Center of Orthopaedic and Trauma Surgery/Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany.
World J Pediatr. 2018 Apr;14(2):176-183. doi: 10.1007/s12519-017-0105-7. Epub 2018 Feb 20.
Most orthopedic surgeons prefer spica cast immobilization in children for 4 to 12 weeks after surgical hip reconstruction in children with developmental hip dysplasia. This challenging treatment may be associated with complications. Studies are lacking that focus on early mobilization without casting for postoperative care after hip reconstruction.
Twenty-seven children (3.4±2.0 years), including 33 hips with developmental hip dysplasia (DDH) and dislocation of the hip (Tönnis grade 1 to 4), who underwent hip reconstruction (Dega acetabuloplasty, varisation-derotation osteotomy and facultative open reduction) were retrospectively included in this study. Postoperatively the patients were placed in an individual foam shell with 30 degrees of hip abduction, hip extension, and neutral rotation. Early mobilization physiotherapy was performed within the first few days after the surgery under epidural anaesthesia. Full weight bearing was allowed after 3-4 weeks. All children received a clinical examination and radiographic evaluation before and after surgical intervention. The follow-up period was 12.3±2.9 months.
On average, the postoperative acetabular index decreased significantly from 36.9 to 21.7 degrees and the center-edge angle increased from 9.9 to 28.6 degrees. All hips had reached Tönnis grade 1 at the time of the last follow-up. No complications such as dislocation of the bone wedge, avascular necrosis of the acetabulum or femur, lack of non-union, or nerve injury, were reported.
In this cohort study, hip reconstruction was successful according to clinical and radiographic outcome parameters after early mobilization without cast therapy. Early mobilization may be used as an alternative treatment option after hip reconstruction in DDH.
大多数骨科医生在儿童发育性髋关节发育不良（DDH）手术后，喜欢在手术后 4 至 12 周内使用管型石膏固定髋关节。这种具有挑战性的治疗方法可能会引起并发症。目前缺乏针对髋关节重建术后不使用石膏固定而早期活动的研究。
本研究回顾性纳入了 27 例（3.4±2.0 岁）儿童（33 髋），其中包括 DDH 和髋关节脱位（Tönnis 1 至 4 级），这些儿童均接受了髋关节重建术（Dega 髋臼成形术、旋转截骨术和选择性切开复位）。术后，患者采用个体化泡沫壳固定，髋关节外展 30°、伸展和中立位旋转。术后数天在硬膜外麻醉下进行早期主动活动物理治疗。术后 3-4 周后允许完全负重。所有儿童均在手术前后接受临床检查和影像学评估。随访时间为 12.3±2.9 个月。
平均而言，术后髋臼指数从 36.9°显著降低至 21.7°，中心边缘角从 9.9°增加至 28.6°。末次随访时所有髋关节均达到 Tönnis 1 级。未报告任何并发症，如骨楔脱位、髋臼或股骨缺血性坏死、骨不连或神经损伤。
在本队列研究中，根据临床和影像学结果参数，早期活动而不使用石膏治疗的髋关节重建是成功的。早期活动可能是 DDH 髋关节重建术后的一种替代治疗选择。
