line, Tonnis grade of osteoarthritis, joint congruency, p/a ratio, acetabular anteversion angle, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale scores, and modified Harris hip score (MHHS) were observed. MHHS were divided into three clinically relevant categories: poor (<70 points), good (70–85 points), and excellent (86–91 points). Patient demographic data, as well as preoperative and postoperative radiographic parameters, were subjected to univariate logistic regression analysis. Multiple regression analysis was used to determine factors influencing postoperative MHHS. Results The follow‐up time was 1.0–3.9 years after surgery, with an average of 1.6 years. By the last follow‐up, MHHS increased from 70 points before surgery to 91 points after surgery (P < 0.001), WOMAC pain score decreased from 4 points before surgery to 0 points after surgery (P < 0.001). WOMAC functional score decreased (Preoperative: 18.0 [4.0]; Postoperative: 4.0 [0], P = 0.004). Six patients had sensory disturbance of the lateral femoral cutaneous nerve, four of which recovered completely during follow‐up. No other complications related to surgical approach, osteotomy, acetabular displacement, acetabular fixation, and postoperative stage were found. There was no significant vascular, nerve, or visceral injuries in any of the patients. On multiple regression analysis, the probability of the postoperative modified Harris hip score of a hip joint with a preoperative lateral center edge angle ≥4.5° being classified as excellent was six times that of angles <4.5° (Exp[β]: 6.249, 95% CI: 1.03–37.85, P = 0.046). Regression analysis of other factors found no significant correlation with postoperative functional scores. Conclusion Overall functional scores post‐PAO significantly improved, and pain symptoms were significantly reduced. Patients with a preoperative lateral center edge angle ≥4.5° had better joint function after surgery.