HASAN HİLMİ MURATLI, Murat CAN, Mehmet Fırat YAĞMURLU, Cem Nuri AKTEKİN, ALİ BİÇİMOĞLU, Abdullah Yalçın TABAK

Legg-Calve-Perthes hastalığında asetabuler çatı ameliyatı sonuçlarımız

Amaç: Legg-Calve-Perthes (LCP) hastalığı nedeniyle asetabuler çatı girişimi uygulanmış olan hastaların sonuçlarını değerlendirdik. Çalışma planı: Kliniğimizde LCP hastalığı tanısı ile takip edilen ve çatı ameliyatı uygulanan 14 hastanın 17 kalçası çalışmaya alındı. Hastaların ortalama yaşı, tanı konduğunda 7 (dağılım 5-9), ameliyatlar sırasında 8 (dağılım 6-10) ve son takip muayenesinde 12 (dağılım 10-16) idi. Hastalar ortalama beş yıl (dağılım 3-9 yıl) süreyle izlendi. Ameliyat öncesinde kalçaların tamamı Catterall 3-4 grubunda idi. Tüm hastalarda en az iki risk faktörü vardı. Ameliyat öncesi ve son takip radyografilerinde ön-arka ve yan Mose küresellik ölçümleri, merkez kenar (CE) açı ölçümleri yapıldı ve istatistiksel olarak karşılaştırıldı. Hastalar ameliyat öncesinde dinamik artrografi ve son takiplerinde ise radyografik ve klinik olarak menteşeli abduksiyon açısından değerlendirildi. Son takip radyografisinde Stulberg sınıflaması modifıye edilerek kalçalar sınıflandırıldı. Klinik olarak Iowa kalça skoru ile değerlendirme yapıldı. Sonuçlar: Mose küresellik ölçümlerinde, ön-arka radyografilerde görülen düzelme istatistiksel bakımdan anlamlı bulunmadı (p>0.05). Yan radyografılerdeki düzelme ise anlamlı idi (p

Anahtar Kelimeler:

Hareket açıklığı, eklem, Çocuk, Kalça eklemi, Legg-Perthes hastalığı, Tedavi sonucu, Asetabulum, Artrografi, Radyografi

Results of acetabular shelf procedures in Legg-Calve-Perthes disease

Objectives: We evaluated the results of acetabular shelf procedures performed for the treatment of Legg-Calve-Perthes (LCP) disease. Methods: The study included 14 patients (17 hips) with LCP disease, who were treated with acetabular shelf operation. The mean ages at the time of diagnosis, operations, and final examinations were 7 years (range 5 to 9 years), 8 years (range 6 to 10 years), and 12 years (range 10 to 16 years), respectively. The mean follow-up was five years (range 3 to 9 years). Before surgery, all patients had Catterall 3-4 hips, and at least two risk factors were identified. On pre- and postoperative anteroposterior and lateral radiograms, the Mose sphericity indices and CE angles were measured. In addition, the presence of hinge abduction was evaluated by dynamic arthrography preoperatively, and on direct radiograms and clinically during final examinations. The hips were graded according to a modified Stulberg classification on final direct radiograms. Clinical evaluation was made with the use of the Iowa hip scores. Results: The Mose measurements did not yield significant improvement on anteroposterior radiograms (p>0.05), whereas postoperative improvement was significant on lateral views (p<0.05). Improvement in CE angles was also statistically significant (p<0.001). According to the Stulberg classification, 10 hips (58.8%) (Stulberg 1-2) were successful, three hips (17.6%) (Stulberg 3) were discussible, and four hips (23.5%) (Stulberg 4-5) were failures. Of four failures, three patients were at the age of 9 years or above. The final Iowa hip scores ranged from 65 to 99 (mean 88.2). Hinge abduction disappeared postoperatively in seven hips (7/13, 53.8%). Conclusion: Acetabular shelf operation following dynamic arthrography may be an alternative treatment option for hips with hinge abduction in LCP disease; however, it does not alter the natural course of the disease as the age increases.

Keywords:

Range of Motion, Articular, Child, Hip Joint, Legg-Perthes Disease, Treatment Outcome, Acetabulum, Arthrography, Radiography,

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