Gelişimsel kalça çıkığı tedavisinde salter osteotomisinin iki farklı yaş grubundaki sonuçlarının karşılaştırılması

Öz

Amaç: Yürüme dönemi çocuklarda gelişimsel kalça çıkığının cerrahi tedavisi oldukça zordur. Avasküler nekroz ve kalça çıkığı tekrarlaması, cerrahi sonrası en sık karşılaşılan problemlerdir. Bu çalışmadaki amacımız GKD (Gelişimsel Kalça Çıkığı) tedavisinde uyguladığımız açık redüksiyon ve Salter osteotomisi yönteminin 2 grup arasındaki ameliyat öncesi ve sonrası asetabuler indeks, avasküler nekroz (AVN) ve redislokasyon oranlarını karşılaştırmaktır.
Yöntemler: Bu prospektif kohort çalışmaya 2014-2017 yılları arasında GKD nedeniyle açık redüksiyon ve salter osteotomisi yapılan hastalardan elde edilen verilerle yapıldı. Grup 1: 18 ay -30 ay (44), Grup 2: 31 ay-48 ay arası (41) hasta mevcuttu. Grupların ameliyat öncesi, ameliyat sonrası ve final asetabuler indeksleri, AVN ve redislokasyon oranları karşılaştırıldı.
Bulgular: Çalışmaya alınan 85 kalçanın 20’si erkek, 65’i kadın idi. Grup 1 hastaların yaş ortalaması 21,6 ay, Grup 2 hastalarının yaş ortalaması ise 38.5 ay idi. Ameliyat sonrası Grup 1 asetabuler indeks ortalama 35.1 dereceden 25,9 dereceye düşürülürken, Grup 2 de ise 33 dereceden 22,1 dereceye kadar düşürüldü. Grup 1 de 10 hastada (%22,72), Grup 2 de ise 4 (%9,75) hastada AVN vardı.
Sonuç: Asetabular indeks her iki grupta da yeterince düzeltildiği gözlendi. AVN’in erken müdahale yapılan çocuklarda daha yüksek oranda olduğu görüldü. Erken müdahale yapılan çocuklarda AVN’in daha yüksek olmasının kalça eklemi kapsülünün daha sıkı sütüre edildiği ve yapılan cerrahi teknikten kaynaklandığına inanıyoruz.

Anahtar Kelimeler

• Kalça çıkığı,Asetabuler indeks,Avasküler nekroz,Redislokasyon

Comparison of salter osteotomy results in two different age groups in the treatment of developmental hip dislocation

Abstract

Aim: Surgical treatment of developmental hip dislocation is highly challenging in children of walking age. The most common complications following surgery include avascular necrosis and redislocation. In this study, we aimed to compare the preoperative and postoperative acetabular index, avascular necrosis (AVN) and redislocation rates between two age groups of open reduction and Salter osteotomy in DDH (Developmental Dysplasia of the Hip).
Methods: This prospective cohort study included patients who underwent open reduction and salter osteotomy for DDH between 2014 and 2017. Patients were grouped based on age as follows: Group 1: 18 -30 months old (n=44), Group 2: 31-48 months old (n=41). Preoperative, postoperative, and final acetabular indexes, AVN and redislocation rates were compared.
Results: Among 85 patients included in the study, 20 were male and 65 were female. The mean ages of Groups 1 and 2 were 21.6 months and 38.5 months, respectively. Following surgery, Group 1 mean acetabular index reduced to 25.9 degrees from 35.1 degrees, while that of Group 2 decreased to 22.1 degrees from 33 degrees. AVN was present in 10 patients (22.72%) in Group 1 and 4 patients (9.75%) in Group 2.
Conclusion: The acetabular index was adequately corrected in both groups. AVN was more frequent in children who had early interventions. We believe that the higher rate of avascular necrosis in children who underwent early intervention is due to surgical technique and using tighter sutures in the hip joint capsule. 

Keywords

• Hip dislocation,Avascular necrosis,Acetabular index,Redislocation

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