A. Erdem BAGATUR, Gazi ZORER, Y. Bilge SÜREL

Pemberton perikapsüler osteotomisinde femur başının örtünmesi yeterli oluyor mu? Üç boyutlu bilgisayarlı tomografi rekonstrüksiyonu ile değerlendirme

Amaç: Açık redüksiyonla birlikte Pemberton perikapsüler osteotomisi yapılan gelişimsel kalça displazili olgularda, ameliyat sonrasında femur başının örtünmesinin yeterli olup olmadığı üç boyutlu bilgisayarlı tomografi rekonstrüksiyonu ile değerlendirildi. Çalışma planı: Prospektif bir çalışma düzeneğinde, 15 ardışık hastanın (12 kız, 3 erkek; ort. yaş 26 ay; dağılım 18-34 ay) ameliyat öncesi ve altı ay sonrası rutin radyografileri çekildi. Üç boyutlu bilgisayarlı tomografi rekonstrüksiyonu yapıldı ve femur başının örtünmesi değerlendirildi. Sonuçlar: Ameliyat öncesi dönemde 38° (dağılım 33-52°) olan asetabuler indeks ortalaması, sonraki dönemde 19 dereceye (dağılım 16-23°) indi. Üç boyutlu bilgisayarlı tomografilerin karşılaştırılması sonucunda, ameliyat sonrasında asetabulumların hepsinde addüksiyon ile ekstansiyon derecelerinde artış, asetabuler anteversiyon derecesinde ise azalma saptandı. Tüm hastalarda femur başının örtünmesi yeterli bulundu. Çıkarımlar: Uygun olgularda, Pemberton perikapsüler osteotomisinin çok iyi sonuçlar verdiğini, osteotomi sonrası femur başı örtünmesinin yeterli olduğunu düşünüyoruz; ancak bu konuda kuşku var ise, konvansiyonel yöntemler yerine üç boyutlu rekonstrüksiyonu yapılan bilgisayarlı tomografi görüntülerini kullanmanın daha doğru olacağı görüşündeyiz.

Anahtar Kelimeler:

Çocuk, Femur başı, Kalça eklemi, Görüntü işleme, bilgisayar destekli, Osteotomi, Tomografi, x-ışınlı bilgisayarlı, Asetabulum, Kıkırdak, eklem, Kalça çıkığı, doğumsal

Is sufficient femoral head coverage obtained after Pemberton's pericapsular osteotomy? Evaluation by three-dimensional computed tomographic reconstruction

We evaluated femoral head coverage by three-dimensional computed tomographic reconstruction after Pemberton's pericapsular osteotomy with open reduction in cases with developmental dysplasia of the hip. Methods: In a prospective design, routine radiographs of 15 consecutive patients were obtained and three-dimensional computed tomographic reconstruction was performed preoperatively and six months after surgery. The mean age at the time of surgery was 26 months (range 18 to 34 months). Twelve patients were girls and three were boys. Results: The mean acetabular index was 38° (range 33-52°) preoperatively, and 19° (range 16-23°) postoperatively. Comparison between pre- and postoperative three-dimensional computed tomographic reconstruction images revealed increased acetabular adduction and extension, and decreased acetabular anteversion in all cases. Sufficient coverage of the femoral head was documented in all patients. Conclusion: Pemberton's pericapsular osteotomy provides successful results in appropriate cases, with sufficient coverage of the femoral head. However, if there is any doubt, utilization of three-dimensional computed tomographic reconstruction images may contribute to a more precise evaluation of the outcome.

Keywords:

Child, Femur Head, Hip Joint, Image Processing, Computer-Assisted, Osteotomy, Tomography, X-Ray Computed, Acetabulum, Cartilage, Articular, Hip Dislocation, Congenital,

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