Umer Masood, Nawaz Haq, Kasi Pashtoon Murtaza, Ahmed Mahmood, Ali Syed Sohail
Department of Surgery, The Aga University, Medical College, Karachi.
J Pak Med Assoc. 2007 Dec;57(12):591-5.
To evaluate the radiographic and functional results of the triple procedure (open reduction, femoral shortening and Salter's Osteotomy) in the treatment of Developmental Dysplasia of the Hip (DDH) disease in older children.
This case-series comprising 23 patients (29 hips) underwent the triple procedure of open reduction, femoral shortening and Salter osteotomy, at Aga Khan University Hospital between June 1995 and June 2005. Patients were classified pre-operatively according to the Tonnis class. Postoperative functional evaluation was performed using Modified MacKay's scoring system and radiographic assessment using Severin's scoring method.
The mean age of patients at presentation was 6.84 years and the average follow-up was 19.6 months. The MacKay score was 'Good' to 'Excellent' in 25 hips; we had a failure in 1 hip joint. The Severin's class was I in 15 (51.7%) hips at the time of final evaluation as compared to none at the time of presentation. Patients younger than 5.6 years of age had a better radiological and clinical outcome as compared to older patients (p-value < 0.05).
The triple procedure of open reduction, femoral shortening and Salter osteotomy gives best results in younger children. Early diagnosis and intervention is therefore imperative in the successful treatment of patients suffering from DDH.
评估三联手术（切开复位、股骨缩短及萨尔特截骨术）治疗大龄儿童发育性髋关节发育不良（DDH）的影像学及功能结果。
本病例系列研究纳入了1995年6月至2005年6月期间在阿迦汗大学医院接受切开复位、股骨缩短及萨尔特截骨术三联手术的23例患者（29髋）。术前根据托尼尼斯分级对患者进行分类。术后采用改良麦凯评分系统进行功能评估，采用塞韦林评分法进行影像学评估。
患者就诊时的平均年龄为6.84岁，平均随访时间为19.6个月。25髋的麦凯评分为“良好”至“优秀”；1个髋关节手术失败。最终评估时，15髋（51.7%）的塞韦林分级为I级，而就诊时无一例为此分级。与大龄患者相比，年龄小于5.6岁的患者影像学及临床结果更佳（p值<0.05）。
切开复位、股骨缩短及萨尔特截骨术三联手术在低龄儿童中效果最佳。因此，对于DDH患者的成功治疗，早期诊断和干预至关重要。
