Gelişimsel Kalça Displazili Çocuklarda Medial Yaklaşımla Açık Redüksiyon; 40 Kalçanın Orta Dönem Sonuçları

Abstract

Bu çalışmada ortalama 12 aylık olan çocuklarda medial yaklaşımla yapılan açık reduksiyo-nun sonuçlarının değerlendirilmesi amaçlanmıştır. Kliniğimizde 1980-2002 yılları arasında medial yaklaşımla açık redüksiyon yapılarak tedavi edilen 28 hastanın (22 kız, 6 erkek) 40 kalçası geriye dönük olarak incelendi. Çalışmaya yalnızca tipik kalça çıkığı olan olgular alındı. Ameliyat öncesi ve sonrası asetabuler indeks ve ameliyat sonrası femur boyun açıları karşılaştırıldı. Klinik değerlendirme modifiye McKay, radyolojik değerlendirme Severin Kriterleri kullanılarak yapıldı. Avasküler nekroz gelişen kalçalar Ka-lamchi- MacEwen Kriterleri'ne göre değerlendirildi. Hastalar ortalama 58 ay süre ile izlendi. Son kontrollerde ameliyat sonrası dönemde asetabuler indeks değerlerindeki azalma istatistiksel olarak anlamlı iken, femur boyun açıları arasında anlamlı bir fark bulunamadı. Opere edilen 40 kalçanın klinik olarak 33 (% 82.5)'ü çok iyi, 7 ( 17.5)'si iyi olarak tanımlanmıştır. Orta ve kötü grubunda hasta yoktur. Radyolojik olarak da 26'sı(% 65.0) çok iyi, 4 ( % 10.0)'u iyi, 5 (% 12.5)'i orta ve 5 (% 12.5)'i kötü olarak tanımlanmıştır. 0-12 aylık yaş grubunda %78.3 oranında çok iyi radyolojik sonuç alınırken bu oran 13-24 aylık yaş grubunda %47.1 düzeyine inmekte idi. Bu sonuçlar, 12 ay civarı yaş grubundaki gelişimsel kalça displazili çocuklarda medial yaklaşımla açık redüksiyonun yeterli bir tedavi olabileceğini göstermektedir Open Reduction Through a Medial Approach for Developmental Dysplasia of the Hip in Children In this study we evaluated the results of open reduction through medial approach in children who are 12 months of age in average. The retrospective evaluation of 40 hips (28 patients; 22 girls and 6 boys)was made whose treatment was performed using open reduction through a medial approach between 1980-2002. Only typical dislocations were included. The values of the acetabular index and the angle of the femoral neck were evaluated both preoperatively and postoperatively. Clinical and radiographical evaluations were made according to the modified Mc Kay and Severin's criteria, respectively. The hips in which avascular necrosis developed were evaluated according to the Kalamachi-MacEwen criteria. The mean follow up of the patints was 58 months. In finally contrls, the decrease in the values of the acetabular index was statistically meaningful at the postoperative period, but the difference of the angle of the femoral neck values of the operated and the non-operated groups were not statistically meaningful. 40 hips were operated, clinically 33 of them (82,5) were very good, 7 (% 17,5) of them were good, there were not any patients who come out to be in average or bad groups. Radiologically 26 of them (%65,0) come out to be very good, 4 of them (% 10,0) were good, 5 of them (%12,5) were average and 5 of them (%12,5) were bad.The radiographical results of the hips in children between 0-12 months of age were excellent in %78.3 of them while the result was %47.1 in children between 13-24 months of age. These data showed that open reduction through a medial approach can be a succesful method for treatment of the developmental dysplasia of the hip in children who are about 12 months of age

Keywords

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References

1. Castillo R, Sherman FC. Medial adductor open reduction for congenital dislocation of the hip. J Pediatr Orthop 1990; 10: 335–340.
2. Konigsberg DE, Karol LA, Colby S, et al. Results of medial open reduction of the hip in infants with developmental dislocation of the hip.J Pediatr Orthop 2003; 23: 1–9.
3. Mankey MG, Arntz GT, Staheli LT. Open reduction through a medial approach for congenital dislocation of the hip. A critical review of the Ludloff approach in sixty-six hips. J Bone Joint Surg (Am) 1993; 75: 1334–1345.
4. Mergen E, Adyaman S, Omeroglu H, et al. Medial approach open reduction for congenital dislocation of the hip using the Ferguson procedure. A review of 31 hips. Arch Orthop Trauma Surg. 1991; 110: 169–172. 5. Kalamachi A, Schmidt TL, MacEwen GD: Congenital dislocation of the hip. Open reduction by medial approach. Clin Orthop. 1982; 169: 127–132.
5. Ward WT, Vogt M, Grudziak JS, et al: Severin classification system for evaluation of the results of operative treatment of congenital dislocation of the hip j. Bone and Joint Surg. 1997; 79–A: 656–663.
6. McKay DW. A comparison of the innominate and pericapsuler osteotomy in the treatment of congenital dislocation of the hip. Clin Orthop. 1974; 98: 124–132. 8. Bennett JT, MacEwen GD. Congenital dislocation of the hip. Recent advances and current problems Clin Orthop. 1989; 247: 15–21.
7. Gabuzda GM, Renshaw TS. Reduction of congenital dislocation of the hip. J Bone and Joint Surg. 1992; 74–A: 624–631
8. Weinstein SL. Natural History of Congenital Hip Dislocation and Dysplasia. Clin Orthop. 1987; 225: 62–75.

9. Weinstein SL. Developmental hip Dysplasia and Dislocation: Part: II, J Bone and Joint Surg Am. 2003 Oct; 85–A(10): 2024–2035.
10. Herring JA. Conservative Treatment of Congenital Dislocation of the Hipin the newborn and infant. Clin Orhop. 1992; 281: 41–47.
11. Heikkila E, Rhooppy S, Louthima I. The management of primary acetabular dysplasia. J Bone and Joint Surg. 1985, 67B: 25–28.
12. Simons GW. A Competetive Evaluation Of The Current Methods For Open Reductionof The Congenitally Displaced Hip, Orthop Clin North America. 1980; 2: 61. 15. Castillo R, Sherman FC. Medial Adductor Open Reduction For Congenital Dislocation Of The Hip. J Pediatr Orthop. 1990; 10: 335–340.
13. Fabry G: Torsion of the femur. Acta Orthop Belg, Tome 43 Fasc. 4, 1977.
14. Roose PE, Chingren G, LKlaaren HE, et al: Open Reduction For Congenital Dislocation Of The Hip Using The Ferguson Procedure.J Bone And Joint Surg. 1997; 61–A: 915–921.
15. Koizumi W, Moriya H, Tsuchiya K, et al. Ludloff’s Medial Approach For Open Reduction Of Congenital Dislocation Of The Hip. A 20 Year Follow up. J Bone and Joint Surg. 1996; 78B: 924–929.
16. Tümer Y, Ward WT, Grudziak J. Medial Open Reduction İn The Treatment Of Developmental Dislocation Of The Hip. J Pediatr Orthop. 1997; 17: 2176–2180.
17. Yıldız M, Baki C, Önder Ç, et al: Doğuştan Kalça Çıkı- ğında Medial Adduktör Yaklaşımla Açık Redüksiyonun Sonuçları. KTÜ Tıp Fak Dergisi, 1987; 1: 544–552.
18. Pous JG, Camous JY, El Blidi S. Cause And Prevention Of Osteochondritis In Congenital Dislocation Of The Hip.Clin Orthop. 1992; 281: 56–62.