Ozkut Afsar T, Iyetin Yusuf, Unal Omer K, Soylemez M Salih, Uygur Esat, Esenkaya Irfan
Goztepe Research and Training Hospital, Orthopedics and Traumatology, Istanbul, Turkey.
Pendik Regional Hospital, Orthopedics and Traumatology, Istanbul, Turkey.
Acta Orthop Traumatol Turc. 2018 Mar;52(2):81-86. doi: 10.1016/j.aott.2018.01.006. Epub 2018 Feb 15.
To evaluate the midterm clinical and radiological outcomes of the medial approach using two intervals for developmental hip dysplasia (DDH).
The study involved 62 hips of 47 patients (41 girls, 6 boys) treated with medial approach for DDH from 1999 to 2010. The age of the patients at surgery was 18.7 ± 2.25 months. Follow up of the patients was 11.3 ± 3.07 years. The age of the patients at the last follow up was 12.6 ± 1.74 years. According to the Tönnis classification, 13 hips were grade II, 27 hips were grade III and 22 hips were grade IV. Patients were evaluated according to Omeroglu radiological criteria and modified McKay functional criteria. The presence of avascular necrosis (AVN) of the hip was questioned using the KalamchiMacEwen classification.
Radiologically, forty eight (77%) hips were evaluated as "excellent", 8 (13%) hips as "good" and 5 (8%) hips as "fair plus" and 1 (%2) hip as "fair minus". Two (3%) patients had type 1 temporary AVN and one (1%) patient had type 4 AVN with coxa magna and overgrowth of the greater trochanter. According to McKay functional criteria, 56 (90%) hips had "excellent" and 6 (10%) had "good" results. Two (3.2%) hips of one patient had to be reoperated with Salter osteotomy and femoral shortening + derotation osteotomy.
Medial approach using two separate intervals for tenotomy and capsulotomy does not jeopardize the medial circumflex or the femoral vessels and yields satisfactory midterm results for children 18 months old with dysplasia of the hip.
Level IV, therapeutic study.
评估采用两种不同间隙的内侧入路治疗发育性髋关节发育不良（DDH）的中期临床和影像学结果。
本研究纳入了1999年至2010年间采用内侧入路治疗DDH的47例患者（41例女孩，6例男孩）的62个髋关节。手术时患者年龄为18.7±2.25个月。患者随访时间为11.3±3.07年。末次随访时患者年龄为12.6±1.74岁。根据Tönnis分类，13个髋关节为Ⅱ级，27个髋关节为Ⅲ级，22个髋关节为Ⅳ级。根据Omeroglu影像学标准和改良McKay功能标准对患者进行评估。采用Kalamchi-MacEwen分类法评估髋关节有无缺血性坏死（AVN）。
影像学上，48个（77%）髋关节评估为“优秀”，8个（13%）髋关节为“良好”，5个（8%）髋关节为“中等偏上”，1个（2%）髋关节为“中等偏下”。2例（3%）患者出现1型暂时性AVN，1例（1%）患者出现4型AVN，伴有髋部增大和大转子过度生长。根据McKay功能标准，56个（90%）髋关节结果为“优秀”，6个（10%）为“良好”。1例患者的2个（3.2%）髋关节不得不再次手术，采用Salter截骨术和股骨缩短+旋转截骨术。
采用两种不同间隙进行肌腱切断术和关节囊切开术的内侧入路不会危及旋股内侧血管或股血管，对于18个月大的髋关节发育不良患儿可产生满意的中期结果。
Ⅳ级，治疗性研究。
