髋臼周围截骨术治疗成人髋关节发育不良.ppt

髋臼周围截骨术治疗成人髋关节发育不良及长期结果;提纲;;早期临床症状;骨科检查;骨科检查;Ｘ线片表现;CE角与臼顶倾斜角;Shenton’s 线;;合并异常;保守治疗预后; 我国髋关节的疾病构成;髋关节周围截骨术 Prof. R. Ganz 1984 年应用于临床 是目前世界上临床效果最好的手术方法之一;相关基础研究; The Bernese periacetabular osteotomy is performed through a modified Smith-Petersen approach, including an osteotomy of the anterior superior iliac spine to dissect the inguinal ligament and the adjacent muscles. (A) With four periacetabular osteotomies and a controlled fracture, the acetabulum is completely mobilized from the innominate bone. (B) For fixation of the reoriented fragment, three cortical screws are used. (C) The posterior column of the true pelvis remains intact maintaining stability through an intact continuity of the pelvic ring.;髋关节周围截骨术;;;; ;;;;;;;;;;3D CT 影像重建;直接髋关节核磁造影检查;;;;耻骨支截骨;髂骨截骨;髂骨及坐骨支截骨;;;手术中的特殊器械;术中透视;自体血回输;术中控制性降压;; ;; 术中危险因素;术后x线评价;;;;;;;;;手术中如何评价髋臼旋转是否满意截骨术后髋臼后倾;手术中如何评价髋臼旋转是否满意截骨术后髋臼后倾;;手术中如何评价髋臼旋转是否满意截骨术后髋臼前倾; 从1997年开始 目前已完成 600余例手术 中期随访结果良好 4-10 年随访结果: 93% 优良 (92ps, 104hips) Y. Huang, H. Zhang et al: Mid-term Follow-up of Bernese Periacetabular Osteotomy through Ilioinguinal Approach. Chin. J. Orthop. 27(7): 499-504, 2007;长期随访结果;;;;患者自我评价;Mean 20-year Followup;;Fig. 3A–G Radiographs are shown of a 26-year-old woman with a dysplastic right hip with (A) an LCE angle of 16 and an AI of 12 without any signs of osteoarthritis. (B) The postoperative LCE angle was 32 and the AI -2. At the (C) 10- year and the (D) 20-year followups, no osteoarthitic changes were seen. (E) In the corresponding false-profile views, (F) the preoperative ACE angle of 39 to 45 postoperatively and (G) no osteoarthritic changes were seen at the 10-year followup. LCE = lateral center edge angle; AI = acetabular index; ACE = anterior center edge angle.;;;热点问题及研究方向;;个体化方案;;;78;79;Thank You For Your Attention 谢谢大家