Karlen Judson W, Skaggs David L, Ramachandran Manoj, Kay Robert M
Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
J Pediatr Orthop. 2009 Oct-Nov;29(7):676-82. doi: 10.1097/BPO.0b013e3181b7691a.
The purpose of this study is to evaluate the use of the Dega osteotomy in the treatment of hip pathology resulting from both developmental dysplasia (DDH) and neuromuscular disease (NM).
We retrospectively reviewed the results of one surgeon's operative experience with the Dega osteotomy for the treatment of DDH and NM. Forty-four patients (50 hips) with an average length of follow-up of 53 months were identified. The Dega was customized at the time of surgery to provide more anterior or posterior coverage depending on the needs of the individual hip.
In all cases, there were no intraoperative complications and all hips were well reduced postoperatively. In the DDH group, there were 22 children (26 hips), who underwent surgery at a mean age of 3.1 years. Thirteen hips had a concomitant open reduction and 4 had a femoral osteotomy. There were 5 complications: 2 femoral head lateralizations, 2 avascular necroses (asymptomatic), and 1 traumatic dislocation. One patient (1 hip) had a reoperation. All patients had unlimited physical activity with no limp with an improvement in the acetabular index from 37 degrees preoperatively to 13 degrees at last follow-up. In the NM group, there were 22 children (24 hips), who underwent surgery at a mean age of 6.3 years. Twenty-three hips had concomitant procedures performed. At an average of 56 months postoperatively, all patients were pain-free. There were 5 complications: 1 graft dislodgement, 1 graft collapse, and 3 femoral head lateralizations. Three patients (3 hips) had a reoperation. Acetabular index improved from 36 degrees preoperatively to 14 degrees, and the migration percentage ranged from 84% to 14%.
In this series of Dega osteotomies, one of the largest in the English literature, the osteotomy seems safe and effective in the treatment of both DDH and NM hip disease. The Dega osteotomy is utilitarian, as it may provide increased acetabular coverage anteriorly or posteriorly depending on where it is hinged.
Therapeutic study, clinical case series: level IV.
本研究的目的是评估戴加截骨术在治疗发育性髋关节发育不良（DDH）和神经肌肉疾病（NM）所致髋关节病变中的应用。
我们回顾性分析了一位外科医生使用戴加截骨术治疗DDH和NM的手术经验结果。确定了44例患者（50髋），平均随访时间为53个月。戴加截骨术在手术时进行定制，根据个体髋关节的需要提供更多的前方或后方覆盖。
所有病例均无术中并发症，所有髋关节术后复位良好。在DDH组中，有22名儿童（26髋），平均手术年龄为3.1岁。13髋同时进行了切开复位，4髋进行了股骨截骨术。有5例并发症：2例股骨头外移、2例无症状性缺血性坏死和1例创伤性脱位。1例患者（1髋）进行了再次手术。所有患者体力活动不受限，无跛行，髋臼指数从术前的37°改善至末次随访时的13°。在NM组中，有22名儿童（24髋），平均手术年龄为6.3岁。23髋同时进行了其他手术。术后平均56个月时，所有患者均无疼痛。有5例并发症：1例移植物移位、1例移植物塌陷和3例股骨头外移。3例患者（3髋）进行了再次手术。髋臼指数从术前的36°改善至14°，移位百分比从84%降至14%。
在这一系列戴加截骨术中，是英文文献中规模最大的之一，该截骨术在治疗DDH和NM髋关节疾病方面似乎安全有效。戴加截骨术很实用，因为根据其铰链位置，它可以增加髋臼前方或后方的覆盖。
治疗性研究，临床病例系列：IV级。
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