Sufian S Ahmad, Gaia Giudici, Justus Stamp, Quentin Karisch, Henning Windhagen, Marco Haertlé
{"title":"髋臼周围截骨术中耻骨切口位置对耻骨根移位影响的三维CT模拟研究。","authors":"Sufian S Ahmad, Gaia Giudici, Justus Stamp, Quentin Karisch, Henning Windhagen, Marco Haertlé","doi":"10.1302/2633-1462.67.BJO-2024-0223.R1","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>Periacetabular osteotomy (PAO) has become widely recognized as the gold standard for the correction of acetabular pathomorphologies. However, the pubic cut has raised concerns due to complications such as delayed union and its association with anterior hip syndrome. The aim of this study was to examine the impact of the position of the pubic cut on the displacement of the pubic root during PAO surgery.</p><p><strong>Methods: </strong>The study included thin-sliced CT scans of 58 hips with symptomatic hip dysplasia. Overall, 3D simulations of PAO were performed in triplicate, incorporating three variations of the pubic cut, specifically positioned 5, 10, or 15 mm medial to the iliopectineal eminence. Full displacement of the pubic osteotomy was noted by two independent investigators. Analysis of variance was used for comparison between means. Logistic regression was used to determine factors influencing displacement of the pubic root.</p><p><strong>Results: </strong>The incidence of complete pubic bone displacement increased with the medial position of the cut, with rates of 17.24% for a 5 mm cut, 36.21% for a 10 mm cut, and the highest at 82.76% for a 15 mm cut medial to the iliopectineal eminence (p < 0.001). The odds of complete displacement were reduced ten-fold with a lateral 5 mm pubic cut (odds ratio 0.1, 95% CI 0.04 to 0.20, p < 0.001).</p><p><strong>Conclusion: </strong>The position of the pubic cut is the most significant determinant of pubic root displacement in PAO surgery. Loss of contact at the pubic osteotomy is likely associated with delayed union and postoperative anterior hip syndrome. Choosing a lateral pubic cut positioned 5 mm medial to the iliopectineal eminence is expected to result in a ten-fold reduction in the risk of complete pubic bone displacement. Appreciating the results of this study when performing the pubic cut may help mitigate the risk of post-PAO anterior hip syndrome.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"748-754"},"PeriodicalIF":2.8000,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221529/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of pubic cut position on pubic root displacement in periacetabular osteotomy : a 3D CT simulation study.\",\"authors\":\"Sufian S Ahmad, Gaia Giudici, Justus Stamp, Quentin Karisch, Henning Windhagen, Marco Haertlé\",\"doi\":\"10.1302/2633-1462.67.BJO-2024-0223.R1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>Periacetabular osteotomy (PAO) has become widely recognized as the gold standard for the correction of acetabular pathomorphologies. However, the pubic cut has raised concerns due to complications such as delayed union and its association with anterior hip syndrome. The aim of this study was to examine the impact of the position of the pubic cut on the displacement of the pubic root during PAO surgery.</p><p><strong>Methods: </strong>The study included thin-sliced CT scans of 58 hips with symptomatic hip dysplasia. Overall, 3D simulations of PAO were performed in triplicate, incorporating three variations of the pubic cut, specifically positioned 5, 10, or 15 mm medial to the iliopectineal eminence. Full displacement of the pubic osteotomy was noted by two independent investigators. Analysis of variance was used for comparison between means. Logistic regression was used to determine factors influencing displacement of the pubic root.</p><p><strong>Results: </strong>The incidence of complete pubic bone displacement increased with the medial position of the cut, with rates of 17.24% for a 5 mm cut, 36.21% for a 10 mm cut, and the highest at 82.76% for a 15 mm cut medial to the iliopectineal eminence (p < 0.001). The odds of complete displacement were reduced ten-fold with a lateral 5 mm pubic cut (odds ratio 0.1, 95% CI 0.04 to 0.20, p < 0.001).</p><p><strong>Conclusion: </strong>The position of the pubic cut is the most significant determinant of pubic root displacement in PAO surgery. Loss of contact at the pubic osteotomy is likely associated with delayed union and postoperative anterior hip syndrome. Choosing a lateral pubic cut positioned 5 mm medial to the iliopectineal eminence is expected to result in a ten-fold reduction in the risk of complete pubic bone displacement. Appreciating the results of this study when performing the pubic cut may help mitigate the risk of post-PAO anterior hip syndrome.</p>\",\"PeriodicalId\":34103,\"journal\":{\"name\":\"Bone & Joint Open\",\"volume\":\"6 7\",\"pages\":\"748-754\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-07-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221529/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Bone & Joint Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1302/2633-1462.67.BJO-2024-0223.R1\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bone & Joint Open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1302/2633-1462.67.BJO-2024-0223.R1","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的:髋臼周围截骨术(PAO)已被广泛认为是矫正髋臼病理形态的金标准。然而,由于延迟愈合等并发症及其与髋关节前路综合征的关联,耻骨切口引起了人们的关注。本研究旨在探讨PAO手术中耻骨切口位置对耻骨根移位的影响。方法:对58例有症状性髋关节发育不良的髋关节进行薄层CT扫描。总体而言,PAO的3D模拟进行了三次,包括三种耻骨切口的变化,具体位置为髂耻耻骨隆起内侧5、10或15 mm。两名独立的调查人员注意到耻骨截骨完全移位。方差分析用于均值之间的比较。采用Logistic回归分析影响耻骨根移位的因素。结果:耻骨完全移位的发生率随切口内侧位置的增加而增加,5mm切口的发生率为17.24%,10mm切口的发生率为36.21%,髂耻耻骨隆起内侧15mm切口的发生率最高为82.76% (p < 0.001)。外侧5mm耻骨切口完全移位的几率降低了10倍(优势比为0.1,95% CI 0.04至0.20,p < 0.001)。结论:在PAO手术中,耻骨切口的位置是决定耻骨根移位的最重要因素。耻骨截骨处失去接触可能与延迟愈合和术后髋前综合征有关。选择位于髂耻耻骨隆起内侧5mm的耻骨外侧切口,可使完全耻骨移位的风险降低10倍。在进行耻骨切割时,欣赏本研究的结果可能有助于降低pao后髋关节前综合征的风险。
Impact of pubic cut position on pubic root displacement in periacetabular osteotomy : a 3D CT simulation study.
Aims: Periacetabular osteotomy (PAO) has become widely recognized as the gold standard for the correction of acetabular pathomorphologies. However, the pubic cut has raised concerns due to complications such as delayed union and its association with anterior hip syndrome. The aim of this study was to examine the impact of the position of the pubic cut on the displacement of the pubic root during PAO surgery.
Methods: The study included thin-sliced CT scans of 58 hips with symptomatic hip dysplasia. Overall, 3D simulations of PAO were performed in triplicate, incorporating three variations of the pubic cut, specifically positioned 5, 10, or 15 mm medial to the iliopectineal eminence. Full displacement of the pubic osteotomy was noted by two independent investigators. Analysis of variance was used for comparison between means. Logistic regression was used to determine factors influencing displacement of the pubic root.
Results: The incidence of complete pubic bone displacement increased with the medial position of the cut, with rates of 17.24% for a 5 mm cut, 36.21% for a 10 mm cut, and the highest at 82.76% for a 15 mm cut medial to the iliopectineal eminence (p < 0.001). The odds of complete displacement were reduced ten-fold with a lateral 5 mm pubic cut (odds ratio 0.1, 95% CI 0.04 to 0.20, p < 0.001).
Conclusion: The position of the pubic cut is the most significant determinant of pubic root displacement in PAO surgery. Loss of contact at the pubic osteotomy is likely associated with delayed union and postoperative anterior hip syndrome. Choosing a lateral pubic cut positioned 5 mm medial to the iliopectineal eminence is expected to result in a ten-fold reduction in the risk of complete pubic bone displacement. Appreciating the results of this study when performing the pubic cut may help mitigate the risk of post-PAO anterior hip syndrome.