Results Obtained 2414 Children With Congenital Hip Dislocation

Year 1968, Volume: 21 Issue: 1, 104 - 123, 28.02.1968

Avni Duraman

https://izlik.org/JA58XD24RZ

Abstract

During the last fifteen years, 2414 patients with 3282 congenital dislocation of the hip aplied to the department of the Orthopedic Surgery of Ankara University Meical Faculty and Gülhane Military Medical Academy. Of these, 1951 (% 81) were treated and followed up as outpatients and the remaining 463 (%19) as inpatient. Of 2414 cases, 1704 (%79) were female and 510 (% 21) were male. The number of patients under one year of age was 159 (%6), those 1 to 3 years 769 (% 31), those 3 to 8 years 690 (%29), those 8 to 18 years 691 (%29), and those over 18 years 115 (%5). As it is known, for patients under three, treatment without surgery is much more successful. Of 2414 cases, 2178 (% 89) were dislocation. 811 being bilateral and 227 (%11) subluxation, 57 being bilateral. Of the 811 children, on whom closed reduction was performed, 120 (14%) could not be followed up while 88 (10%) showed a failure. Of the 603 children that could be followed up, 458 (76%) showed satisfactory early results. In 164 cases, 215 various surgical inteventions were performed; 135 open reduction with or without shelf or osteotomy. Except two died and 6 follow up and 6 missing cases (unfollowed). The results of this open reduction group was 57 percent good (57 of 99 cases). Results were good in 34 (72%) of 47 on whom shelf had been performed. The results of derotation osteotomy after the closed or open reduction was satisfactory in 22 of followed up 29 cases (77%). In 13 of followed up 21 caeses over 18 years of age, the results of bifurcation osteotomies as Haas's was satisfactory. Thus, in 82 (76%) followed up cases of 102 that shelf and osteotomy without open reduction performed results good. What is known with certainly is that congenital hip dislocation should be diagnosed during the early stages of infancy and treatment started immadiatly after the diagnosis.

Keywords

Congenital Hip Dislocation , Orthopedics , Surgical Treatment

Ethical Statement

-

Supporting Institution

Ankara University Faculty of Medicine, Clinic of Orthopedics and Traumatology, Gülhane Military Medical Academy

Project Number

-

Thanks

-

2414 Doğmalık Kalça Çıkığına Ait İnceleme

https://izlik.org/JA58XD24RZ

Abstract

1 - Bize gelen 2414 hastanın (% 6) sı 1 yaşından küçük, (%31) i 1-3 yaşta, (%29) u 3-8 yaşta, (% 29) u 8-18 yaşta ve (%5) i de 18 yaş üstündedir. En ideal tedavi yaşındakiler (%31) dir. Geri kalanların pek azında anatomik fonksiyonel bir kalça kazanılabilir.


2 - 2414 vak'ada 811 (565 i poliknilik, 246 sı yatan) hastada kapalı reduksiyon yapılmıştır. 8-9 aylık alçı ve sonra 2-3 aylık Dennis - Brown ve benzeri adduksiyon pergelile ve masajla tedavi edilmiştir. 120 (% 14) ü takibedilmemiş, 88 (% 10) unda yeniden çıkık olmuş ve reduksiyon başarısız olmuştur. 603 yani (% 76) vak'ada sonuç başarılıdır.


3 - 2414 vak'adan 164 ünde 215 ameliyat yapılmıştır. Bunlardan 313 ünde cerrahi reduksiyon veya buna ilâveten shelf veya osteotomi yapılmıştır. Ölen 2 si, halen takipte olan 6 sı ve takip edilemiyen 6 sı hariç 99 vak'adan 57 sinde (%57) sonuç başarılıdır. Başarı oranı yalnız cerrahi reduksiyon veya takibedilenlerde % 73, pelvi trokanterik adele rezeksiyonu ve tenatomiden sonra cerrahi reduksiyon yapılanlarda % 60, cerrahi reduksiyon ve 3-6 hafta sonra deratosyon osteotomisi yapılanlarda %50, cerrahi reduksiyon ve shelf ayni seansta yapılanlarda % 48, innominat osteotomi ve cerrahi reduksiyon yapılanlarda %66 dır. Böylece cerrahi reduksiyon yapılanlarda ortalama başarı oranı % 57 dir. Cerrahi reduksiyon yapmadan femur başı çekilerek veya yerinde shelf yapılan 52 vak'ada takibedilebilen 47 sinde başarı oranı %72 dir. Kapalı veya açık reduksiyondan bir süre sonra anteversiyon veya subluksasyin dolayisile derotasyon osteotomisi yapılan 29 vak'adan takibedilebilen 22 sinde başarı oranı % 77 dir. 16 yaşın üzerinde stabil olmayan ağrılı kalça dolayısiyle Haas v.b. osteotomi yapılan 22 vak'adan takibedilebilen 14 ünde başarı oranı % 76 dır. Böylece cerrahi reduksiyon yapılmadan rekonstrüktif ameliyat ve destek ameliyatı yapılan 102 hastadan takibedilebilen 82 sinde başarı oranı % 74 dür.

Görülüyorki gerek cerrahi reduksiyon ve gerekse rekonstrüktif ve destek ameliyatlarında başarı oranı hiçde parlak değildir. Bunda başarısızlığın büyük payı seçilen tedavi metodundan ziyade hastaların bize geç gelmesi, sonra da bu işe hekimlerimizin yeteri kadar eğilmemesidir.


Tedavi yönünden sonuç olarak 0-1 yaşındaki kalça çıkıkları en mutlu, 1-3 yaşındakiler mutlu, 3-5 yaşındakiler hâlâ şanslı ve mutlu, 5-8 yaşındakiler çokaz mutlu, ondan sonrakiler kusurlu kişilerdir. Kalça çıkığının erkenden teşhis ve tedavisi için el birliği ile çalışmak gerekir.

Keywords

Doğmalık Kalça Çıkığı , Konjenital Kalça Çıkığı , Ortopedi , Cerrahi Tedavi

Ethical Statement

-

Supporting Institution

A. Ü. Tıp Fakültesi Ortopedi ve Travmatoloji Kliniği, Gülhane Askeri Tıp Akademisi

Project Number

-

Thanks

-

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