一例双侧发育性髋关节发育不良患者的自身 对照研究：Ganz截骨术较保守治疗在6年 随访中展现更优中期疗效

A Self-Controlled Study of a Patient with Bilateral Developmental Dysplasia of the Hip: Ganz Osteotomy Demonstrates Superior Mid-Term Efficacy Compared to Conservative Treatment over a 6-Year Follow-Up

摘要: 未经治疗的发育性髋关节发育不良(Developmental Dysplasia of the Hip, DDH)可继发骨关节炎，需行髋臼周围截骨术(Periacetabular Osteotomy, PAO，即Ganz截骨术)等干预措施以保留髋关节。PAO通过矫正髋臼方向，改善股骨头覆盖，从而延缓软骨退变。本文报道一例38岁女性双侧DDH患者(Tönnis 1级)，其右侧髋关节接受PAO手术，左侧髋关节采用保守治疗。6年随访结果显示，右侧髋关节功能稳定(Tönnis 1级)，外侧中心边缘角(Lateral Center-Edge Angle, LCEA)由术前4˚改善至37˚，髋臼深度由1.79 mm增至16.46 mm；Harris髋关节评分(HHS)由45分提升至71分。相反，左侧髋关节进展为重度骨关节炎(Tönnis 3级)，LCEA降至1˚，髋臼深度减至3.23 mm，HHS由83分降至36分，最终需行全髋关节置换术(Total Hip Arthroplasty, THA)。本病例凸显了PAO通过生物力学矫正有效延缓骨关节炎进展的优势，支持对DDH患者进行早期外科干预。

Abstract: Untreated developmental dysplasia of the hip (DDH) leads to secondary osteoarthritis, necessitating interventions such as PAO for hip preservation. Periacetabular osteotomy (PAO, Ganz osteotomy) corrects acetabular orientation to improve femoral head coverage, thereby delaying cartilage degeneration. This study reports a 38-year-old female with bilateral DDH (Tonnis grade 1) treated with PAO (right hip) and conservative therapy (left hip). At 6-year follow-up, the right hip exhibited stable function (Tonnis grade 1), with lateral center-edge angle (LCEA) improving from 4˚ to 37˚ and acetabular depth increasing from 1.79 mm to 16.46 mm; the Harris Hip Score (HHS) improved from 45 to 71. Conversely, the left hip progressed to severe osteoarthritis (Tonnis grade 3), with LCEA decreasing to 1˚, acetabular depth reducing to 3.23 mm, and HHS declining from 83 to 36, ultimately requiring total hip arthroplasty (THA). This case highlights PAO’s efficacy in delaying osteoarthritis progression through biomechanical correction, advocating for early surgical intervention in DDH.