Pelvic Osteotomy in Adults / 대한정형외과학회잡지

Pelvic osteotomy is a surgery for correcting acetabular deformity, which causes incomplete coverage of the femoral head or biomechanically abnormal load to the hip joint. Pelvic osteotomy can be divided into two categories: reconstructive or realignment osteotomy and salvage osteotomy. Reconstructive osteotomy can be performed to correct the dysplastic hip with good congruency, and include most pelvic osteotomies, except Chiari osteotomy. Among these, Bernese osteotomy, rotational acetabular osteotomy, and periacetabular rotational osteotomy are commonly being used. Salvage osteotomy, which include Chiari osteotomy only, can be performed to increase the coverage of the femoral head of hip joint with joint incongruency due to the severely deformed femoral head and acetabulum or advanced osteoarthritis. Chiari osteotomy is a kind of arthroplasty reducing the pressure applied to the head, and increasing the bone coverage on the upper part of the femoral head. It is effective in reducing hip pain and slowing degenerative changes; however, as the surface is covered by fibrous cartilage, it is vulnerable to degenerative changes. The pelvic osteotomy is a very important and useful surgical technique to preserve joints, despite being a difficult procedure that is technically demanding.

Treatment of acetabular dysplasia by Chiari osteotomy combined with bone grafting shelf procedure and screw fixation / 中国矫形外科杂志

[Objective] To introduce the Chiari osteotomy combined with bone grafting shelf procedure and scew fixation for the treatment of acetabular dysplasia which was caused by all sorts of reasons.[Methods]Totally 56 patients(63 hips)with acetabular dysplasia were operated by Chiari osteotomy combined with bone grafting procedure and screw fixation from October 1982 to October 2001,the average age of the patients was 20.7 years(8~42 years).There were 7 males who didn 't have acetabular dysplasia of both hips,49 females in which 7 ones had acetabular dysplasia of both hips.The X-ray graphies before operation showed:average CE angle was 4?(-20?~ 18?),femoral head coveragement ratio was 60%(42%~75%).Sharp angle was 51?(40? ~58?),AC angle was 27?(20?~38?).All of the patients had subluxation of hip(broken Shentions line)of different degrees except two.[Results]Thirty-two patients(37 hips)had followed up results for average 45 months(6 months to 8 years).Thirty hips were obviously pain-free.The average CE angle was 44?(41? ~62?),Shape angle was 37?(30?~45?)AC angle was 12?(8? ~18?),Harris hip score was increased from 76.3(61~82)before operation to 89(76~95)after operation.Two hips had the complication of bone absorbtion after operation.[Conclusion]The Chiari osteotomy combined with bone grafting shelf procedure and stew fixation is a better procedure for the treatment of acetabular dysplasia,the main advantages of it are as following:(1)The injury during the operation is light without much blood lost,blood tranfusion is not needed.(2)It has the merits of Chiari osteotomy.(3)It can increase the femoral head coveragemean efficiently.The diameter of acetabular from anterior to posterior and the diameter form left to right can be increased.(4)It is not easy for the bone grafted to the absorbed.(5)It works in the case which can 't be absolved by only Chiari osteotomy.

Chiari Osteotomy in Old Congenital Dislocation of the Hip / 대한정형외과학회잡지

Twelve neglected congenital dislocations of the hip in ten patients over the age of eight years were treated by open reduction and chiari osteotomy. Reduction was aided by preoperative traction only in two hips, by femoral shortening with preoperative traction in three and by femoral shortening only in seven. The average follow up period in our series is 3 years, ranging from 1 year and 2 moths to 4 years and 5 months. The overall results were good but one case of avascular necrcsis and one case of redislocation were seen. By our experience it is thought that all old and congenitally dislocated hip in the growing age can be reduced by femoral shortening with soft tissue release, and preoperative traction for its reduction is not undispensable. The most problem in the treatment of the old congenital dislocation of the hip is the postoperative partial ankylosis in the affected hip and this problem would be overcome by delicate operative technique and meticulous hemostasis.