İsmail Murad PEPE, Emre ÇALIŞSAL, Ertuğrul AKŞAHİN, Ali BİÇİMOĞLU

Gelişimsel Kalça Displazisi Nedeni ile Tek Seansta Birleşik Cerrahi Tedavi Uyguladığımız Hastalarımızın Uzun Dönem Klinik ve Radyolojik Sonuçlarının Analizi

Amaç: Gelişimsel kalça displazisi nedeniyle tek seansta birleşik cerrahi tedavi uygulanan hastaların uzun dönem radyolojik ve klinik sonuçlarının araştırılması. Gereç ve Yöntem: Tek seansta açık yerleştirme, innominate osteotomi ve femoral osteotomi uyguladığımız ve iskelet gelişimini tamamlamış 39 hastanın 48 kalçası bu çalışmada değerlendirmeye alınmıştır. Değerlendirmeye alınan hastaların ortalama takip süreleri 12,8 (±3,9) yıldı. Çalışmada hastaların cerrahi işlem yaşı, cerrahi öncesi, erken cerrahi sonrası ve son kontroldeki asetabular indeksleri, son kontroldeki radyolojik ve klinik sonuçları, avasküler nekroz varlığı ve merkez-köşe açıları (CEA) ölçülmüştür. Bulgular: Barrett'in Modifiye McKay Kriterlerine göre 39 hastanın; 28'inde (% 71,8) mükemmel, 8'inde iyi (% 20,5), 3'ünde orta (%7,7) sonuç elde edildi. Olguların hiçbirinde kötü sonuca rastlanmamıştır. Kalamchi Mac Ewen sınıflamasına göre 39 hastanın 8'inde (%20,5) avasküler nekroza rastlandı. Cerrahi öncesi ile erken cerrahi sonrası ve son kontrollerde ölçülen asetabuler indeks değerleri birbirleri ile karşılaştırıldı. Ortalama değişimler anlamlı bulundu (p

Long-Term Clinical and Radiological Outcome of Simultaneous Combined Surgery in Developmental Dysplasia of the Hip

Objective: The aim of this study was to investigate the long term clinical and radiological outcome of simultaneously combined surgery in developmental dysplasia of the hip. Material and Method: Fortyeight hips of 39 skeletally maturated patients who underwent simultaneously open reduction, innominate ostetomy and femoral osteotomy were evaluated. Mean follow up years were 12,8 (±3,9). Patients age, preoperative early postoperative and end control acetabular indexes, radiological and clinical classification outcomes, avascular necrosis, center-edge angles were reported. Results: According to Barrett's modified McKay criteria in 39 patients; 28 (%71,8) had excellent, 8 had (%20,5) good, 3 had (%7,7) fair results. There were no poor results. According to Kalamchi Mac Ewen classification in 39 patients there were 8 (%20,5) patients had avascular necrosis. Preoperative, early postoperative and end control acetabular indexes were analyzed. There were significiant mean change (p<0.001). Conclusion: We investigated in our study that long term results of simultaneously combined surgery in developmental dysplasia of the hip were good outcome. But there were remarkable studies found low hip survive in very long term. We think that some pathologies, not able to find with conventional methods, may cause this catastrophic results. Very long term follow up will help us to find this pathologies.

PDF

___

Forlin E, Munhoz da Cunha LA, Figueiredo DC. Treatment of developmental dysplasia of the hip after walking age with open reduction, femoral shortening, and acetabular osteotomy. Orthop Clin North Am 2006; 37: 149-60.
Wirth T, Stratmann L, Hinrichs F. Evolution of late presenting developmental dysplasia of the hip and associated surgical procedures after 14 years of neonatal ultrasound screening. J Bone Joint Surg Br 2004; 86: 585-9. Klisic P, Jankovic L. Combined procedure of open reduction and shortening of the femur in treatment of congenital dislocation of the hips in older children. Clin Orthop Relat Res 1976; 119: 60-9.
Stojimorvic I. Our way of open reduction for congenital dislocation of the hip. Acta Chir Jugoslav 1959; 6: 202. 5.
Dimitriou JK, Cavadias AX. One-stage surgical procedure for congenital dislocation of the hip in older children. Long-term results. Clin Orthop Relat Res 1989; 246: 30-8.
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 1986; 68: 79-87.
Tonnis D, Behrens K, Tscharani F. A modified technique of the triple pelvic osteotomy: early results. J Pediatr Orthop 1981; 1: 241-9.
Severin E, Contribution to the knowledge of congenital dislocation of the hip joint. Late results of closed reduction and arthrographic studies of recent cases. Acta Chir Scand 1941; Supp 63. 9.
Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1980; 62: 876-88. Cakirgil GS. "Radical reduction" procedure for treatment of congenital dislocation of the hip in older children. Isr J Med Sci 1980; 16: 344-6.
Massie WK, Howorth MB. Congenital dislocation of the hip. II. Results of open reduction as seen in early adult period. J Bone Joint Surg Am 1951; 33: 171-90. Chan A, Cundy PJ, Foster BK, et al. Late diagnosis of congenital dislocation of the hip and presence of a screening programme: South Australian population-based study. Lancet 1999; 354: 1514-7.
Williamson DM, Glover SD, Benson MK. Congenital dislocation of the hip presenting after the age of three years. A long-term review. J Bone Joint Surg Br 1989; 71: 745-51.
Thomas SR, Wedge JH, Salter RB. Outcome at forty-five years after open reduction and innominate osteotomy for late- presenting developmental dislocation of the hip. J Bone Joint Surg Am 2007; 89: 2341-50.
Subasi M, Arslan H, Cebesoy O, et al. Outcome in unilateral or bilateral DDH treated with one-stage combined procedure. Clin Orthop Relat Res 2008; 466: 830-6.
Olney B, Latz K, Asher M. Treatment of hip dysplasia in older children with a combined one-stage procedure. Clin Orthop Relat Res 1998; 347: 215-23. Reichel H, Hein W. Dega acetabuloplasty combined with intertrochanteric osteotomies. Clin Orthop Relat Res 1996; 323: 234-42.
Ryan MG, Johnson LO, Quanbeck DS, et al. One-stage treatment of congenital dislocation of the hip in children three to ten years old. Functional and radiographic results. J Bone Joint Surg Am 1998; 80: 336-44. El-Sayed MM. Single-stage open reduction, Salter innominate osteotomy, and proximal femoral osteotomy for the management of developmental dysplasia of the hip in children between the ages of 2 and 4 years. J Pediatr Orthop B 2009; 18: 188-96.
Utterback JD, MacEwen GD. Comparison of pelvic osteotomies for the surgical correction of the congenital hip. Clin Orthop Relat Res 1974; 98: 104-10. Gulman B, Tuncay IC, Dabak N, et al. Salter's innominate osteotomy in the treatment of congenital hip dislocation: a long-term review. J Pediatr Orthop 1994; 14: 662-6.
Morin C, Rabay G, Morel G. Retrospective review at skeletal maturity of the factors affecting the efficacy of Salter's innominate osteotomy in congenital dislocated, subluxated and dysplastic hips. J Pediatr Orthop B 1998; 18: 246-53.
Millis MB, Hall JE. Transiliac lengthening of the lower extremity. A modified innominate osteotomy for the treatment of postural imbalance. J Bone Joint Surg Am 1979; 61: 1182- 94.
Ağuş H, Kalenderer Ö, Pedükcoşkun S, ve ark. Yürüme sonrası gelişimsel kalça çıkığının cerrahi tedavisinde erken prognostik faktörlerin değerlendirilmesi. Acta Orthop Traumatol Turc 1999; 33: 35-9.