Buradasınız

Hasta Yaşının Gelişimsel Kalça Displazisi Tedavisinde Uygulanan Pelvik Osteotomilerin Sonuçları Üzerine Etkisi

Effect of Patient Age on Radiographic and Clinical Results of Pelvic Osteotomies for DDH

Journal Name:

Publication Year:

Keywords (Original Language):

Abstract (2. Language): 
Objectives: To evaluate the effect of patient age on radiographic and clinical results of developmental dysplasia of hip (DDH) treated with pelvic osteotomy. Material and Methods: Fourty-three hip of 33 patients with more than 1 year follow-up were evaluated. The patients were devided two groups, group I had under 48 months old and group II had over 48 months old patients. Mean follow-up period was 25.4 months (13-60) and 38.4 months (12¬ 75) in group I and II, respectively. Results: In group I group II respectively; mean acetabular index (AI) was lovered to 20.8° and 25.9°, mean cenral- edge (CE) angle was up to 28.9° and 26.6° (p<0.05). Excellent or good radiographic results accounted for 85.7% and 87.5%, and clinical results for 91.4% and 75% in groups I and II, respectively. Avascular necrosis of the femoral head was noted in 6 hips (17%) in group I and 2 hips (25%) in group II. When we were compared the group I and II; best clinical results were found in Group I (p<0.05), but other results were the same (p>0.05). Conculation We have a more successfull clinical results by making the pelvic osteotomies for DDH in early ages. ©2007, Firat University, Medical Faculty
Abstract (Original Language): 
Giriş: Gelişimsel kalça displazisi (GKD) tedavisinde uygulanan Salter pelvik osteotomisi (SPO) ve Pemberton pelvik osteotomisinde (PPO), hasta yaşının klinik ve radyolojik sonuçlar üzerine etkisini değerlendirmek Gereç ve Yöntem: GKD nedeniyle pelvik osteotomi yapılan hastalardan, klinik ve radyolojik takipleri düzenli olan ve takip süreleri 1 yılı aşan, toplamda 33 hastanın 43 kalçası çalışmaya alındı. Ameliyat yaşının, klinik ve radyolojik sonuçlar üzerine etkisini araştırmak amacıyla hastalar retrospektif olarak iki yaş grubuna ayrıldı. Grup I, 48 ay altı ve grup II, 48 ay üstü hastaları içermekte idi. Hastaların ortalama takip süreleri grup I'de 25.4 ay (13-60), grup II'de 38.4 ay (12-75) idi. Bulgular: Grup I'de asetabüler indeks açısındaki (Aİ) düzelme ortalama 20.8° merkez-kenar açısındaki (MKA) artış ortalama 28.9°, grup II'de Aİ'deki düzelme ortalama 25.9°, MKA'daki artış 26.6° bulundu. Her iki grubta da Aİ ve MKA'daki düzelme belirgin şekilde anlamlıydı (p<0.05). Severin radyolojik ölçütlerine göre; grup I'de çok iyi ve iyi toplamı %85.7; grup II'de %87.5 bulundu. Modifiye McKay ölçütlerine göre klinik değerlendirmede; grup I'de çok iyi ve iyi toplamı %91.4; grup II'de %75 bulundu. Avasküler nekroz, grup I'de 6 (%17) kalçada, grup II'de 2 (%25) kalçada görüldü. Grup I'de klinik sonuçlar daha başarılıyken (p<0.05), gruplar arasında Aİ ve M K A değişim miktarı, A V N görülme sıklığı ve radyolojik ölçütler açısından fark yoktu (p>0.05). Sonuç: GKD tedavisinde uygulanan pelvik osteotomilerin küçük yaşta yapılması, klinik sonuçları daha başarılı yapmaktadır. ©2007, Fırat Üniversitesi, Tıp Fakültesi
107-111

REFERENCES

References: 

1. Ryan MG, Johnson LO, Quanbeck DS, Minkowitz B. One-stage treatment of congenital dislocation of the hip in children three to ten years old: functional and radiographic results. J Bone Joint Surg Am 1998; 80A: 336-344.
2. Herring JA. Developmental dysplasia of the hip. In: Tachdjian's Pediatric Orthopaedics. Vol. 1, 3rd ed. Philadelphia: W.B.Saunders; 2002: 513-654.
3. Severin E. Contribution to knowledge of congenital dislocation of hip joint: Late results of closed reduction and arthrographic studies of recent cases. Acta Chir Scand 1941; 84 (Suppl 63): 1¬142.
4. Barrett WP, Staheli LT, Chew DE. The effectiveness of the Salter
innominate osteotomy in the treatment of congenital dislocation of the hip. J Bone Joint Surg (Am) 1986; 68: 79-87.5. Salter RB, Kostuik J, Dallas S. Avascular necrosis of the femoral head as a complication of treatment for congenital dislocation of the hip in young children: A clinical and experimental
investigation. Can J Surg 1969; 12: 44-61.
6. Bucholz RW, Ogden JA. Patterns of ischemic necrosis of the proximal femur in nonoperatively treated congenital hip disease. In: The hip. Proceedings of the Sixth Open Scientific Meeting of the Hip Society. St.Louis: CV Mosby; 1978. p.43-63.
7. Facizewski T, Kiefer GN, Coleman SS. Pemberton osteotomy for residual acetabular dysplasia in children who have congenital dislocation of the hip. J Bone Joint Surg (Am) 1993; 75: 643-649.
8. Salter RB. Innominate osteotomy in treatment of congenital dislocation and subluxation of the hip. . J Bone Joint Surg 19619. Macnicol MF, Bertol P. The Salter innominate osteotomy: should
i
t be combined with concurrent open reduction? J Pediatr Orthop 2005; 14: 415-421.
10. Saleh JM, O'Sullivan ME, O'Brien TM. Pelvic remodeling after Salter osteotomy J Pediatr Orthop 1995; 15: 342-345.
11. Takashi S, Hattori T, Konishi N, Iwata H. Acetabular Development After Salter's Innominate Osteotomy for Congenital Dislocation of the Hip: Evaluation by Three-Dimensional Quantitative Method.1998; 18: 802-806.
12. Lejman T, Strong M, Michno P. Capsulorrhaphy versus capsulectomy in open reduction of the hip for developmental dysplasia. J Pediatr Orthop 1995; 15: 98-100.
13. Morin C, Rabay G, Morel G: Retrospective review at skeletal maturity of the factors affecting the efficacy of Salter's innominate osteotomy in congenital dislocated, subluxated, and dysplastic hips. J Pediatr Orthop 1998; 18: 246-253.
14. Salter RB, Dubos JP. The first fiftheen years personel experience with innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. Clin Orthop 1974; 98: 72¬103.
15. Zadeh HG, Catterall A, Hashemi-Nejad A, Perry RE. Test of
stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hip. J Bone Joint Surg (Br) 2000; 82: 17-27.
Karakurt ve İncesu
16. Lin Chii-Jeng, Lin Yung-Tai, Lai Ko-An. Intraoperative Instability for Developmental Dysplasia of the Hip in Children 12 to 18 Months of Age as a Guide to Salter Osteotomy. J Pediatr
Orthop 2000; 20: 575-578.
17. Murphy SB, Millis MB, Hall JE. Surgical Correction of
Acetabular Dysplasia in the Adult: A Boston Experience. Section I: Symposium: Periacetabular Osteotomy. Clin Orthop 1999; 1:
38-44.
18. Olney B, Latz K, Asher M. Treatment of hip dysplasia in older children with a combined one-stage procedure. Clin Orthop 1998; 347: 215-223.
19. Berkeley ME, Dickson JH, Cain TE, Donovan MM. Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old. J Bone Joint Surg Am 1984; 66A:
412-420.
20. Vedantam R, Capelli AM, Schoenecker P L. Pemberton Osteotomy for the Treatment of Developmental Dysplasia of the Hip in Older Children. J Pediatr Orthop 1998; 8: 254-258.
21. Wada A, Fujii T, Takamura K, Yanagida H, Taketa T, Nakamura T. Pemberton Osteotomy for Developmental Dysplasia of the Hip in Older Children. J Pediatr Orthop 2003; 23: 508-513.

Thank you for copying data from http://www.arastirmax.com