胫骨旋转截骨术能有效改善髋关节疼痛患者的疼痛和功能,避免髋关节镜检查-短期随访

IF 1.4 4区 医学 Q3 ORTHOPEDICS
Vitali Goriainov, Mohamed Farook, Ivor Vanhegan, Tom Pollard, Antonio Andrade
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引用次数: 0

摘要

主要目的是确定胫骨远端旋转截骨术(DTDO)治疗胫骨畸形髋部疼痛后的短期临床结果,并回顾共存的病理形态如何影响治疗。所有因髋部疼痛伴胫骨旋转畸形而行DTDO的患者被认为是主要病因。假设正常胫骨扭转范围为0-40°,经踝线相对于股骨后髁测量。所有患者髋关节撞击试验屈曲内收内旋试验(FADIR)均为阳性。年龄大于50岁或出现退行性关节改变和神经肌肉疾病的患者被排除在外。观察到相关的同侧mri定义的关节内病理形态学(cam/钳子),非cam/钳子相关的唇裂和异常的股/髋臼联合形态(McKibbin指数)。分析术前、术后功能结局。32例患者行DTDO。平均胫骨扭转度48.8°(41 ~ 63°),平均年龄27岁(18 ~ 44岁),平均随访时间30个月(16 ~ 45个月)。9例患者(28%)夹持钳/夹持钳共存,8例患者(25%)McKibbin指数过高(51 ~ 76°)。总体而言,63%的患者(包括54%的共存病理患者)在单独DTDO后显着改善了髋关节功能。术前与术后12个月的评分计算如下:国际髋关节预后工具-12 - 41 vs 67 (P <0.01);髋部预后评分日常生活活动量表- 47 vs 70 (P <0.05);和髋关节预后评分运动量表- 36比64 (P <0.05)。髋部疼痛患者通常表现为胫骨和/或股骨旋转畸形和cam/钳子病变的组合。重要的是考虑胫骨畸形作为髋关节疼痛的病因。在有症状的髋关节撞击患者中,即使存在共存的病理形态,采用DTDO进行胫骨旋转也能在12个月内取得显著的临床和功能恢复。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Tibial derotation osteotomies are effective in improving pain and function and avoiding hip arthroscopy in patients with hip pain—a short-term follow-up
ABSTRACT The primary objective was to determine short-term clinical outcomes following distal tibial derotation osteotomy (DTDO) performed to manage hip pain in the presence of tibial maltorsion and to review how co-existing pathomorphology affected the management. All patients undergoing DTDO for hip pain with tibial rotational deformities recognized as the predominant aetiology were included. Normal tibial torsion range was assumed as 0–40°, measured by trans-malleolar line relative to femoral posterior condyles. All patients had a positive hip impingement test Flexion Adduction Internal Rotation test (FADIR). The patients older than 50 years or presenting with degenerative joint changes and neuromuscular conditions were excluded. Associated ipsilateral MRI-defined intra-articular pathomorphology (cam/pincer), non-cam/pincer-related labral tears and abnormal combined femoral/acetabular version (McKibbin index) were noted. Pre-operative and post-operative functional outcomes were analysed. Thirty-two patients underwent DTDO. Mean tibial torsion was 48.8° (41–63°), average age was 27 years (18–44), and average follow-up was 30 months (16–45). Nine patients (28%) had a co-existing cam/pincer, and eight patients (25%) had an excessive McKibbin index (51–76°). Overall, 63% of all patients (including 54% of patients with co-existing pathology) experienced significant hip functional improvement following DTDO alone. Pre-operative vs 12 months post-operative scores were calculated as follows: International Hip Outcome Tool-12—41 vs 67 (P &lt; 0.01); Hip Outcome Score Activities of Daily Living Scale—47 vs 70 (P &lt; 0.05); and Hip Outcome Score Sport Scale—36 vs 64 (P &lt; 0.05). Patients with hip pain frequently present with a combination of tibial and/or femoral rotational deformity and cam/pincer lesions. It is important to consider tibial maltorsion as an aetiology of hip pain. Tibial derotation with DTDO results in significant clinical and functional recovery within 12 months in symptomatic hip impingement patients even in the presence of co-existing pathomorphology.
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