Biçimoğlu Ali, Ağuş Haluk, Omeroğlu Hakan, Tümer Yücel
3rd Clinics of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
Clin Orthop Relat Res. 2008 Apr;466(4):847-55. doi: 10.1007/s11999-008-0127-5. Epub 2008 Feb 21.
We questioned whether our modified soft tissue surgical procedure can provide acceptable results with lower complication rates in developmental dysplasia of the hip (DDH). We retrospectively reviewed 143 patients (185 hips) with a mean age of 11.6 months at operation and a minimum followup of 5 years (mean, 7.5 years; range, 5-13 years). We used a posteromedial approach and sectioned the adductor longus and iliopsoas tendons. If we achieved an arthrographically documented anatomic reduction we closed the incisions; if not, we made an arthrotomy to obtain an anatomic reduction through the same incision at the same session. A hip score indicating an acceptable outcome was obtained in 168 hips (90.8%). We identified osteonecrosis of the femoral head (ON) in 36 (19.5%) hips and redislocation in four (2.2%). Both the ossific nucleus and physis were affected in 10 of the 36 hips with ON. We performed secondary operations in 12 hips (6.5%). Hips of the infants after walking age and hips with higher preoperative dislocation grades, acetabular indices, and ON were more prone to having lower hip scores. Based on the data, we believe routine arthrotomy is not needed during posteromedial surgery in DDH and this modified procedure was safe and effective.
Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
我们质疑我们改良的软组织手术方法在发育性髋关节发育不良（DDH）中能否以较低的并发症发生率提供可接受的结果。我们回顾性分析了143例患者（185髋），手术时平均年龄为11.6个月，最短随访5年（平均7.5年；范围5 - 13年）。我们采用后内侧入路，切断内收长肌和髂腰肌肌腱。如果通过关节造影证实实现了解剖复位，我们就关闭切口；如果没有，则在同一次手术中通过同一切口进行关节切开术以获得解剖复位。168髋（90.8%）获得了表明结果可接受的髋关节评分。我们在36髋（19.5%）中发现了股骨头坏死（ON），4髋（2.2%）出现再脱位。在36例发生ON的髋关节中，有10例的骨化核和生长板均受到影响。我们对12髋（6.5%）进行了二次手术。学步期后婴儿的髋关节以及术前脱位程度、髋臼指数和ON较高的髋关节更容易获得较低的髋关节评分。基于这些数据，我们认为在DDH的后内侧手术中无需常规进行关节切开术，这种改良手术方法是安全有效的。
II级，预后研究。有关证据水平的完整描述，请参阅作者指南。
