Gelişimsel kalça displazilerinde pemberton perikapsüler osteotomisinin erken dönem sonuçları

Amaç: Pemberton perikapsüler osteotomisi uygulanan, gelişimsel kalça displazili (GKD) hastaların kısa dönem sonuçlarının değerlendirilmesi. Materyal ve Metot: 20 hastanın (17 kız, 3 erkek) 24 kalçasına Pemberton perikapsüler ostetomisi uygulandı. Hastaların ortalama yaşı 29,67 ay (17-72 ay) idi. 4 has- tada bilateral GKD mevcuttu. Tönnis sınıflandırmasına göre 4 kalça (%16,7) grade 2, 11 kalça (%45,8) grade 3, 9 kalça (%37,5) grade 4 olarak değerlendirildi. 3 kal- çaya açık redüksiyon ve Pemberton osteotomisine femoral kısaltma, derotasyon ve varizasyon osteotomisi konsantrik ve uyumlu bir kalça eklemi redüksiyonu sağ- lamak amacı ile eklendi. Bütün hastalar adduktor teno- tomi uygulandı. 24 kalçanın 3üne eklem kapsülü açılma- dan kapalı pemberton osteotomisi uygulandı. Ameliyat öncesi ve son kontrol radyografilerinde asetabuler indeks ve lateral migrasyon indeksi (Reimer) ölçüldü. Klinik fonksiyonel değerlendirme Modifiye McKay sınıflamasına göre, femur başı avasküler nekrozu ise Kalamchi- MacEwen kriterlerine göre değerlendirildi. Bulgular: Ortalama takip süresi 53 aydır (12-145 ay). Fonksiyonel sonuçlarda McKay kriterlerine göre 20 kalça (%83,3) mükemmel, 2 kalça (%8,3) iyi ve 2 kalça (%8,3) orta olarak değerlendirildi. Asetabuler indeks ameliyat öncesi dönemde ortalama 38,75o iken ameliyat sonrası kontrol grafisinde ortalama 16,71oye azalmıştır. Reimerın lateral migrasyon indeksi ise ameliyat öncesi %85,04 iken ameliyat sonrası %12,22ye gerilemiştir. Kalamchi-McEwen kriterlerine göre 1 kalçada (%4,2) Tip II, 1 kalçada(%4,2) da Tip III avasküler nekroz tespit edildi. Sonuçlar: Pemberton periasetabular osteotomi gelişim- sel kalça displazili hastalarda düşük öğrenme eğrisi olan, etkili, güvenilir ve başarılı bir tedavi yöntemidir.

(Short term outcomes of pemberton pericapsular osteotomy in developmental dysplasia of the hip)

Background: To evaluate the short-term outcomes of the patients who received Pemberton Pericapsuler Osteotomy treatment, for developmental dysplasia of the hip (DDH). Material and Methods: Twenty patients (17 girls and 3 boys); mean age 29.67 months; (range 17-72 months) were treated with Pemberton pericapsuler osteotomy. Four patients had bilateral involvement. According to the Tönnis classification, 9 hips (37.5%) were classified as grade IV, 11 hips (45.8 %) were grade III, and 4 hips were grade II (16.7%). Three hips required one or more surgical procedures such as femoral shortening and derotational osteotomy concomitant with the Pemberton osteotomy to achieve a concentric and congruous reduction of the hip joint. Closed pemberton osteotomy (without opening the capsule) was performed in only 3 of 24 hips. Adductor tenotomy was performed in all patients. The acetabular index was measured on preoperative and postoperative pelvic radiographs. Lateral migration index (Reimer) was also evaluated. Clinical evaluation was made according to the McKay criteria, and avascular necrosis of the femoral head was evaluated using the Kalamchi-MacEwen criteria. Results: The mean follow-up was 53 months (12-145 months). According to the McKay criteria clinical results were excellent in 20 hips (83.3%), good in 2 hips (8.3%) and moderate in 2 hips (8.3%). The mean acetabular index decreased from 38.75° pre-operatively to 16.71° post-operatively. Lateral migration index has changed from preoperative 85% to 11%, postoperati- vely. According to the Kalamchi-MacEwen evaluation criteria, 1 hip was type II (4.2%) and 1 hip was type III (4.2%). Conclusions: Pemberton pericapsular osteotomy was found to be a safe, effective and successful treatment method with low education curve in short term follow-up of patients with DDH.

PDF

___

1. Tachdjian MO. Developmental Dysplasia of the hip. In: Herring JA, ed. Tachdjian's Pediatric Orthopedics [3 th ed.] Philidelphia: W.B. Saunders Company; 2002:513-709.
2. Bennet JT, McEwen GD. Congenital dislocation of hip. Recent advances and current problems. Clin Orthop Relat Res 1989;247:15-21.
3. Barlow TG. Early Diagnosis and Treatment of Congenital Dislocation of the Hip. J Bone Joint Surg Br 1962;44:292-301.
4. Coleman SS. Developmental dislocation of the hip. Evolutionary changes in diagnosis and treatment. J Pediatr Orthop 1994;14: 1-2.
5. Ortolani M. Congenital hip dysplasia in the light of early and very early diagnosis. Clin Orthop Relat Res 1976;119:6-10.
6. Catteral A. The early diagnosis of congenital dislocation of the hip. J Bone Joint Surg Br 1994;76:515-26.
7. Schuler P, Feltes E, Kienapfel H, Griss P. Ultrasound examination for the early determınatıon of dysplasia and congenital dislocation of neonatal hips. Clin Orthop Relat Res 1990;258:18-26.
8. Huang SC, Wang JH. A comparative study of nonoperative versus operative treatment for developmental dysplasia of the hip in patients of walking age. J Pediatr Orthop 1997;17:181-8.
9. Beaty J. Developmental dysplasia of the hip. In: Canale Tery S. ed. Campbells Operative Orthopaedics. [10 th ed.]. Philadelphia, Mosby;2003: 1079-123.
10. Wilson MG, Poss R. Diagnosis and Medical /Surgical Management in osteoaerthritis of hip In: Moskovitz RW, ed. Osteoarthritis of the hip. Philadelphia, WB Saunders Company; 1992:621-49.
11. Tokgözoğlu MN. Pemberton osteotomisi. In: Ege R, ed. Kalça Cerrahisi ve Sorunları Ankara: THK Basımevi; 1996:337-44.
12. McKay DW. A comparison of the innominate and the pericapsuler osteotomy in the treatment of congenital dislocation of the hip. Clin Orthop Relat Res 1974;98:124-32.
13. Severin E. Contribution to the knowledge of congenital Dislocation of the hip joint. Late results of closed reduction and artrographic studies of recent cases. Acta Chir Scandinavica 1941;84:63-71.
14. Kalamchi A, McEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1980;62:786-88.
15. Pemberton PA. Pericapsular osteotomy of the ilium for treatment of congenital subluxation and dislocation of the hip. J Bone Joint Surg Am 1965;47:65-86.
16. Pemberton PA. Pericapsular osteotomy of the ilium for the treatment of congenitally dislocated hips. Clin Orthop Relat Res 1974;98: 41-54.
17. Alanay A, Tokgözoğlu M, Aksoy C, Çil A, Yazıcı M, Tokgözoğlu N. Gelişimsel kalça displazisi tedavisinde pemberton osteotomisinin yeri: # minimum 10 yıllık takip sonuçları. XVII. Milli Türk Ortopedi ve Travmatoloji Kongre Kitabı;Ankara:Türkiye; 2001:311-4.
18. Hellinger J, Schmidt H. The pericapsular osteotomy of the os ilium in the treatment of flat acetabulum. Arch Orthop Trauma Surg 1982; 101:53-7.
19. Zorer G, Bagatur AE. Çift taraflı kalça displazisinde tek seansta çift taraflı pemberton perikapsüler osteotomisi. Acta Orthop Traumatol Turc 2002;36:288-94.
20. Gordon JE, Capelli AM, Strecker WB, Delgado ED, Schoenecker PL. Pemberton pelvic osteotomy and varus rotational osteotomy in the treatment of acetabular dysplasia in patients who have static encephalopathy. J Bone Joint Surg Am 1996;78:1863-71.
21. Hamzaoglu A, Esenkaya ø, Durmaz H, Aşik M, Aritamur A. øleri yaştaki doğuştan kalça çıkığının açık redüksiyon, kısaltma, derotasyon, varizasyon ve pemberton asetabuloplastisi ile cerrahi tedavisi. Acta Orthop Traumatol Turc 1990;24:9-12
22. Shea KG, Coleman SS, Carroll K, Stevens P, Boerum DHV. Pemberton pericapsular osteotomy to treat a dysplastic hip in cerebral palsy. J Bone Joint Surg Am 1997;79:1342-51.
23. Faciszewski T, Kiefer G, Coleman SS. Pemberton osteotomy for residual acetabular dysplasia in children who have congenital dislocation of the hip. J Bone Joint Surg Am 1993;75:643-9.
24. Zorer G, Sürel B, Karlı MÜ, Savran K. DKÇ Tedavisinde salter ve pemberton ameliyatlarının asetabuler deformasyonu düzeltme etkinliklerinin karşılaştırılması. XII. Milli Türk Ortopedi ve Travmatoloji Kongre Kitabı; Ankara:Türkiye; 1992:374-9.
25. Kessler JI, Stevens PM, Smith JT, Carroll KL. Use of Allografts in Pemberton Osteotomies. J Pediatr Orthop 2001;21:468-73.
26. Wada A, Fujii T, Takamura K. Pemberton osteotomy for developmental dysplasia of the hip in older children. J Pediatr Orthop 2003; 23:508-13.
27. Weinstein SL. Developmental hip dysplasia and dislocation. In Morrissy R, Weinstein SL. ed. Lovell and Winters Pediatric Orthopaedics. [4th ed.] Philedelphia: Lipincot-Raven; 1996:903-50.
28. Coleman SS. The subluxating or wandering femoral head in developmental dislocation of the hip. J Pediatr Orthop 1995;15:785-8.
29. Slomczykowski M, Mackenzie WG, Stern G, Keller KA, Glutting J. Acetabular volume. J Pediatr Orthop 1998;18:657-61.
30. Bagatur AE, Zorer G, Sürel YB. Pemberton perikapsüler osteotomisinde femur başının örtünmesi yeterli oluyor mu? Üç boyutlu bilgisayarlı tomografi rekonstrüksiyonu ile değerlendirme. Acta Orthop Traumatol Turc 2002;36:203-10.
31. Cummings RJ. How the pemberton innominate osteotomy really works: an animal study. J Surg Orthop Adv 2004;13:166-9.