Bebeklerde Gelişimsel Kalça Displazisinde Kapalı Redüksiyon Sırasında İntraoperatif Kalça Artrografisi: Cerrahi Karar Verme ve Sekonder Müdahale Riski Açısından Karşılaştırmalı Bir Çalışma

Öz

Bu çalışma, bebeklerde gelişimsel kalça displazisi (GKD) için kapalı redüksiyon sırasında yapılan intraoperatif kalça artrografinin tedavi başarısızlığı ve sekonder cerrahi gereksinimi açısından prognostik bilgi sağlayıp sağlamadığını değerlendirdi ve hasta yaşının etkisini inceledi. Bu retrospektif karşılaştırmalı çalışmaya, kapalı redüksiyon ve ardından kalça spika alçısı uygulanan ≤1 yaşındaki 79 hastaya ait 88 kalça dâhil edildi. Hastalar intraoperatif değerlendirme yöntemine göre gruplandırıldı: yalnızca floroskopi (Grup 1) veya floroskopi ile birlikte artrografi (Grup 2). Birincil sonuç ölçütü tedavi başarısızlığı olup, Grup 1’de yeniden çıkık nedeniyle sekonder açık redüksiyon ve Grup 2’de konsantrik olmayan redüksiyon nedeniyle intraoperatif olarak açık redüksiyona geçilmesi şeklinde tanımlandı. İkincil sonuç ölçütleri arasında avasküler nekroz (AVN), 24. ayda asetabular indeks (AI) ve 5. yılda lateral merkez–kenar açısı (LCEA) yer aldı. ≤6 ay ve 6–12 ay yaş grupları için alt grup analizleri yapıldı. Genel başarısızlık oranları gruplar arasında benzerdi (%18,8’e karşı %20,0, p=1,000). Ancak başarısızlığın zamanlaması farklıydı: Grup 2’deki başarısızlıklar intraoperatif olarak saptandı ve yönetildi, oysa Grup 1’deki başarısızlıklar daha geç dönemde ortaya çıktı ve ek cerrahi gerektirdi. Radyografik sonuçlar ve AVN insidansı benzerdi (p>0,05). Her iki grupta da 6 aydan büyük hastalarda başarısızlık oranları belirgin olarak daha yüksekti. Artrografi genel başarısızlık oranını azaltmadı veya radyografik sonuçları iyileştirmedi, ancak konsantrik olmayan redüksiyonun erken saptanmasını ve derhal kesin tedavinin uygulanmasını sağladı; böylece intraoperatif karar vermeyi destekledi ve gecikmiş sekonder girişimleri potansiyel olarak azaltabilecektir.

Anahtar Kelimeler

• Kapalı redüksiyon
• Gelişimsel kalça displazisi
• Kalça artrografisi
• Açık redüksiyon
• Tedavi başarısızlığı

Intraoperative Hip Arthrography During Closed Reduction for Developmental Dysplasia of the Hip in Infants: A Comparative Study of Surgical Decision-Making and Secondary Intervention Risk

Öz

This study evaluated whether intraoperative hip arthrography performed during closed reduction for developmental dysplasia of the hip (DDH) in infants provides prognostic information regarding treatment failure and the need for secondary surgery and examined the influence of patient age. This retrospective comparative study included 88 hips in 79 patients aged ≤1 year who underwent closed reduction followed by hip spica casting. Patients were grouped according to intraoperative assessment method: fluoroscopy alone (Group 1) or fluoroscopy combined with arthrography (Group 2). The primary outcome was treatment failure, defined as secondary open reduction for redislocation in Group 1 and intraoperative conversion to open reduction due to nonconcentric reduction in Group 2. Secondary outcomes included avascular necrosis (AVN), acetabular index (AI) at 24 months, and lateral center–edge angle (LCEA) at 5 years. Subgroup analyses were performed for patients aged ≤6 months and 6–12 months. Overall failure rates were similar between groups (18.8% vs 20.0%, p=1.000). However, the timing of failure differed: failures in Group 2 were detected and managed intraoperatively, whereas those in Group 1 presented later and required additional surgery. Radiographic outcomes and AVN incidence were comparable (p>0.05). Failure rates were substantially higher in patients older than 6 months. Although arthrography did not reduce overall failure or improve radiographic results, it enabled early identification of nonconcentric reduction and immediate definitive management, thereby supporting intraoperative decision-making and potentially reducing delayed secondary procedures.

Anahtar Kelimeler

• Closed reduction
• Developmental dysplasia of the hip
• Hip arthrography
• Open reduction
• Treatment failure

Kaynakça

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