Ischio-pubic stress fracture after peri-acetabular osteotomy in patients with hip dysplasia
Tóm tắt
Ischio-pubic stress fracture is one of the potential complications after peri-acetabular osteotomy (PAO) in patients with hip dysplasia. The purpose of this study was to examine the prevalence of and risk factors for ischio-pubic fractures following PAO. A total of 296 hips in 275 patients who underwent transposition osteotomy of the acetabulum between 2001 and 2012 were retrospectively reviewed. Patient characteristics and radiographic parameters were compared between patients with and without fracture. Fourteen ipsilateral hips (4.7 %) in 14 female patients had fracture of the inferior pubic ramus (11 hips) or the ischial ramus (three hips) on the same side as the surgery at an average of 4.6 weeks after PAO. Multivariate analysis indicated that younger age at operation (odds ratio of 1.43 per five years, p = 0.0169) and greater degree of correction (odds ratio of 1.98 per five degrees, p = 0.0005) were significantly associated with ischio-pubic fracture as independent risk factors. All fractures healed conservatively with partial weight-bearing. Younger female patients and greater deformity corrections increased the risk of ischio-pubic stress fracture after PAO.
Tài liệu tham khảo
Nakamura S, Ninomiya S, Takatori Y, Morimoto S, Umeyama T (1998) Long-term outcome of rotational acetabular osteotomy: 145 hips followed for 10–23 years. Acta Orthop Scand 69:259–265
Delimar D, Cicak N, Klobucar H, Pećina M, Korzinek K (2002) Acetabular roof reconstruction with pedicled iliac graft. Int Orthop 26:344–348
Hasegawa Y, Iwase T, Kitamura S, Yamauchi Ki K, Sakano S, Iwata H (2002) Eccentric rotational acetabular osteotomy for acetabular dysplasia: follow-up of one hundred and thirty-two hips for five to ten years. J Bone Joint Surg Am 84:404–410
Yasunaga Y, Takahashi K, Ochi M, Ikuta Y, Hisatome T, Nakashiro J, Yamamoto S (2003) Rotational acetabular osteotomy in patients forty-six years of age or older: comparison with younger patients. J Bone Joint Surg Am 85-A:266–272
Naito M, Shiramizu K, Akiyoshi Y, Ezoe M, Nakamura Y (2005) Curved periacetabular osteotomy for treatment of dysplastic hip. Clin Orthop Relat Res 433:129–135
Ito H, Matsuno T, Minami A (2007) Rotational acetabular osteotomy through an Ollier lateral U approach. Clin Orthop Relat Res 459:200–206
Delimar D, Bohacek I, Pecina M, Bicanic G (2014) Acetabular roof reconstruction with pedicled iliac graft: ten years later. Int Orthop 38:199–201
Matsuo A, Jingushi S, Nakashima Y, Yamamoto T, Mawatari T, Noguchi Y, Shuto T, Iwamoto Y (2009) Transposition osteotomy of the acetabulum for advanced-stage osteoarthritis of the hips. J Orthop Sci 14:266–273
Fujii M, Nakashima Y, Noguchi Y, Yamamoto T, Mawatari T, Motomura G, Iwamoto Y (2011) Effect of intra-articular lesions on the outcome of periacetabular osteotomy in patients with symptomatic hip dysplasia. J Bone Joint Surg (Br) 93:1449–1456
Clohisy JC, Schutz AL, St John L, Schoenecker PL, Wright RW (2009) Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res 467:2041–2052
Trousdale RT, Ekkernkamp A, Ganz R, Wallrichs SL (1995) Periacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips. J Bone Joint Surg Am 77:73–85
Crockarell J Jr, Trousdale RT, Cabenela ME, Berry DJ (1999) Early experience and results with the periacetabular osteotomy: The Mayo Clinic experience. Clin Orthop Relat Res 363:45–53
Matta JM, Stover MD, Siebenrock K (1999) Periacetabular osteotomy through the Smith-Petersen approach. Clin Orthop Relat Res 363:21–32
Espinosa N, Strassberg J, Belzile EL, Millis MB, Kim YJ (2008) Extraarticular fractures after periacetabular osteotomy. Clin Orthop Relat Res 466:1645–1651
Tsuboi M, Hasegawa Y, Fujita K, Kawabe K (2011) Pubic/ischial stress fractures after eccentric rotational acetabular osteotomy. J Orthop Sci 16:38–43
Karashima H, Naito M, Shiramizu K, Kiyama T, Maeyama A (2011) A periacetabular osteotomy for the treatment of severe dysplastic hips. Clin Orthop Relat Res 469:1436–1441
Wiberg G (1939) Studies on dysplastic acetabula and congenital subluxation of the hip joint: with special reference to the complication of osteo-arthritis. Acta Chir Scand 83:5–135
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502
Altman RD, Gold GE (2007) Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthr Cartil 15:A1–A56
Crowe JF, Mani VJ, Ranawat CS (1979) Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am 61:15–23
Dalstra M, Huiskes R (1995) Load transfer across the pelvic bone. J Biomech 28:715–724
Kaku N, Tsumura H, Taira H, Sawatari T, Torisu T (2004) Biomechanical study of load transfer of the pubic ramus due to pelvic inclination after hip joint surgery using a three-dimensional finite element model. J Orthop Sci 9:264–269
Willett TL, Wynnyckyj C, Wang J, Grynpas MD (2011) The fatigue resistance of rabbit tibiae varies with age from youth to middle age. Osteoporos Int 22:1157–1165
Milgrom C, Finestone A, Shlamkovitch N, Rand N, Lev B, Simkin A, Wiener M (1994) Youth is a risk factor for stress fracture. A study of 783 infantry recruits. J Bone Joint Surg (Br) 76:20–22
Pavlov H, Nelson TL, Warren RF, Torg JS, Burstein AH (1982) Stress fractures of the pubic ramus. A report of twelve cases. J Bone Joint Surg Am 64:1020–1025
Hill PF, Chatterji S, Chambers D, Keeling JD (1996) Stress fracture of the pubic ramus in female recruits. J Bone Joint Surg (Br) 78:383–386