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 3’üne 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 16,71o‘ye azalmıştır. Reimer’ın lateral migrasyon indeksi ise ameliyat öncesi %85,04 iken ameliyat sonrası %12,22’ye 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.

Kaynakça

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