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 ?

Yıl 2023, Cilt: 24 Sayı: 1, 8 - 14, 03.01.2023

Hakan Bahar Fırat Yağmuroğlu

https://doi.org/10.18229/kocatepetip.983218

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

• 1. Kural B, Devecioğlu Karapınar E, Yılmazbaş P, Eren T. Risk Factor Assessment and a Ten-Year Experience of DDH Screening in a Well-Child Population. Biomed Res Int. 2019;(4):7213681.
• 2. Lyu X, Chen T, Yang Z, et al. Tubingen hip flexion splint more succesful than Pavlik harness for decentred hips after the age of three months. Bone Joint J. 2021;103-B (5):991-998.
• 3. Yegen M, Atalar H, Gunay C, et al. Reduction of the dislocated hips with the Tubingen hip flexion splint in infants. Int Orthop. 2019;43(9):2099-2103.
• 4. Karakaş ES, Baktir A, Argün M, Türk CY. One-stage treatment of congenital dislocation of the hip in older children. J Pediatr Orthop. 1995;15(3):330-6.
• 5. Terjesen T, Horn J. Management of late-detected DDH in children under three years of age: 49 children with follow-up to skeletal maturity. Bone Jt Open. 2020;1:55-63.
• 6. Ryan MG, Johnson LO, Quanbeck DS, Minkowitz B. One-stage treatment of congenital dislocation of the hip in children three to ten years old. Functional and radiographic results. J Bone Joint Surg Am. 1998;80(3):336-44.
• 7. Malvitz TA, Weinstein SL. Closed reduction for congenital dysplasia of the hip. Functional and radiographic results after an average of thirty years. J Bone Joint Surg Am. 1994;76(12):1777-92.
• 8. Herring JA. Tachdjian’s Paediatric Orthopaedics. Vol 1. Section 2 6th ed. Philadelphia: Saunders, 2020 Nov;422-471.
• 9. Konya MN, Aydin BK, Yildirim T, Sofu H, Gürsu S. Does Previous Hip Surgery Effect the Outcome of Tönnis Triple Periacetabular Osteotomy? Mid-Term Results. Medicine (Baltimore). 2016;95(10): 3050.
• 10. Alfonso VP, Gaspar GM, Enrique GG, Luis M. Developmental dysplasia of the hip: update of management. EFORT Open Rev. 2019 17;4(9):548-556.
• 11. Lyu X, Fu G, Feng C, et al. Clinical and radiological outcomes of combined acetabuloplasty with acetabular redirectional osteotomy and femoral shortening for children older than 9 years of age with developmental dysplasia of the hip: a retrospective case series. J Pediatr Orthop B. 2020;29(5):417-423.
• 12. Pollet V, Bonsel J, Ganzeboom B, Sakkers R, Waarsing E. Morphological variants to predict outcome of avascular necrosis in developmental dysplasia of the hip. Bone Joint J. 2021;103-B(5):999-1004.
• 13. Hussain RN, Rad D, Watkins WJ, Carpenter C. The incidence of avascular necrosis following a cohort of treated developmental dysplasia of the hip in a single tertiary centre. J Child Orthop. 2021 1;15(3):232-240.
• 14. Weinstein SL, Mubarak SJ, Wenger DR. Developmental hip dysplasia and dislocation. Part II. J Bone Joint Surg Am. 2003;85(10):2024-35.
• 15. Baghdadi T, Bagheri N, Khabiri SS, Kalantar H. The Outcome of Salter Innominate Osteotomy for Developmental Hip Dysplasia before and after 3 Years Old. Arch Bone Jt Surg. 2018;6(4):318-323.
• 16. Chapchal G. Indications for the various types of pelvic osteotomy. Clin Orthop Relat Res. 1974;(98):111-5.
• 17. Gulman B, Tuncay IC, Dabak N, Karaismailoglu N. Salter's innominate osteotomy in the treatment of congenital hip dislocation: a long-term review. J Pediatr Orthop. 1994;14(5):662-6.
• 18. Salter RB, Dubos JP. The first fifteen year's personal experience with innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. Clin Orthop Relat Res. 1974;(98):72-103.
• 19. Weinstein SL, Mubarak SJ, Wenger DR. Developmental hip dysplasia and dislocation. Part II. J Bone Joint Surg Am. 2003;85(10):2024-35.
• 20. Baki C, Sener M, Aydin H, Yildiz M, Saruhan S. Single-stage open reduction through a medial approach and innominate osteotomy in developmental dysplasia of the hip. J Bone Joint Surg Br. 2005;87(3):380-3.
• 21. Williamson DM, Glover SD, Benson MK. Congenital dislocation of the hip presenting after the age of three years. A long-term review. J Bone Joint Surg Br. 1989;71(5):745-51.
• 22. Konya MN, Tuhanioğlu Ü, Aslan A, et al. A comparison of short-term clinical and radiological results of Tönnis and Steel pelvic osteotomies in patients with acetabular dysplasia. Eklem Hastalik Cerrahisi. 2013;24(2):96-101.
• 23. Tejpal T, Shanmugaraj A, Gupta A, et al. Outcomes and complications of patients undergoing Salter's innominate osteotomies for hip dysplasia: a systematic review of comparative studies. J Hip Preserv Surg. 2021 19;7(4):621-630.
• 24. Kothari A, Grammatopoulos G, Hopewell S, Theologis T. How Does Bony Surgery Affect Results of Anterior Open Reduction in Walking-age Children With Developmental Hip Dysplasia? Clin Orthop Relat Res. 2016;474(5):1199-208.
• 25. Schoenecker PL, Strecker WB. Congenital dislocation of the hip in children. Comparison of the effects of femoral shortening and of skeletal traction in treatment. J Bone Joint Surg Am. 1984;66(1):21-7.
• 26. McKay DW. A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip. Clin Orthop Relat Res. 1974;(98):124-32.
• 27. Tuhanioğlu Ü, Gültekin A, Oğur HU, Seyfettinoğlu F, Serarslan U. Comparison of the results of Pemberton and Salter osteotomies applied in developmental dysplasia of the hip. Kocaeli Med J. 2018;(2):81-86.
• 28. Subasi M, Arslan H, Cebesoy O, Buyukbebeci O, Kapukaya A. Outcome in unilateral or bilateral DDH treated with one-stage combined procedure. Clin Orthop Relat Res. 2008;466(4) : 830-836.
• 29. Wang TM, Wu KW, Shih SF, Huang Sc, Kuo Kn. Outcomes of open reduction for developmental dysplasia of the hip: does bilateral dysplasia have a poorer outcome? J Bone Joint Surg Am. 2013;95(12):1081-1086.