DÖRT YAŞINDAN BÜYÜK GELİŞİMSEL KALÇA DİSPLAZİSİ OLAN HASTALARDA, TEK AŞAMALI AÇIK REDÜKSİYON, FEMORAL KISALMA VE SALTER OSTEOTOMİSİ’NİN RADYOLOJİK SONUÇLARINI, İLK AMELİYAT YAŞI NASIL ETKİLER ?

Öz

AMAÇ: Pediatrik ortopedide, tedavisi en tartışmalı konulardan biri, Gelişimsel Kalça Displazisidir (GKD). Tanı ve tedavi zamanlaması, bu durumu başarılı bir şekilde tedavi etmek için ana hedeftir. Özellikle gelişmekte olan ülkelerde ilerleyen yaşa kadar teşhis edilemeyen vakalar halen görülmektedir. Gecikmiş tanı ve tedavi , ilerleyen yaşla birlikte daha kapsamlı ameliyatlara yol açar ve düşük memnuniyet oranlarına neden olabilir. Bu çalışmanın amacı, Gelişimsel Kalça Displazisi’nin tek aşamalı tedavisinin sonuçlarına, hasta yaşının etkisini değerlendirmektir.
GEREÇ VE YÖNTEM: 2004 ve 2010 yılları arasında hastanemizde tedavi edilen 23 hasta (34 kalça) çalışmaya dahil edildi. Ortalama ameliyat yaşları 7,5 olan hastalara açık redüksiyon, femoral kısaltma ve Salter innominate osteotomi’yi içeren tek basamaklı tedavi uygulandı. Radyolojik sonuçlar, asetabular indeksteki, asetabuler açıdaki ve Severin radyolojik sınıflamasına göre düzelme ve son takiplerindeki Bucholz ve Ogden avaskuler nekroz (AVN) sınıflamasına göre değerlendirildi.
BULGULAR: Hastalarımızın ortalama takip süremiz 60 ay (24 ila 84 ay arası) idi. Asetabuler indeks, ameliyat öncesi 39.7°±1.4° (25° - 52° arası) iken ameliyat sonrası 21.8°±1.8° saptandı. Ameliyat sonrası çekilen pelvis grafilerinde ölçülen asetabuler açıda ortalama düzelme miktarı 17.9°±0.8° saptandı. Bucholz ve Ogden AVN sınıflamasına göre; 1 hastada Tip 1 (% 2.9) ve 1 hastada Tip 3 (% 2.9) AVN saptandı. Radyolojik olarak 8 yaş ve altındaki çocuklarda başarı oranı (85.7%) belirgin olarak yüksekti. (p =0.008)
SONUÇ: Asetabuler indeks ve Severin’in radyolojik sınıflamasındaki düzelmeye göre, 4 - 8 yaş aralığında tedavi edilen GKD’nin tek basamaklı tedavisi sonrası başarılı sonuçlar elde edilir. Ancak 8 yaştan daha büyük çocukların radyolojik sonuçları 8 yaş altındakilere göre daha kötü sonuçlanmaktadır.

Anahtar Kelimeler

• Gelişimsel Kalça Displazisi
• Kalça
• Femur
• Ostetotomi
• Developmental Hip Dysplasia
• Hip
• Osteotomy

HOW DOES INITIAL SURGERY AGE AFFECT THE RADIOLOGICAL RESULTS OF SINGLE-STAGE OPEN REDUCTION, FEMORAL SHORTENING, AND SALTER’S OSTEOTOMY IN PATIENTS OVER THE AGE OF FOUR WITH DEVELOPMENTAL HIP DYSPLASIA ?

Öz

OBJECTIVE: One of the most controversial issues in pediatric orthopedics is Developmental dysplasia of the hip (DDH). The timing of diagnosis and treatment are is the main goal to treat this condition successfully. Neglected cases that may remain undiagnosed until advancing age are still seen especially in developing countries. Delayed diagnosis and treatment with advancing age leads to more extensive surgery and cause low satisfactory rates. The aim of this study is to evaluate the effect of patients’ age on the results of single-stage treatment of Developmental Dysplasia of the Hip.
MATERIAL AND METHODS: 23 patients (34 hips) treated in our hospital between 2004 and 2010 were included in the study. Single-stage treatment including open reduction, femoral shortening, and Salter’s innominate osteotomy was applied to patients whose mean age of surgery was 7.5 years. Radiological results were evaluated in terms of improvement in the acetabular index, in the acetabular angle and according to Severin’s classification, and Bucholz and Ogden’s avascular necrosis (AVN) classification at the final follow-up.
RESULTS: The average follow-up period was 60 (range: 24 - 84) months. While the acetabular index was 39.7°±1.4° (range: 25°- 52°) preoperatively, it was measured as 21.8°±1.8° postoperatively. The mean amount of improvement in the acetabular angle was 17.9°±0.8°. According to Bucholz and Ogden’s classification, one patient (2.9%) had Type 1 AVN and one patient (2.9%) had Type 3 AVN. Radiologically, the success rate (85.7%) was significantly higher in children aged 8 years and younger (p = 0.008).
CONCLUSIONS: According to the improvement in the acetabular index and Severin's radiological classification, successful results are obtained after a single-step treatment of DDH, which is treated in the 4-8 age range. However, the radiological results of children older than 8 years are worse than those under 8 years old.

Anahtar Kelimeler

• Developmental Hip Dysplasia
• Hip
• Osteotomy

Kaynakça

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