Gelişimsel Kalça Displazisi Tanılı Hastalarda Yürüme Çağında Artroskopik Reduksiyon Ve Dega Asetabuloplasti Tedavisi

GİRİŞ ve AMAÇ: Çalışmamızın amacı merkezimizde yürüme çağında gelişimsel kalça displazisi tanısı almış hastalarda aynı seansta yapılan artroskopik redüksiyon ve Dega ostetomisi cerrahisinin radyolojik ve klinik sonuçlarını incelemektir. YÖNTEM ve GEREÇLER: Aynı seansta artroskopik redüksiyon ve Dega osteotomisi yapılan 13 hasta retrospektif olarak incelendi.Preoperetif Tönnis evresi, asetabuler indexler, postoperatif femoral baş örtüm oranı ve asetabuler indexler ölçüldü. Kalamichi-MacEwen sınıflamasına göre AVN, MacKay sınıflamasına göre klinik durum değerlendirildi. BULGULAR: Ameliyat öncesi, ortalama AI açısı 38.4 (dağılım 34-44) idi ve en son takipte ortalama AI 21.7 (dağılım, 20-26) derece idi. Ortalama, femur başı kapsama oranı% 90.7 (aralık,% 80-100) idi. McKay sınıflamasına göre; 7 hastada Grade I kalça, 5 hastada Grade II, 1 hastada Grade III kalça vardı. TARTIŞMA ve SONUÇ: Gelişimsel kalça displazisi tedavisinde yürüme çağı döneminde artroskopik redüksiyon, kısa dönem sonuçları açısından açık redüksiyona alternatif olabilecek bir tekniktir. Daha büyük hasta sayıları ile prospektif, uzun vadeli ve karşılaştırmalı çalışmalara ihtiyaç olduğu aşikardır.

Arthroscopic Reduction and Dega Acetobuloplasty Treatment in Walking Age Children with Irreducible Developmental Dysplasia of the Hip

INTRODUCTION: The aim of our study was to investigatethe radiological and clinical results of arthroscopic reduction, which has promising results, along with Dega acetobuloplasty in children over 18 months of age who were admitted to our center.METHODS: 13 patients operated with arthroscopic reductionand Dega acetabuloplasty in same session evaluated retrospectively. Preoperative Tönnis grade, acetabular indexes, postoperative acetabular indexes, coverage ratio of the femoral head were measured. Postoperative AVN was evaluated according to the Kalamchi and MacEwen classification and MacKay classification was criteria forclinical evaluation.RESULTS: Preoperatively, the mean,AI angle was 38.4 (range, 34 to 44 ) degree and at the latest follow-up, the mean AI was 21.7 (range, 20 to 26) degrees. The mean, femoral head coverage ratio was 90.7 % (range, 80 to 100%). According to McKay classification; 7 patients had Grade I hip, 5 patients had Grade II, and 1 patient had Grade III hip.DISCUSSION and CONCLUSION: Arthroscopic reduction for developmental dysplasia of hip at walking age is a technique that might be an alternative to open reduction from the point of short-term results. It is clear that prospective, long-term and comparative studies with larger patient numbers are needed.

PDF

___

1. Herring JA. Tachdjian’s Pediatric Orthopaedics. 4th ed. Philadelphia: Saunders Elsevier; 2008;637-770.
2. Tönnis D. Congenital dysplasia and dislocation of the hip in children and adults. Berlin, etc: Springer-Verlag 1987.
3. El-Sayed M, Ahmed T, Fathy S, Zyton H. The effect of Dega acetabuloplasty and Salter innominate osteotomy on acetabular remodelling monitored by the acetabular index in walking DDH patients between 2 and 6 years of age: short- to middle-term follow-up. J Child Orthop. 2012; 6:471-7.
4. Gross R. Arthroscopy in hip disorders in children. Orthop Rev 1977; 6:43-9.
5. Heyman C H, Herndorn C H. Legg-Perthes disease; a method for the measurement of the roentgenographic result. J Bone Joint Surg Am. 1950; 32 A(4):767-78.
6. Kalamchi A, MacEwen G D. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1980; 62:876-88.
7. Eberhardt O, Wirth T, Fernandez F F. Arthroscopic Anatomy of the Dislocated Hip in Infants and Obstacles Preventing Reduction. Arthroscopy. 2015; 31(6):1052-9.
8. Dega W. Transiliac osteotomy in the treatment of congenital hip dysplasia. Chir Narzadow Ruchu Ortop Pol 1974;39:601-13.
9. Heyman C H, Herndorn C H. Legg-Perthes disease; a method for the measurement of the roentgenographic result. J Bone Joint Surg Am. 1950; 32 A(4):767-78.
10. Bolland BJ, Wahed A, Al-Hallao S, Culliford DJ, Clarke NM. Late reduction incongenital dislocation of the hip and the need for secondary surgery:radiologic predictors and confounding variables. J Pediatr Orthop 2010;30:676–82.
11. Bulut O, Oztürk H, Tezeren G, Bulut S. Arthroscopic-assisted surgical treatment for developmental dislocation of the hip. Arthroscopy. 2005; 21:574-9.
12. Öztürk H, Oztemur Z, Bulut O, Tezeren G, Bulut S. Arthroscopic-assisted surgical treatment for developmental dislocation of the hip before the age of 18 months. Arch Orthop Trauma Surg. 2013; 133:1289–94.
13. Lee SH, Jang WY, Choi GW, Lee YK, Jung HW. Is the Transverse Acetabular Ligament Hypertrophied and Hindering Reduction in Developmental Dysplasia of Hip? Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2018; 34(4), 1219-26.
14. Xu H, Yan Y, Xu C, Li T, Zhao T, Liu N,Lei W. Effects of arthroscopic-assisted surgery on irreducible developmental dislocation of hip by mid-term follow-up. Medicine, 2016; 95(33), e4601.
15. Kitano T, Imai Y, Morita M, Nakagawa K, Wada M, Sakai, et al. New treatment method for developmental dysplasia of the hips after walking age: arthroscopic reduction with limboplasty based on the findings of preoperative imaging. J Orthop Sci. 2010; 15:443-51.
16. Eberhardt O, Wirth T, Fernandez FF. Arthroscopic reduction and acetabuloplasty for the treatment of dislocated hips in children of walking age: a preliminary report. Arch Orthop Trauma Surg. 2014; 134:1587- 94.
17. Zhao L, Yan H, Yang C, Cai D, Wang Y. Medium-term results following arthroscopic reduction in walking-age children with developmental hip dysplasia after failed closed reduction. Journal of Orthopaedic Surgery and Research 2017; 12:135.