IMPACT OF SALTER INNOMINATE OSTEOTOMY ON ACETABULAR MORPHOLOGY AND DIRECTION IN DEVELOPMENTAL DISLOCATION OF THE HIP BY THREE-DIMENSIONAL COMPUTER TOMOGRAPHY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIANGJun ¹ , RENShuang ² ,  LIUMin ¹

1. Department of Pediatric Surgery, West China Hospital, Sichuan Univercity, Chengdu Sichuan, 610041, P. R. China;
2. Department of Medical Education, West China Hospital, Sichuan Univercity, Chengdu Sichuan, 610041, P. R. China;

Corresponding?author：

LIUMin, Email: huaxilm@163.com

Keywords：

Developmental dislocation of the hip; Salter innominate osteotomy; Acetabular morphology; Threedimensional CT

DOI：

10.7507/1002-1892.20150288

Video：

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Objective To investigate the impact of the Salter innominate osteotomy on the acetabular morphology and direction and the relationship between them in children with developmental dislocation of the hip (DDH) by three-dimensional CT. Methods Between January 2013 and January 2015, 51 patients with unilateral DDH were treated. All patients were females with an average age of 2 years and 5 months (range, one year and 6 months to 5 years). All the patients underwent open reduction of the hip, Salter innominate osteotomy, proximal femoral osteotomy, and hip cast immobilization for treatment. The data of three-dimensional CT before surgery and at 1 week after surgery were measured and collected as follows:the anterior acetabular index (AAI), posterior acetabular index (PAI), axial acetabular index (AxAI), acetabular anteversion angle (AAA) of the acetabulum, and the distances of the forward, outward, and lateral rotation of the distal osteotomy fragments. The differences of AAI, PAI, AxAI, AAA between before and after surgeries were compared and the difference values of the data with significant difference results were calculated. The relationship between the difference values and the distances of three different rotation directions before and after surgeries were tested by Spearman correlation analysis. Results There were significant differences in the AAI, PAI, and AAA between before and after surgery (P<0.05), but no significant difference was found in the AxAI between before and after surgery (t=0.878, P=0.384). The difference values of AAI, PAI, and AAA were (4.518±4.601), (4.219±6.660), and (3.919±4.389)° respectively. The distances of the outward, lateral, and forward rotation of the distal osteotomy fragments after surgery were (0.420±0.339), (2.440±0.230), and (0.421±0.311) cm. There was a significant correlation between the three different rotation directions and AAI difference (P<0.05), especialy the outward rotation (r=0.981). There was a correlation between the outward, forward rotation and PAI, AAI differences (P<0.05), and no significant correlation between the lateral rotation and PAI, AAA was found (P>0.05). There was a significant correlation between the forward rotation and AAA difference (r=0.841). Conclusion Salter innominate osteotomy can increase the curvature of the anterior wall of the acetabulum in DDH, but reduce the curvature of the rear wall. At the same time, it can also change the direction of the acetabulum, significantly decrease the acetabular anteversion, but it can not change the depth of the acetabulum. The main factors of the curvature change after Salter innominate osteotomy of DDH is attributable to outward rotation, followed by forward rotation, and the main factor of the acetabular direction change is attributable to forward rotation.

Citation： JIANGJun, RENShuang, LIUMin. IMPACT OF SALTER INNOMINATE OSTEOTOMY ON ACETABULAR MORPHOLOGY AND DIRECTION IN DEVELOPMENTAL DISLOCATION OF THE HIP BY THREE-DIMENSIONAL COMPUTER TOMOGRAPHY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(11): 1332-1336. doi: 10.7507/1002-1892.20150288 Copy

1.	Salter RB. The classic. Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip by Robert B. Salter, J Bone Joint Surg (Br), 1961, 43B:518. Clin Orthop Relat Res, 1978, (137):2-14.
2.	喬永東, 司建煒, 劉建波, 等. 改良及經典Salter截骨術治療先天性髖關節發育不良的療效比較. 中國矯形外科雜志, 2010, 18(11):944-946.
3.	丁曉飛, 蘇柱程, 廖世杰, 等. 切開復位、Salter骨盆截骨術治療兒童發育性髖關節脫位的近期治療評價. 中國矯形外科雜志, 2013, 21(9):879-882.
4.	Eren A, Pekmezci M, Demirkiran G, et al. Modified Salter osteotomy for the treatment of developmental displasia of the hip:description of a new technique that eliminated the use of pins for internal fixation. J Bone Joint Surg (Br), 2007, 89(10):1375-1378.
5.	El-Sayed MM. Single-stage open reduction, Salter innominate osteotomy, and proximal femoral osteotomy for the management of developmental displasia of the hip in children between the ages of 2 and 4 years. J Pediatr Orthop B, 2009, 18(4):188-196.
6.	田琦, 周勝武. Salter骨盆截骨術治療兒童發育性髖關節脫位療效觀察. 臨床軍醫雜志, 2013, 41(10):1028-1029, 1031.
7.	高健偉, 魏開斌, 秦之威, 等. Salter截骨術結合部分改良術式治療幼兒先天性髖關節發育不良或脫位. 中國骨與關節損傷雜志, 2012, 27(10):909-910.
8.	王偉, 王曉東. 一期Salter截骨聯合股骨近端截骨在3~8歲延遲治療發育性髖關節脫位中的應用. 中國矯形外科雜志, 2011, 19(9):718-720.
9.	師東良, 齊燕, 王予彬, 等. Salter骨盆截骨術的現代臨床應用觀點. 中國骨與關節雜志, 2014, 3(9):697-701.
10.	Welke B, Schwarze M, Hurschler C, et al. The effect of Salterosteotomy for juvenile hip dysplasia:muscle forces and joint reactions. J Biomech, 2012, 45(S1):S276.
11.	Wakabayashi K, Wada I, Horiuchi O, et al. MRI findings in residual hip dysplasia. J Pediatr Orthop, 2011, 31(4):381-387.
12.	Keskin D, Ezirmik N, Karsan O. Effects of Salter innominate osteotomy on the sacroiliac joint in patients with developmental hip dysplasia. J Int Med Res, 2003, 31(4):330-334.
13.	馬云青, 張洪. 髖關節撞擊綜合征與髖關節發育不良的臨床表現、骨科檢查及鑒別診斷. 中國骨腫瘤骨病, 2011, 10(5):459-463.
14.	Dandachli W, Kannan V, Richards R, et al. Analysis of cover of the femoral head in normal and dysplastic hips:new CT-based technique. J Bone Joint Surg (Br), 2008, 90(11):1428-1434.
15.	Giori NJ, Trousdale RT. Acetabular retroversion is associated with osteoarthritis of the hip. Clin Orthop Relat Res, 2003, (417):263-269.
16.	Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg (Am), 2003, 85-A(2):278-286.
17.	Kalberer F, Sierra RJ, Madan SS, et al. Ischial spine projection into the pelvis:a new sign for acetabular retroversion. Clin Orthop Relat Res, 2008, 466(3):677-683.
18.	Ezoe M, Naito M, Inoue T. The prevalence of acetabular retroversion among various disorders of the hip. J Bone Joint Surg (Am), 2006, 88(22):372-379.
19.	宋國勇, 李石玲, 趙建, 等. 股骨髖臼撞擊癥的CT表現分析. 醫學影像學雜志, 2013, 23(2):281-284.
20.	Kiyama T, Naito M, Shiramizu K, et al. Postoperative acetabular retroversion causes posterior osteoarthritis of the hip. Int Orthop, 2009, 33(3):625-631.

1. Salter RB. The classic. Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip by Robert B. Salter, J Bone Joint Surg (Br), 1961, 43B:518. Clin Orthop Relat Res, 1978, (137):2-14.
2. 喬永東, 司建煒, 劉建波, 等. 改良及經典Salter截骨術治療先天性髖關節發育不良的療效比較. 中國矯形外科雜志, 2010, 18(11):944-946.
3. 丁曉飛, 蘇柱程, 廖世杰, 等. 切開復位、Salter骨盆截骨術治療兒童發育性髖關節脫位的近期治療評價. 中國矯形外科雜志, 2013, 21(9):879-882.
4. Eren A, Pekmezci M, Demirkiran G, et al. Modified Salter osteotomy for the treatment of developmental displasia of the hip:description of a new technique that eliminated the use of pins for internal fixation. J Bone Joint Surg (Br), 2007, 89(10):1375-1378.
5. El-Sayed MM. Single-stage open reduction, Salter innominate osteotomy, and proximal femoral osteotomy for the management of developmental displasia of the hip in children between the ages of 2 and 4 years. J Pediatr Orthop B, 2009, 18(4):188-196.
6. 田琦, 周勝武. Salter骨盆截骨術治療兒童發育性髖關節脫位療效觀察. 臨床軍醫雜志, 2013, 41(10):1028-1029, 1031.
7. 高健偉, 魏開斌, 秦之威, 等. Salter截骨術結合部分改良術式治療幼兒先天性髖關節發育不良或脫位. 中國骨與關節損傷雜志, 2012, 27(10):909-910.
8. 王偉, 王曉東. 一期Salter截骨聯合股骨近端截骨在3~8歲延遲治療發育性髖關節脫位中的應用. 中國矯形外科雜志, 2011, 19(9):718-720.
9. 師東良, 齊燕, 王予彬, 等. Salter骨盆截骨術的現代臨床應用觀點. 中國骨與關節雜志, 2014, 3(9):697-701.
10. Welke B, Schwarze M, Hurschler C, et al. The effect of Salterosteotomy for juvenile hip dysplasia:muscle forces and joint reactions. J Biomech, 2012, 45(S1):S276.
11. Wakabayashi K, Wada I, Horiuchi O, et al. MRI findings in residual hip dysplasia. J Pediatr Orthop, 2011, 31(4):381-387.
12. Keskin D, Ezirmik N, Karsan O. Effects of Salter innominate osteotomy on the sacroiliac joint in patients with developmental hip dysplasia. J Int Med Res, 2003, 31(4):330-334.
13. 馬云青, 張洪. 髖關節撞擊綜合征與髖關節發育不良的臨床表現、骨科檢查及鑒別診斷. 中國骨腫瘤骨病, 2011, 10(5):459-463.
14. Dandachli W, Kannan V, Richards R, et al. Analysis of cover of the femoral head in normal and dysplastic hips:new CT-based technique. J Bone Joint Surg (Br), 2008, 90(11):1428-1434.
15. Giori NJ, Trousdale RT. Acetabular retroversion is associated with osteoarthritis of the hip. Clin Orthop Relat Res, 2003, (417):263-269.
16. Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg (Am), 2003, 85-A(2):278-286.
17. Kalberer F, Sierra RJ, Madan SS, et al. Ischial spine projection into the pelvis:a new sign for acetabular retroversion. Clin Orthop Relat Res, 2008, 466(3):677-683.
18. Ezoe M, Naito M, Inoue T. The prevalence of acetabular retroversion among various disorders of the hip. J Bone Joint Surg (Am), 2006, 88(22):372-379.
19. 宋國勇, 李石玲, 趙建, 等. 股骨髖臼撞擊癥的CT表現分析. 醫學影像學雜志, 2013, 23(2):281-284.
20. Kiyama T, Naito M, Shiramizu K, et al. Postoperative acetabular retroversion causes posterior osteoarthritis of the hip. Int Orthop, 2009, 33(3):625-631.

Chinese Journal of Reparative and Reconstructive Surgery

IMPACT OF SALTER INNOMINATE OSTEOTOMY ON ACETABULAR MORPHOLOGY AND DIRECTION IN DEVELOPMENTAL DISLOCATION OF THE HIP BY THREE-DIMENSIONAL COMPUTER TOMOGRAPHY

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