Yetkin SÖYÜNCÜ, Mustafa ÜRGÜDEN, F. Feyyaz AKYILDIZ, HAKAN ÖZDEMİR, Erdoğan ALTINEL

Gelişimsel kalça displazisinin Pavlik bandajıyla tedavisinin yönlendirilmesinde ultrasonografinin kullanımı

Amaç: Pavlik bandajı ile tedavi edilen gelişimsel kalça displazili hastalarda ultrasonografi ve direkt grafinin kullanımı değerlendirildi. Çalışma planı: Graf yöntemine göre ultrasonografik olarak gelişimsel kalça displazisi saptanan 18 bebek (14 kız, 4 erkek), ultrasonografik olarak iyileşme saptanıncaya kadar Pavlik bandajı ile ortalama 3.2 ay (dağılım 2-5 ay) süreyle tedavi edildi. Kalça eklemlerinin tedaviye başlamadan önce, tedavi bitiminde ve takip muayenelerinde direkt grafileri çekildi ve Tönnis kriterlerine göre asetabuler açılar değerlendirildi. Sonuçlar: Tedavi öncesi radyografilerde 18 kalçanın 13’ünde (%72) hafif, beşinde (%28) yüksek dereceli displazi görülürken, tedavi bitiminde kalçaların dördünde (%22) hafif, ikisinde (%11) yüksek dereceli displazi gözlendi. Ortalama 13.5. ayda (dağılım 11-23 ay) yapılan kontrol muayenesinde ise tüm kalçalar radyolojik olarak normale dönmüştü. Ultrasonografik iyileşme gözlenen (Graf tip I) kalçaların hiçbirinde takip döneminde avasküler nekroz, erken subluksasyon ve dislokasyon görülmedi. Çıkarımlar: Ultrasonografik matürasyonun, gelişimsel kalça displazisinin Pavlik bandajıyla tedavisini sonlandırmada yeterli olacağına inanıyoruz. Böylece, hem yetersiz hem de aşırı tedaviden kaçınılmış olur.

Anahtar Kelimeler:

Kalça çıkığı, doğumsal, Asetabulum, Tanı teknik ve işlemleri, Ortopedik fiksasyon araçları, Süt çocuğu, yenidoğan, Ultrasonografi

Use of ultrasonography in the management of developmental dysplasia of the hip by Pavlik harness

Objectives: We evaluated the use of ultrasonography and roentgenography in patients with developmental dysplasia of the hip treated with a Pavlik harness. Methods: Eighteen babies (14 girls, 4 boys) with sonographically diagnosed developmental dysplasia of the hip according to the method of Graf were treated with a Pavlik harness until sonographic maturation was reached. Mean duration of treatment was 3.2 months (range 2-5 months). Direct radiographies of all hips were obtained before and at the end of treatment and at follow-up examinations. Acetabular indices were assessed according to the guidelines of Tönnis. Results: Radiographies obtained before and at the end of treatment demonstrated low-grade dysplasia in 72% (13 hips) and in 22% (4 hips) and high-grade dysplasia in 28% (5 hips) and in 11% (2 hips), respectively. Radiological follow-up examinations after an average of 13.5 months (range 11-23 months) showed mature hips in all subjects. There were no cases of avascular necrosis, early subluxation or dislocation, and no other complications associated with the treatment by the Pavlik harness. Conclusion: We concluded that sonographic maturation of the hip (Graf type I) is adequate to discontinue the Pavlik harness treatment, enabling to avoid both undertreatment and overtreatment.

Keywords:

Hip Dislocation, Congenital, Acetabulum, Diagnostic Techniques and Procedures, Orthopedic Fixation Devices, Infant, Newborn, Ultrasonography,

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1. Bradley J, Wetherill M, Benson MK. Splintage for congenital dislocation of the hip. Is it safe and reliable? J Bone Joint Surg [Br] 1987;69:257-63.
2. Suzuki S, Yamamuro T. Avascular necrosis in patients treated with the Pavlik harness for congenital dislocation of the hip. J Bone Joint Surg [Am] 1990;72:1048-55.
3. Viere RG, Birch JG, Herring JA, Roach JW, Johnston CE. Use of the Pavlik harness in congenital dislocation of the hip. An analysis of failures of treatment. J Bone Joint Surg [Am] 1990;72:238-44.
4. Mubarak S, Garfin S, Vance R, McKinnon B, Sutherland D. Pitfalls in the use of the Pavlik harness for treatment of congenital dysplasia, subluxation, and dislocation of the hip. J Bone Joint Surg [Am] 1981;63:1239-48.
5. Herring JA. Conservative treatment of congenital dislocation of the hip in the newborn and infant. Clin Orthop 1992; (281):41-7.
6. Tonnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop 1976;(119) :39-47.
7. Tachdjian MO. Congenital dislocation of the hip. In: Wickland EH, Jr., editor. Pediatric orthopaedics. 2nd ed. Philadelphia: Saunders; 1990. p. 297-548.
8. Graf R. New possibilities for the diagnosis of congenital hip joint dislocation by ultrasonography. J Pediatr Orthop 1983;3:354-9.
9. Graf R. Classification of hip joint dysplasia by means of sonography. Arch Orthop Trauma Surg 1984;102:248-55.
10. Graf R. Fundamentals of sonographic diagnosis of infant hip dysplasia. J Pediatr Orthop 1984;4:735-40.
11. Graf R, Wilson B. Sonography of the infant. Hip and its therapeutic implication. 4th ed. Weinheim: Chapman and Hall; 1995.
12. Terjesen T, Bredland T, Berg V. Ultrasound for hip assessment in the newborn. J Bone Joint Surg [Br] 1989;71:767-73.
13. Morin C, Harcke HT, MacEwen GD. The infant hip: realtime US assessment of acetabular development. Radiology 1985;157:673-7.
14. Castelein RM, Sauter AJ. Ultrasound screening for congenital dysplasia of the hip in newborns: its value. J Pediatr Orthop 1988;8:666-70.
15. Polanuer PA, Harcke HT, Bowen JR. Effective use of ultrasound in the management of congenital dislocation and/or dysplasia of the hip. Clin Orthop 1990;(252):176-81.
16. Engesaeter LB, Wilson DJ, Nag D, Benson MK. Ultrasound and congenital dislocation of the hip. The importance of dynamic assessment. J Bone Joint Surg [Br] 1990;72:197-201.
17. Rachbauer F, Sterzinger W, Klestil T, Krismer M, Frischhut B. Acetabular development following early treatment of hip dysplasia by Pavlik harness. Arch Orthop Trauma Surg 1994;113:281-4.
18. Tucci JJ, Kumar SJ, Guille JT, Rubbo ER. Late acetabular dysplasia following early successful Pavlik harness treatment of congenital dislocation of the hip. J Pediatr Orthop 1991;11:502-5.