Okay BULUT, Zekeriya OZTEMUR, Ozhan PAZARCİ, Umut Hatay GOLGE, Seyran KİLİNC

MRI clasification in developmental dysplasia of the hip with reference to soft tissue changes

Amaç: Sunulan prospektif çalışmanın amacı kapalı ya da açık redüksiyon yapılan GKD'li olgularda patolojik yumuşak doku değişikliklerinin; redüksiyonun devamı üzerine etkisinin MRG ile incelenmesidir. Gereç ve Yöntemler: 2003 ve 2012 yılları arasında tedavi edilen 34 olgunun 46 kalça prospektif takip edildi. Redüksiyon sonrası tüm çocuklara MRG uygulandı. MRG sınıflaması (Kashiwagi) triradiat kıkırdak düzeyindeki aksiyel kesitlerdeki posterior asetebular kenara göre yapıldı. Kashiwagi MRG sınıflamasından farklı olarak; Grup 2 MRG'deki patolojik yumuşak doku değişikliklerine göre iki alt gruba ayrıldı (2A ve 2B). Bulgular: Keskin posterior asetebular rim bulunan 27 kalça grup 1 olarak değerlendirildi. Yuvarlak posterior asetebular kenar olan 16 hasta grup 2'de yer aldı. Bunlardan patolojik yumuşak doku değişikliği bulunmayan 6 olgunun 9 kalçası grup 2A'da yer aldı. Patolojik yumuşak doku değişikliklerinden en az biri bulunan 6 olgunun 7 kalçası grup 2B'de yer aldı. İnverte labrum bulunan 3 kalça grup 3'te yer aldı. Grup 2B ve 3 kalçalarda redüksiyon sonrası dislokasyon ve ek cerrahi işlem gereksinimi olduğu izlendi. Sonuç: Kashiwaginin Pavlik bandajı ile redükte oluna bilirlik hakkında bilgi veren MRG sınıflaması kapalı ya da açık redüksiyon yapılan daha ileri yaş olgularda da faydalıdır. Bu olgularda değerlendirmede redüksiyona engel yumuşak doku yapılarıda dikkate alınmalıdır. Sınıflamanın bu modifikasyonu ile ileri yaş olgularda tedavi seyri açısından daha yararlı bilgiler verdiğini düşünmekteyiz

Gelişimsel kalça displazisinde yumuşak doku değişiklikleri dikkate alınarak yapılan MRG sınıflaması

Objective: Purpose of the presented prospective study is to assess the pathological soft tissues together and examine their effect on the continuation of reduction in DDH cases treated with closed or open reduction by using MRI technique. Materials and Methods: 46 hips of 34 cases treated between 2003 and 2012 were prospectively studied. MRI was performed on all children after reduction. Kashiwagi MRI classification was made according to the posterior acetabular rim on axial images at the level of triradiate cartilage. As different from Kashiwagi, the group of patientes were divided two subgroups (2A and 2B) according to pathological soft tissue changes on MRI. Results: 27 hips with sharp posterior acetabular rims were involved in Kashiwagi group 1. Sixteen hips with rounded and dysplastic posterior acetabular rims were involved in group 2. In these cases, 9 hips of 6 cases not diagnosed with pathological soft tissue changes obstructing reduction on MRI were included in group 2A. In addition to rounded posterior acetabular rims, 7 hips of 6 cases having at least one of the soft tissue changes such as pulvinar, transverse acetabular ligament, labrum and hypertrophy of ligamentum teres were involved in group 2B. Redislocation was observed after plaster cast in all cases in group 2B and open reduction and salter osteotomy were applied. Three hips with inverted labrum were involved in group 3. Conclusion: Presented study provides more useful information on the course of treatment in cases where Kashiwagi's classification modification and closed/open reduction and immobilization were conducted by taking soft tissue factors obstructing reduction into consideration

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