Serkan SİPAHİOĞLU, Sinan ZEHİR, Hüseyin AŞKAR, Uğur Erdem IŞIKAN

Gelişimsel kalça displazisi tedavisinde Salter osteotomisi

Amaç. Gelişimsel kalça displazisi bulunan olgularda Salter pelvik osteotomi uygulaması sonrasıerken dönem sonuçlarını radyolojik ve klinik olarak değerlendirmek. Yöntem. Kliniğimize 2002- 2008 yılları arasında başvuran ve daha önce herhangi bir tedavi uygulanmamış GKD tanısıkonmuş, açık redüksiyon ve Salter İnnominate osteotomi ile tedavi edilmiş 51 kalça (44 hasta,12erkek, 32 kız, ortalama yaş 30,7 ay) ortalama 25 aylık takip sonucunda retrospektif olarakdeğerlendirildi. Olgular klinik olarak McKay sınıflamasına, radyolojik olarak Severininkriterlerine ve avasküler nekroz (AVN) varlığı ise Kalamchi-MacEwen kriterlerine göredeğerlendirildi. Bulgular. Preoperatif asetabular indeksi ortalama 37,4 (29-50) derece olanhastaların en son takibi sırasında alınan postoperatif asetabular indeks değerleri ortalama 24,1 (12- 32) derece bulundu. MacKay ın klinik değerlendirme sistemine göre 51 kalçanın 43ü (%84)mükemmel, 7si (%13,7) iyi, 1i (%2) orta idi. Severinin radyolojik sınıflamasına göre 26 kalça(%51) çok iyi, 15 kalça (%29,4) iyi, 8 kalça (%15,7) orta ve 2 kalça (%3,9) kötü olarakdeğerlendirildi Postoperatif AVN oranı yaklaşık %17,6 (9 kalça) idi. Sonuç. Onsekiz ay sonrasıGKD tedavisinde Salter innominate osteotomisi etkin bir yöntem olarak pelvis osteotomisiseçenekleri arasında değerlendirilebilir. İleri yaşlarda artan komplikasyon riskini düşürmek içinosteotomi tekniğine uygun yapılmalıdır.

Salter osteotomy in the treatment of developmental dysplasia of the hip

Aim. We evaluated the short-term results of Salter pelvic osteotomy for the treatment ofdevelopmental dysplasia of the hip (DDH). Methods. Forty four patients (32 girls, 12 boys; meanage 30.7months) with DDH underwent Salter innominate osteotomies in 51 hips were evaluatedretrospectively. Clinical evaluations were made according to the McKay criteria, radiologicassessment was made using Severin criteria and avascular necrosis of the femoral head wasassessed using the Kalamchi-MacEwen criteria. The mean follow-up period was 25 month.Results. The mean acetabular index which was 37.4o (29-50) preoperatively decreased to 24.1o(12-32) postoperatively. Clinical results were excellent in 43 hips (84%), good in 7 (13.7%) andmoderate in one (2%) patient. 26 hips (51%) were excellent, 15 hips (29.4%) were good, 8 hips(15.7%) were moderate and 2 hips (3.9%) were bad according to Severin radiologic classification.According to the Kalamchi-MacEwen criteria, there was avascular necrosis in nine hips (17.6%)postoperatively. Conclusion. Salter innominate osteotomy can be evaluated as one of the effectivemethod among pelvic osteotomies in the treatment of DDH patients older than eghteen yearsold.For reducing complication risk which increases age osteotomy should be done in a propertechnique.

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1. Songur M, Akel I, Karahan S, Kuzgun U, Tümer Y. Prevalence of untreated hip dislocation in Turkish children aged 6 months to 14 years. Acta Orthop Traumatol Turc 2011; 45: 215-20.
2. Salter RB, Dubos JP. The first fifteen years personal experience with innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. Clin Orthop Relat Res. Jan-Feb 1974; 72-103.
3. Senaran H, Bowen JR, Harcke HT. Avascular necrosis rate in early reduction after failed Pavlik harness treatment of developmental dysplasia of the hip. J Pediatr Orthop. Mar 2007; 27: 192-7.
4. Salter RB, Kostuik J, Dallas S. Avascular necrosis of the femoral head as a complication of treatment for congenital dislocation of the hip in young children: A clinical and experimental investigation. Canadian journal of surgery. Journal canadien de chirurgie. Jan 1969; 12: 44-61.
5. Salter RB. Innominate Osteotomy in the Treatment of Congenital Dislocation and Subluxation of the Hip. J Bone Joint Surg Br 1961; 43: 518-39.
6. McKay DW. A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip. Clin Orthop Relat Res. Jan-Feb 1974; 124-32.
7. Severin E. Congenital dislocation of the hip; development of the joint after closed reduction. J Bone Joint Surg Am. Jul 1950; 32: 507-18.
8. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am. Sep 1980; 62: 876-88.
9. Herring JA, Tachdjian MO. Developmental Dysplasia of the Hip. In: Herring JA, ed. Tachdjian's pediatric orthopaedics. 4th ed. Philadelphia: Saunders/Elsevier 2008.
10. Utterback JD, MacEwen GD. Comparison of pelvic osteotomies for the surgical correction of the congenital hip. Clin Orthop Relat Res. Jan-Feb 1974; 104-10.
11. Macnicol MF, Bertol P. The Salter innominate osteotomy: Should it be combined with concurrent open reduction? J Pediatr Orthop B. Nov 2005; 14: 415-21.
12. Moulin P, Morscher E. Long-term results of the Salter pelvic osteotomy. Der Orthopade. Nov 1988; 17: 479-84.
13. Barrett WP, Staheli LT, Chew DE. The effectiveness of the Salter innominate osteotomy in the treatment of congenital dislocation of the hip. J Bone Joint Surg Am. Jan 1986; 68: 79-87.
14. Gulman B, Tuncay IC, Dabak N, Karaismailoglu N. Salter's innominate osteotomy in the treatment of congenital hip dislocation: A long-term review. J Pediatr Orthop. Sep-Oct 1994; 14: 662-6.
15. Tükenmez M, Perçin S, Tezeren G, Cingöz MA. Gelişimsel Kalça Displazisinin Tedavisinde Salterin Iliyak Osteotomisi Sonuçlarımız. Turkiye Klinikleri 2006; 26: 390-5.
16. Gallien R, Bertin D, Lirette R. Salter procedure in congenital dislocation of the hip. J Pediatr Orthop. Aug 1984; 4: 427-30.
17. Ege R. Kalça cerrahisi ve sorunları. Ankara: Türk Hava Kurumu Basımevi 1996.
18. Senaran H, Karalezli MN, Simsek S, Arazi M, Kapicioglu MI. [Comparison of K- wire fixation methods in terms of stability in Salter iliac osteotomies]. Acta Orthop Traumatol Turc 2007; 41: 104-7.
19. Eren A, Pekmezci M, Demirkiran G, Cakar M, Guven M, Yazici M. Modified Salter osteotomy for the treatment of developmental dysplasia of the hip: Description of a new technique that eliminated the use of pins for internal fixation. J Bone Joint Surg Br. Oct 2007; 89: 1375-8.
20. Powell EN, Gerratana FJ, Gage JR. Open reduction for congenital hip dislocation: The risk of avascular necrosis with three different approaches. J Pediatr Orthop. Mar-Apr 1986; 6: 127-32.
21. Zadeh HG, Catterall A, Hashemi-Nejad A, Perry RE. Test of stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hip. J Bone Joint Surg Br. Jan 2000; 82: 17-27.
22. Thomas IH, Dunin AJ, Cole WG, Menelaus MB. Avascular necrosis after open reduction for congenital dislocation of the hip: Analysis of causative factors and natural history. J Pediatr Orthop. Sep-Oct 1989; 9: 525-31.
23. Ogden J. Normal and abnormal circulation. In: Tachdjian MO, ed. Congenital dislocation of the hip. New York: Churchill Livingstone 1982; 798.
24. Hansson G, Althoff B, Bylund P, Jacobsson B, Lofberg AM, Lonnerholm T. The Swedish experience with Salter's innominate osteotomy in the treatment of congenital subluxation and dislocation of the hip. J Pediatr Orthop. Mar-Apr 1990; 10: 159-62.
25. Tonnis D. Surgical treatment of congenital dislocation of the hip. Clin Orthop Relat Res. Sep 1990; 33-40.
26. Roth A, Gibson DA, Hall JE. The experience of five orthopedic surgeons with innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. Clin Orthop Relat Res. Jan-Feb 1974; 178-82.
27. Klisic P, Jankovic L, Basara V. Long-term results of combined operative reduction of the hip in older children. J Pediatr Orthop. Sep-Oct 1988; 8: 532-4.
28. Berkeley ME, Dickson JH, Cain TE, Donovan MM. Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old. J Bone Joint Surg Am. Mar 1984; 66: 412-20.
29. Bohm P, Brzuske A. Salter innominate osteotomy for the treatment of developmental dysplasia of the hip in children: Results of seventy-three consecutive osteotomies after twenty-six to thirty-five years of follow-up. J Bone Joint Surg Am. Feb 2002; 84: 178-86.
30. Kapukaya A, Subaşı M, Necmioğlu S, Kırkgöz T. Gelişimsel kalça çıkıkların cerahi tedavisinde Salter pelvik osteotomisinin sonuçları. Journal of Arthroplasty Arthroscopic Surgery 2000; 11: 156-61.
31. Aguş H, Kalenderer Ö, Pedükcoflkun S, Eryanılmaz G, Resole A. Yürüme sonrası gelişimsel kalça çıkıklarının cerrahi tedavisinde erken prognostik faktörlerin değerlendirilmesi. Acta Orthop Traumatol Turc 1999; 35-9.
32. Ozcelik A, Omeroglu H, Inan U, Ozyurt B, Seber S. Acta Orthop Traumatol Turc 2002; 36: 100-5.