Gelişimsel Kalça Displazisinde Aynı Seansta Açık Redüksiyon ve Salter Osteotomisi Sonuçlarımız

Öz

Amaç: Bu çalışmada, yürüme çağında gelişimsel kalça displazisi GKD nedeniyle tanı konularak, açık redüksiyon ve Salter’in İnnominate Osteotomi SİO tedavisi yapılan olguların erken dönem sonuçlarını değerlendirmek amaçlanmıştır. Hastalar ve Yöntemler: 2001-2004 yılları arasında Harran Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Kliniğinde, yürüme çağında GKD tanısı konularak açık redüksiyon ve SİO uygulanan ve en az 2 yıllık takipleri olan, 19 çocuğun 23 kalçası çalışmaya dahil edildi. Ameliyat sırasındaki yaşları ortalaması 34.4 ay 18 ay-52 ay idi. Hastalardan 16’sı kız, 3’ü erkekti ve 4’ünde iki taraflı tutulum vardı. Ortalama takip süresi 31.8 ay olarak bulundu. Preoperatif, postoperatif 1. hafta ve son takiplerde direk grafiyle asetabular indeks Aİ ; preoperatif, postoperatif 1. hafta ve 1.yılda 2 boyutlu bilgisayarlı tomografi BT ile aksiyel asetabular indeks AAİ ölçümleri yapıldı. Hastalar son takiplerinde klinik olarak McKay sınıflaması ve radyolojik olarak ise Severin kriterlerine göre değerlendirildi. Bulgular: Klinik olarak 19 kalçada %82.6 mükemmel ve iyi sonuç 14 kalça mükemmel, 5 kalça iyi , 4 kalçada % 17.4 ise orta sonuç elde edildi. Radyolojik olarak Severin kriterlerine göre; 13 kalçada grup 1 mükemmel , 5 kalçada grup 2 iyi , 4 kalçada grup 3 orta ve 1 kalçada grup 1 kötü sonuç elde edildi. Buna göre 18 kalçada % 78.3 mükemmel ve iyi sonuca ulaşıldı. 4 ayrı hastada yüzeyel enfeksiyon, redislokasyon, hematom gelişimi ve alçı açıldıktan sonra femur diafiz kırığı olmak üzere, 4 komplikasyon gelişti. Bu komplikasyonların tamamı tedaviye iyi yanıt verdi. Aİ preoperatif 40.43°’den takipte 20.48°’e; AAİ ise 18.09°’den 13.43°’e gerilediği saptandı. Orta ve kötü klinikradyolojik sonuç alanların asetabuler indeksleri Aİ ve AAİ ile mükemmel ve iyi sonuç alan grubun değerleri karşılaştırıldığında arada anlamlı fark saptanmadı. Sonuç: Yürüme çağı GKD’li olgularda; açık redüksiyon ve SİO kombinasyonunun etkili bir tedavi seçeneği olduğu görüşündeyiz

Anahtar Kelimeler

• Gelişimsel kalça displazisi,Cerrahi tedavi,Açık redüksiyon,Salter İnnominat Osteotomisi

The Simultaneous Open Reduction and Salter Innominate Osteotomy in The Treatment of Developmental Dysplasia of The Hip: The Preliminary Results

Abstract

Objectives: This study was conducted to evaluate the early results of open reduction and Salter Innominate Osteotomy SIO performed in ambulatory patients with Developmental Dysplasia of the Hip DDH . Patients and Methods: We reviewed the results of the open reduction and SIO in 23 hips of the 19 patients with DDH in children of walking age who had been operated between 2001 and 2004 at Harran University Department of Orthopedics. All patients had a minimum 2 years follow up. Patients age at the time of operation was 34.4 months range, 18-52 months . There were 16 female and one male patients. Of them 4 had bilateral, 15 had unilateral disease. The mean follow up was 31.8 months . Acetabular index were measured preoperatively, at the first postoperative week and at the last follow up by the direct X-ray and axial acetabular index were determined preoperatively, at the first postoperative week and at the first postoperative year by 2 dimentional computed tomography. Theclinical results were evaluated according to Mc Kay classification, whereas radiological results according to the Severin scoring criteria. Results:. Clinical results were as follows; 19 hips 82.6 % were excellent or good, and 4 hips 17.4 % were fair. According to Severin's radiological scoring 18 hips 78.3 % were excellent or good, 4 hips 17.4 % were fair and one was 4.3 % poor results. The ages of three of four patients with fair results and the patient with poor radiological score were greater than 48 months. Postoperatively, 4 complications developed in four separate patients; which were superficial infection, redislocation, hemotoma formation and femoral diaphyseal fracture after opening the cast. All complications resolved with the treatment. The acetabular index averaged 40.43° preoperatively and 20.48°at the last follow up and the axial acetabular index improved 13.43° at the last follow up from 18.09° preoperatively. Significant differences were not found in the preoperative and recent acetabular indices AI and AAI when compared the fair and poor groups versus the excellent and groups.Conclusion: We conclude that the open reduction and SIO combination is an effective treatment in ambulatory DDH patients

Keywords

• Developmental dysplasia of the hip,Surgical treatment,Open reduction,Salter’s Innominate Osteotomy

References

1. Tachdjian MO. Pediatric Orthopedics. 3nd ed. Philadelphia, W.B: Saunders Co; 2002: 513-654.
2. Salter, R. B.: Innominate Osteotomy in the Treatment of Congenital Dislocation and Subluxation of the Hip. J. Bone and Joint Surg, 1961; 43-B(3): 518-39.
3. Salter, R. B., and Dubos, J.-P.: The First Fifteen Years' Personal Experience with Innominate Osteotomy in the Treatment of Congenital Dislocation and Subluxation of the Hip. Clin Orthop, 1974; 98: 72-103.
4. McKay, D. W.: A Comparison of the Innominate Osteotomy in the Treatment of Congenital Dislocation of the Hip. Clin. Orthop, 1974; 98: 124-32. Pericapsular
5. Barret WP, Staheli LT, Chew DE. The effectiveness of the Salter innominate osteotomy in 0the treatment of the congenital dislocation of the hip. J Bone Joint Surg 1986; 68-A: 79-87
6. Gulman B, Tuncay IC, Dabak N, et al: Salter’s innominate osteotomy in the treatment of congenital hip dislocation: A long-term review. J Pediatr Orthop, 1994; 14:662–6.
7. Powell EN, Gerratana FJ, Gage JR. Open reduction for congenital hip dislocation: the risk of avascular necrosis with three different approaches. J Pediatr Orthop 1986; 6: 127-32.
8. Fixsen JA. Anterior and posterior subluxation innominate osteotomy. J Bone Joint Surg Br 1987; 69B:361–4. hip following Tonnis D. Congenital hip dislocation. New York: Thieme Stratton Inc; 1982.

9. Severin E. Contribution to the knowledge of congenital dislocation of the hip joint; late results of closed reduction and arthrographic studies of recent cases. Acta Chir Scand 1941; 84 (Suppl 63):1-142.
10. Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint. Acta Chir Scand 1939; 83(Suppl 58): 1–7.
11. Hernandez RJ, Poznanski AK. CT evaluation of pediatric hip disorders. Orthop Clin North Am 1985; 16A: 513– 41.
12. Haidar R., Jones R., Vergroessen D. Simultaneous open reduction and Salter innominate osteotomy for developmental dysplasia of the hip. J Bone Joinr Surg 1996; 78-B: 471-6.
13. Ito H, Ooura H, Kobayashi M, Matsuno T. Middle-term results of Salter innominate osteotomy. Clin Orthop Relat Res, 2001; (387): 156-64.
14. Klisic P, Jankovic L, Basara V. Long term results ofcombined operative reduction of the hip in older children. J Pediatric Orthop, 1988; 8 (5): 535-9.
15. Karakaş ES, Baktır A, Argun M, Türk CY. One stage treatment of congenital dislocation of the hip in older children. J Pediatric Orthop, 1995; 15 (3): 330-6.
16. 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,1984; 66A: 412–20.
17. Ağuş H, Kalenderer Ö, Pedükcoşkun S, Eryanılmaz G, Reisoğlu A. Yürüme sonrası gelişimsel kalça çıkığının cerrahi tedavisinde erken prognostik faktörlerin değerlendirilmesi. Acta Orthop Traumatol Turc 1999; 33: 35-9.
18. Söyüncü Y, Özenci M, Ürgüden M, Akyıldız F, Gür S. Yürüme çağındaki çocuklarda gelişimsel kalça displazisinin tek aşamalı cerrahi tedavisi. Artroplasti Artroskopik Cerrahi, 2004, 15(4): 200-6.
19. Sarban S, Ozturk A, Tabur H, Isikan UE. Anteversion of the acetabulum and femoral neck in early walking age patients with developmental dysplasia of the hip. J Pediatr Orthop B, 2005; 14(6): 410-4.
20. Utterback TD, MacEwen GD. Comparison of pelvic osteotomies for the surgical correction of the congenital hip. Clin Orthop, 1974; 98:104–10.
21. Morin C, Rabay G, Morel G: Retrospective review at skeletal maturity of the factors affecting the efficacy of Salter’s congenital dislocated, subluxated, and dysplastic hips. J Pediatr Orthop, 1998; 18: 246–53. osteotomy in
22. Millis MB, Murphy SB. Use of computed tomographic reconstruction in planning osteotomies of the hip. Clin Orthop Relat Res, 1992; 274: 154-9.
23. Takashi S, Hattori T, Konishi N, et al: Acetabular development after Salter’s innominate osteotomy for congenital dislocation of the hip: Evaluation by three- dimensional quantitative method. J Pediatr Orthop, 1998; 18: 802–6.
24. Frick SL, Kim SS, Wenger DR. Pre- and postoperative three-dimensional computed tomography analysis of triple innominate osteotomy for hip dysplasia. J Pediatr Orthop, 2000; 20: 116–23.
25. Macnicol MF, Bertol P. The Salter innominate osteotomy: should it be combined with concurrent open reduction? J Pediatr Orthop B, 2005; 14(6): 415-21.