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

Year 2005, Volume: 22 Issue: 1, 18 - 24, 31.12.2009

Dr. A. Pişkin, Dr. T.n. Karaismailoglu Dr. T.n. Karaismailoglu Dr. A. Sıgırcı Dr. A. Sıgırcı

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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