| ObjectiveTo discuss the short-term clinical outcome of Bernese periacetabular osteotomy for developmental dysplasia of hip.MethodsUsing a retrospective approach to collect 79(87 hips)follow-up patiens who underwent Bernese periacetabular osteotomy for developmental dysplasia of hip from January 1,2014 to December 31,2019 in our hospital.71 cases(79 hips)with complete follow-up data were selected as the study subjects,19 patients(22 hips)were male and 52patients(57 hips)were female,whose age were 10-54 years(average was 30.3 years).Before operation and at the last follow-up,71 patients(79 hips)underwent the pelvic X-ray radiographs,Harris hip scores and International Hip Outcome Tool.The effect of periacetabular osteotomy was evaluated by observing the Lateral center-edge angle(LCEA),Acetabular index angle(AI),the Sharp angle,Ac-etabular coverage ratio and the continuity of the Shenton’s line on the X-ray radiographs.VAS score was used to assess the degree of pain in patients.Harris hip scores and The Short Version of International Hip Outcome Tool were used to assess joint function and the quality of patients’ life.Hip osteoarthritis was evaluated by T(?)nnis,Yasunaga were used to evaluate the degree of anastomosis between femoral head and acetabulum.Harris hip scores<80 was defined as an adverse outcome.ResultsAll 71 patients were followed up for 1-6 years,with an average of 2.97 years.At the last follow-up,the LCE Angle increased from(8.76±13.06)preoperatively to(37.60±8.46),which was statistically significant(t=-16.470,P=0.000,< 0.01).The AI Angle decreased from(22.71±9.44)preoperatively to(0.60±7.02).There was statistical significance(t=16.702,P=0.000,< 0.01).Sharp Angle decreased from(48.09±4.93)to(33.81±5.01)before operation,which was statistically significant(t=18.063,P=0.000,< 0.01).Acetabular coverage increased from(0.58±0.14)preoperatively to(0.90±0.08),which was statistically significant(t=-17.208,P=0.000,< 0.01).Shenton’s line continuously increased from 45 to61 hips preoperatively,which was statistically significant(χ2=7.338,P=0.007,< 0.01).VAS score decreased from(4.80±2.32)preoperatively to(1.63±1.66),which was statistically significant(t=9.857,P=0.000,< 0.01).Harris hip score increased from(60.90±21.35)preoperatively to(81.18±7.46).It was statistically significant(t=-7.969,P=0.000,< 0.01),and the score of IHOT-12 increased from(61.34±26.10)preoperatively to(87.00±19.79)at the late follow-up,which was statistically significant(t=-6.963,P=0.000,< 0.01).Multivariate logistic regression analysis showed that:(1)When LCE Angle >38°,the probability of adverse outcome was 16.573 times higher than that when LCE Angle was 20°-38°,which was statistically significant(CI: 2.516 ～ 81.511;P =0.003);(2)When the AI Angle was-10°-0°,the probability of adverse outcome was 0.083 times higher than that when the AI Angle was 0°-10°,with statistical significance(CI:0.013 ～ 0.588;P = 0.012);(3)The probability of adverse outcomes with average or poor preoperative femoral head and acetabulum was 7.794 times higher than that with excellent preoperative head and acetabulum,which was statistically significant(CI: 2.057-27.628;P =0.034).In addsitrion,a1 ge of onset,sex,BMI,preoperative LCE Angle and preoperative AI Angle did not affect the prognosis.The ROC curve showed that the truncation values of LCE Angle and AI Angle were38.1° and-9°,respectively.The specificity and sensitivity of the LCE Angle cutoff value were 75% and 78%.Patients with a postoperative LCE Angle <38.1° had a success rate of83%(35/42).In contrast,patients with postoperative LCEA >38.1° had a success rate of only 32%(12/37).The specificity of the AI Angle cutoff value was 28%,and the sensitivity was 98%.Patients with a postoperative AI Angle of 0°-10° had a success rate of 65%(30/46).The success rate was 70%(16/23)for the patients with a postoperative LCE angle of-9°-0°,and patients with a postoperative AI Angle of <-9° had a success rate of 10%(1/10).ConclusionBernese periacetabular osteotomies in correcting the deformity of the hip joint,increasing the acetabular coverage and inclusion is extremely effective.Additionally,it can not only obviously relieve or eliminate the pain of the patient’s hip joint,but also improve the mobile function of the hip joint and effectively delay the progression of hip osteoarthritis.The short-term efficacy after the operation is satisfactory,but long-term efficacy need further follow-up investigation.It would get a better prognosis for the patients with great degree of anastomosis between femoral head and acetabulumhips and proper postoperative correction of LCE angle and AI angle. |
