MEHMET SELAHATTİN DEMİRHAN, Fatih DİKİCİ, Levent ERALP, Mehmet ÖNEN, Bora GÖKSAN

Gelişimsel kalça displazisinde 0-18 aylık bebekler için tedavi algoritması ve prospektif sonuçlarımız

Amaç: Gelişimsel kalça displazisi (GKD) bulunan 0-18 ay arası hastalar için oluşturduğumuz algoritmaya göre tedavi edilmiş ve yeterli takibi bulunan olguların tedavi sonuçlarını incelemek. Hastalar ve yöntem: Kliniğimizde GKD tedavisinde kullanılmak üzere oluşturulan algoritmaya göre, GKD tanısı konmuş, Pavlik bandajına cevap vermemiş veya Pavlik bandajı kullanımı endikasyonu bulunmayan 2-18 ay arası hastaların tedavileri prospektif olarak değerlendirildi. Ortalama 42 ay (15-90 ay) süreyle takip edilen 33 kalça (24 hasta; 21 kız, 3 erkek; ort. yaş 7.4 ay; dağılım 2.5-18 ay) incelemeye alındı. Ultrasonografi incelemelerinde Grafin tiplemeleri kullanıldı. Hastaların son kontrollerinde, avasküler nekroz varlığı Kalamchi ve MacEwen kriterleri; radyolojik derecelendirmeler ise Severin kriterlerine göre yapıldı. Sonuçlar: Tedavi öncesinde 37.3$\circ$ (20-58$\circ$) olan asetabular indeks ölçümleri tedavi sonrasında ortalama 21.8$\circ$ (15-30$\circ$) bulundu. Kalamchi'ye göre altı kalçada (%18.2) tip I, üç kalçada (%9.1) tip II, bir kalçada (%3) tip III avasküler nekroz saptandı. Severin kriterlerine göre 21 kalça grup I, on kalça grup II, iki kalça grup III'te bulundu. Dört kalçaya takipleri sırasında asetabular osteotomi ile tavan ameliyatları yapıldı. Son kontrollerinde tüm hastaların hareket açıklıkları tam olarak bulundu. Hiçbir hastada ağrı ve topallama şikayeti gözlenmedi. Çıkarımlar: Oluşturulan algoritmaya uygun olarak tedavi edilen GKD'li kalçalarda elde edilen başarılı klinik sonuçlar, 0-18 ay arası tipik GKD tedavisinin bu algoritma ile standartlaştırılabileceğini gösterdi.

Anahtar Kelimeler:

Asetabulum, Kalça çıkığı, doğumsal, Algoritma, Artrografi, Osteoartrit, kalça, Femur başı nekrozu, Süt çocuğu, yenidoğan, İleriye dönük çalışma, Tomografi, x-ışınlı bilgisayarlı

A treatment algorithm for developmental dysplasia of the hip for infants 0 to 18 months of age its prospective results

Objectives: We evaluated the results of treatment in patients who were treated according to an algorithm established for developmental dysplasia of the hip (DDH) during the first 18 months of life. Methods: We developed an algorithm for DDH to be used in infants at 0 to 18 months of age. Patients who did not respond to, or who did not have the indication for, the use of Pavlik harness were treated according to our algorithm and evaluated prospectively. Thirty-three hips (24 patients; 21 girls, 3 boys; mean age 7.4 months; range 2.5 to 18 months) were followed-up for a mean of 42 months (range 15 to 90 months). Ultrasonographic evaluation was performed using the Graf method. Avascular necrosis was evaluated according to the Kalamchi and MacEwen classification, and radiological results according to the Severin classification. Results: The mean acetabular index angles before and after treatment were 37.3$\circ$ (range 20 to 58$\circ$ and 21.8$\circ$ (range 15$\circ$ to 30$\circ$), respectively. According to the Kalamchi and MacEwen classification, six hips (18.2%) had type I, three hips (9.1%) had type II, and one hip (3%) had type III avascular necrosis. According to the Severin criteria, 21 hips were considered in group I, 10 in group II, and two hips in group III. Acetabular osteotomies were performed in four hips. All patients had full range of motion without any pain and limp. Conclusion: Successful clinical results obtained in the hips treated according to this algorithm for DDH may serve to justify its use as a standard algorithm in the treatment of infants at ages 0 to 18 months.

Keywords:

Acetabulum, Hip Dislocation, Congenital, Algorithms, Arthrography, Osteoarthritis, Hip, Femur Head Necrosis, Infant, Newborn, Prospective Studies, Tomography, X-Ray Computed,

PDF

___

1.Fleissner PR Jr, Ciccarelli CJ, Eilert RE, Chang FM, Glancy GL. The success of closed reduction in the treatment of complex developmental dislocation of the hip. J Pediatr Orthop 1994;14:631-5.
2. 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;76:1777-92.
3. Mitani S, Nakatsuka Y, Akazawa H, Aoki K, Inoue H. Treatment of developmental dislocation of the hip in children after walking age. Indications from two-directional arthrography. J Bone Joint Surg [Br] 1997;79:710-8.
4. Forlin E, Choi IH, Guille JT, Bowen JR, Glutting J. Prognostic factors in congenital dislocation of the hip treated with closed reduction. The importance of arthrographic evaluation. J Bone Joint Surg [Am] 1992;74:1140-52.
5. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg [Am] 1980;62:876-88.
6. Severin E. Congenital dislocation of the hip: development of the joint after closed reduction. J Bone Joint Surg [Am]1950;32:507-18.
7. Zionts LE, MacEwen GD. Treatment of congenital dislocation of the hip in children between the ages of one and three years. J Bone Joint Surg [Am] 1986;68:829-46.
8. Graf R. New possibilities for the diagnosis of congenital hip joint dislocation by ultrasonography. J Pediatr Orthop 1983;3:354-9.
9. Carlioz H, Filipe G. The natural history of the limbus in congenital dislocation of the hip: an arthrographic study. In: Tachdjian MO, editor. Congenital dislocation of the hip. 1st ed. New York: Churchill-Livingstone; 1982. p. 247-62.
10. Drummond DS, O'Donnell J, Breed A, Albert MJ, Robertson WW. Arthrography in the evaluation of congenital dislocation of the hip. Clin Orthop 1989;(243):148-56.
11. Hughes RJ. Intrinsic obstructive factors in congenital dislocation of the hip: the role of arthrography. In: Tachdjian MO, editor. Congenital dislocation of the hip. 1st ed. New York: Churchill-Livingstone; 1982. p. 227-46.
12.Weintroub S, Green I, Terdiman R, Weissman SL. Growth and development of congenitally dislocated hips reduced in early infancy. J Bone Joint Surg [Am] 1979;61:125-30.
13. Browning WH, Rosenkrantz H, Tarquinio T. Computed tomography in congenital hip dislocation. The role of acetabular anteversion. J Bone Joint Surg [Am] 1982;64:27-31.
14. Peterson HA, Klassen RA, McLeod RA, Hoffman AD. The use of computerised tomography in dislocation of the hip and femoral neck anteversion in children. J Bone Joint Surg [Br] 1981;63:198-208.
15. Smith BG, Kasser JR, Hey LA, Jaramillo D, Millis MB. Postreduction computed tomography in developmental dislocation of the hip: part I: analysis of measurement reliability. J Pediatr Orthop 1997;17:626-30.
16. Stanton RP, Capecci R. Computed tomography for early evaluation of developmental dysplasia of the hip. J Pediatr Orthop 1992;12:727-30.
17. Harcke HT. Imaging in congenital dislocation and dysplasia of the hip. Clin Orthop 1992;(281):22-8.
18. Quinn RH, Renshaw TS, DeLuca PA. Preliminary traction in the treatment of developmental dislocation of the hip. J Pediatr Orthop 1994;14:636-42.
19.Weinstein SL. Traction in developmental dislocation of the hip. Is its use justified? Clin Orthop 1997;(338):79-85.
20. Tonnis D. An evaluation of conservative and operative methods in the treatment of congenital hip dislocation. Clin Orthop 1976;(119):76-88.
21. Powell EN, Gerratana FJ, Gage JR. Open reduction for congenital hip dislocation: the risk of avascular necrosis with three different approaches. J Pediatr Orthop 1986;6:127-32
22. Morcuende JA, Meyer MD, Dolan LA, Weinstein SL. Longterm outcome after open reduction through an anteromedial approach for congenital dislocation of the hip. J Bone Joint Surg [Am] 1997;79:810-7.
23. Gabuzda GM, Renshaw TS. Reduction of congenital dislocation of the hip. J Bone Joint Surg [Am] 1992;74:624-31.