T. Paavilainen 全髋关节置换术中骨碎片巩固的破坏 – 失败的原因

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论证：保守治疗髋关节发育不良，特别是髋关节脱位，在幼儿早期及时诊断可以取得良好的效果。
在这种情况下，成年髋脱位患者的首选治疗选择是全髋关节置换术。为了在髋关节置换术中恢复下肢长度的差异，可以使用T. Paavilainen提出的缩短截骨术。然而，根据俄罗斯骨科医师使用上述方法的结果，仍未解决破坏骨碎片固结的问题。

目的是确定在全髋关节置换术中根据T. Paavilainen大转子截骨后影响骨碎片实变的因素，并评估其意义用环扎螺钉固定后与用专用转子板固定。

材料与方法。本研究包括联邦政府预算机构以Research institute of traumatology and orthopedics named after R.R. Vreden的国家创伤和骨科医学研究中心在2003年至2019年期间使用T. Paavilainen方法进行的208例全髋关节置换术的临床观察，采用两种固定碎片的方法。第一组包括观察用两个螺丝和一个环扎固定大转子的碎片。在第二组，使用一个特别设计的叉板来固定。在分析x线片时，评估碎片之间接触长度对碎片实变的影响。为此，将大转子碎片分为两部分：不与股骨干接触（A）和与股骨干接触（B）。分析了B/A比对拼接频率的影响。此外，确定了股骨骨干部位螺钉插入点之间的距离，
评估骨组织的质量，并考虑病史中该髋关节区域的手术干预。

结果。根据所获得的数据，当股骨碎片相互接触B长度小于3.5厘米时，股骨碎片实变侵犯的相对风险较高。一个同样重要的因素是大转子碎片（B/A小于1）与股骨干接触程度的指数。此外，病史中髋关节的手术干预会增加采用这种缩短截骨术方法未将大转子碎片与股骨骨干接合的相对风险。

结论。由于对儿童髋关节脱位缺乏及时的诊断和保守治疗，髋关节重建的整形干预往往不能达到预期的效果，但往往会显著增加进一步的关节置换术的复杂性。因此，根据本研究的许多因素，即大转子碎片与股骨干接触的绝对值，大转子碎片与股骨干接触程度的指标，以及病史中对这个髋关节
的手术干预，根据T. Paavialinen，它们可以作为客观的工具来预测髋关节置换术中没有骨块巩
固的概率。

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作者简介

Alexandr Avdeev

Vreden Russian Research Institute of Traumatology and Orthopedics

编辑信件的主要联系方式.
Email: spaceship1961@gmail.com
ORCID iD: 0000-0002-1557-1899

MD, PhD Student

俄罗斯联邦, 8, Akademika Baykova street, St.-Petersburg, 195427

Igor Voronkevich

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: dr_voronkevich@inbox.ru
ORCID iD: 0000-0001-8471-8797

MD, PhD, Head of the Research Department of injuries and their consequences treatment

俄罗斯联邦, 8, Akademika Baykova street, St.-Petersburg, 195427

Dmitrii Parfeev

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: parfeevd@yandex.ru
ORCID iD: 0000-0001-8199-7161

MD, PhD, Head of Department

俄罗斯联邦, 8, Akademika Baykova street, St.-Petersburg, 195427

Anton Kovalenko

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: tonnchik@yandex.ru
ORCID iD: 0000-0003-4536-6834

MD, PhD, researcher of the Department of Diagnosis of Diseases and Injuries of the Musculoskeletal System

俄罗斯联邦, 8, Akademika Baykova street, St.-Petersburg, 195427

David Pliev

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: plievd@gmail.com
ORCID iD: 0000-0002-1130-040X

MD, PhD, Head of Hip Pathology Department

俄罗斯联邦, 8, Akademika Baykova street, St.-Petersburg, 195427

Ekaterina Sannikova

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: sannikovaekaterina@rambler.ru
ORCID iD: 0000-0002-9171-1697

MD, PhD, Associate Professor, The Chair of Traumatology and Orthopedics

俄罗斯联邦, 8, Akademika Baykova street, St.-Petersburg, 195427

Igor Shubnyakov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: shubnyakov@mail.ru
ORCID iD: 0000-0003-0218-3106

MD, PhD, D.Sc., Chief Researcher

俄罗斯联邦, 8, Akademika Baykova street, St.-Petersburg, 195427

Rashid Tikhilov

Vreden Russian Research Institute of Traumatology and Orthopedics; North-Western State Medical University named after I.I. Mechnikov

Email: info@rniito.org
ORCID iD: 0000-0003-0733-2414

MD, PhD, D.Sc., Professor; Professor of Traumatology and Orthopedics Department

俄罗斯联邦, 8, Akademika Baykova street, St.-Petersburg, 195427; 41, Kirochnaya street, Saint-Petersburg, 191015

参考

  1. Баиндурашвили А.Г., Волошин С.Ю., Краснов А.И. Врожденный вывих бедра у детей грудного возраста: клиника, диагностика, консервативное лечение. – СПб.: СпецЛит, 2012. [Baindurashvili AG, Voloshin SY, Krasnov AI. Vrozhdennyy vyvikh bedra u detey grudnogo vozrasta: klinika, diagnostika, konservativnoe lechenie. Saint Petersburg: SpetsLit; 2012. (In Russ.)]
  2. Gkiatas I, Boptsi A, Tserga D, et al. Developmental dysplasia of the hip: a systematic literature review of the genes related with its occurrence. EFORT Open Rev. 2019;4(10):595-601. https://doi.org/10.1302/2058-5241.4.190006.
  3. Тихилов Р.М., Шубняков И.И., Денисов А.О., и др. Имеется ли клинический смысл в разделении врожденного вывиха бедра у взрослых на типы C1 и C2 по Hartofilakidis? // Травматология и ортопедия России. – 2019. – Т. 25. – № 3. – С. 9–24. [Tikhilov RM, Shubnyakov II, Denisov AO, et al. Is the any clinical importance for separation congenitally dislocated hip in adults into types C1 and C2 by Hartofilakidis? Traumatology and Orthopedics of Russia. 2019;25(3):9-24. (In Russ.)]. https://doi.org/10.21823/2311-2905-2019-25-3-9-24.
  4. Шубняков И.И., Тихилов Р.М., Николаев Н.С., и др. Эпидемиология первичного эндопротезирования тазобедренного сустава на основании данных регистра артропластики РНИИТО им. Р.Р. Вредена // Травматология и ортопедия России. – 2017. – Т. 23. – № 2. – С. 81–101. [Shubnyakov II, Tikhilov RM, Nikolaev NS, et al. Epidemiology of primary hip arthroplasty: report from register of vreden russian research institute of traumatology and orthopedics. Traumatology and Orthopedics of Russia. 2017;23(2):81-101. (In Russ.)]. https://doi.org/10.21823/2311-2905-2017-23-2-81-101.
  5. Terjesen T, Horn J, Gunderson RB. Fifty-year follow-up of late-detected hip dislocation: clinical and radiographic outcomes for seventy-one patients treated with traction to obtain gradual closed reduction. J Bone Joint Surg Am. 2014;96(4):e28. https://doi.org/10.2106/JBJS.M.00397.
  6. Абельцев В.П., Переярченко П.В., Крымзлов В.Г., Мохирев А.А. Диспластический коксартроз: спираль развития его лечения // Кремлевская медицина. Клинический вестник. – 2015. – Т. 4. – С. 9–15. [Abel’tsev VP, Pereyarchenko PV, Krymzlov VG, Mokhirev AA. Dysplastic coxarthrosis: the spiral of its development and treatment. Kremlevskaya meditsina. Klinicheskiy vestnik. 2015;(4):9-15. (In Russ.)]
  7. Oner A, Koksal A, Sofu H, et al. The prevalence of femoroacetabular impingement as an aetiologic factor for end-stage degenerative osteoarthritis of the hip joint: analysis of 1,000 cases. Hip Int. 2016;26(2):164-168. https://doi.org/10.5301/hipint.5000323.
  8. Harris MD, MacWilliams BA, Bo Foreman K, et al. Higher medially-directed joint reaction forces are a characteristic of dysplastic hips: A comparative study using subject-specific musculoskeletal models. J Biomech. 2017;54:80-87. https://doi.org/10.1016/j.jbiomech.2017.01.040.
  9. Yang S, Cui Q. Total hip arthroplasty in developmental dysplasia of the hip: Review of anatomy, techniques and outcomes. World J Orthop. 2012;3(5):42-48. https://doi.org/10.5312/wjo.v3.i5.42.
  10. Воронкевич И.А., Парфеев Д.Г., Авдеев А.И. Развитие идей фиксации фрагмента большого вертела в ходе оперативного лечения диспластического коксартроза // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2018. – Т. 6. – № 4. – С. 59–69. [Voronkevich IA, Parfeev DG, Avdeev AI. Development of techniques for greater trochanter fragment fixation during surgical treatment of the dysplastic coxarthrosis. Pediatric traumatology, orthopaedics and reconstructive surgery. 2018; 6(4):59-69. (In Russ.)]. https://doi.org/10.17816/PTORS6459-69.
  11. Hasija R, Kelly JJ, Shah NV, et al. Nerve injuries associated with total hip arthroplasty. J Clin Orthop Trauma. 2018;9(1):81-86. https://doi.org/10.1016/ j.jcot.2017.10.011.
  12. Bicanic G, Barbaric K, Bohacek I, et al. Current concept in dysplastic hip arthroplasty: Techniques for acetabular and femoral reconstruction. World J Orthop. 2014;5(4):412-424. https://doi.org/10.5312/wjo.v5.i4.412.
  13. Yalcin N, Kilicarslan K, Karatas F, et al. Cementless total hip arthroplasty with subtrochanteric transverse shortening osteotomy for severely dysplastic or dislocated hips. Hip Int. 2010;20(1):87-93. https://doi.org/10.1177/112070001002000113.
  14. Rasi AM, Kazemian G, Khak M, Zarei R. Shortening subtrochanteric osteotomy and cup placement at true acetabulum in total hip arthroplasty of Crowe III-IV developmental dysplasia: results of midterm follow-up. Eur J Orthop Surg Traumatol. 2018;28(5):923-930. https://doi.org/10.1007/s00590-017-2076-8.
  15. Ozden VE, Dikmen G, Beksac B, Tozun IR. Total hip arthroplasty with step-cut subtrochanteric femoral shortening osteotomy in high riding hip dislocated patients with previous femoral osteotomy. J Orthop Sci. 2017;22(3):517-523. https://doi.org/10.1016/ j.jos.2017.01.017.
  16. Камшилов Б.В., Тряпичников А.С., Чегуров О.К., и др. Особенности эндопротезирования тазобедренного сустава у пациентов с высоким врожденным вывихом бедра // Травматология и ортопедия России. – 2017. – Т. 23. – № 4. – С. 39–47. [Kamshilov BV, Tryapichnikov AS, Chegurov OK, et al. Features of THA in patients with high congenital hip dislocation. Traumatology and Orthopedics of Russia. 2017;23(4):39-47. (In Russ.)]. https://doi.org/10.21823/2311-2905-2017-23-4-39-47.
  17. Rollo G, Solarino G, Vicenti G, et al. Subtrochanteric femoral shortening osteotomy combined with cementless total hip replacement for Crowe type IV developmental dysplasia: a retrospective study. J Orthop Traumatol. 2017;18(4):407-413. https://doi.org/10.1007/s10195-017-0466-7.
  18. Li X, Sun J, Lin X, et al. Cementless total hip arthroplasty with a double chevron subtrochanteric shortening osteotomy in patients with Crowe type-IV hip dysplasia. Acta Orthop Belg. 2013;79(3):287-292.
  19. Тряпичников А.С., Камшилов Б.В., Чегуров О.К., и др. Некоторые аспекты эндопротезирования тазобедренного сустава с подвертельной укорачивающей остеотомией при врожденном вывихе бедра (обзор литературы) // Травматология и ортопедия России. – 2019. – Т. 25. – № 1. – С. 165–176. [Tryapichnikov AS, Kamshilov BV, Chegurov OK, et al. Some aspects of total hip replacement with subtrochanteric shortening osteotomy in patients with congenital hip dislocation (Review). Traumatology and Orthopedics of Russia. 2019;25(1):165-176. (In Russ.)]. https://doi.org/10.21823/2311-2905-2019-25-1-165-176.
  20. Togrul E, Ozkan C, Kalaci A, Gulsen M. A new technique of subtrochanteric shortening in total hip replacement for Crowe type 3 to 4 dysplasia of the hip. J Arthroplasty. 2010;25(3):465-470. https://doi.org/10.1016/j.arth.2009.02.023.
  21. Reikeras O, Haaland JE, Lereim P. Femoral shortening in total hip arthroplasty for high developmental dysplasia of the hip. Clin Orthop Relat Res. 2010;468(7):1949-1955. https://doi.org/10.1007/s11999-009-1218-7.
  22. Krych AJ, Howard JL, Trousdale RT, et al. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia: surgical technique. J Bone Joint Surg Am. 2010;92 Suppl 1 Pt 2:176-187. https://doi.org/10.2106/JBJS.J.00061.
  23. Hasegawa Y, Iwase T, Kanoh T, et al. Total hip arthroplasty for Crowe type developmental dysplasia. J Arthroplasty. 2012;27(9):1629-1635. https://doi.org/10.1016/j.arth.2012.02.026.
  24. Carlsson A, Bjorkman A, Ringsberg K, von Schewelov T. Untreated congenital and posttraumatic high dislocation of the hip treated by replacement in adult age: 22 hips in 16 patients followed for 1-8 years. Acta Orthop Scand. 2003;74(4):389-396. https://doi.org/10.1080/00016470310017677.
  25. Paavilainen T, Hoikka V, Solonen KA. Cementless total replacement for severely dysplastic or dislocated hips. J Bone Joint Surg Br. 1990;72(2):205-211.
  26. Тихилов Р.М., Мазуренко А.В., Шубняков И.И., и др. Результаты эндопротезирования тазобедренного сустава с укорачивающей остеотомией по методике T. Paavilainen при полном вывихе бедра // Травматология и ортопедия России. – 2014. – № 1. – С. 5–15. [Tikhilov RM, Mazurenko AV, Shubnyakov II. Results of hip arthroplasty using Paavilainen technique in patients with congenitally dislocated hip. Traumatology and Orthopedics of Russia. 2014;(1):5-15. (In Russ.)]. https://doi.org/10.21823/2311-2905-2014-0-1-5-15.
  27. Плиев Д.Г., Тихилов Р.М., Шубняков И.И., и др. Возможность оценки качества костной ткани при переломах шейки бедренной кости рентгенометрическим методом // Травматология и ортопедия России. – 2009. – № 2. – С. 102–106. [Pliev DG, Tikhilov RM, Shubnyakov II, et al. Possibility assessment bone quality by radiogrammetry in femoral neck fractures. Traumatology and Orthopedics of Russia. 2009;(2):102-106. (In Russ.)]
  28. Руководство по хирургии тазобедренного сустава / под ред. Р.М. Тихилова, И.И. Шубнякова. – СПб., 2014. [Rukovodstvo po khirurgii tazobedrennogo sustava. Ed. by R.M. Tikhilov, I.I. Shubnyakov. Saint Petersburg; 2014. (In Russ.)]
  29. Thorup B, Mechlenburg I, Soballe K. Total hip replacement in the congenitally dislocated hip using the Paavilainen technique: 19 hips followed for 1.5-10 years. Acta Orthop. 2009;80(3):259-262. https://doi.org/10.3109/17453670902876789.
  30. Eskelinen A, Remes V, Ylinen P, et al. Cementless total hip arthroplasty in patients with severely dysplastic hips and a previous Schanz osteotomy of the femur: techniques, pitfalls, and long-term outcome. Acta Orthop. 2009;80(3):263-269. https://doi.org/10.3109/17453670902967273.
  31. Hamadouche M, Zniber B, Dumaine V, et al. Reattachment of the ununited greater trochanter following total hip arthroplasty. The use of a trochanteric claw plate. J Bone Joint Surg Am. 2003;85(7):1330-1337. https://doi.org/10.2106/00004623-200307000-00020.

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2. 图 1。大转子接触指数：a — 用两个螺丝和一个钢 丝圈固定方法（第一组）；b — 特别设计的叉板固 定方法（第二组）；A — 未与股骨干接触的大转子 的一部分；B — 与股骨干接触大转子的一部分

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3. 图 2 。两种不同截骨术中该步骤的单步阶段作 用于髋关节的力量：K — 身体的重量（重力）， 不包括肢体的质量，垂直作用于杠杆b的肩膀上； M — 支撑杠杆a肩部骨盆平衡的外展肌肉强度的 向量；M 1，a 1 — 用于转子下截骨术；M 2，a 2 — 用于由T . P a a v i l a i n e n 的截骨术。骨盆平衡 公式：K * b = M * a

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