Aly Ahmad S, Al-Kersh Mohamed A
Department of Orthopaedic Surgery, Ain Shams University, Cairo, Egypt.
J Child Orthop. 2018 Jun 1;12(3):227-231. doi: 10.1302/1863-2548.12.170130.
The purpose of this case series study is to report on the intermediate-term outcomes following a femoral varus derotational osteotomy (FVDO) performed in conjunction with a Dega osteotomy (DO) in management of hip -instability in Down syndrome (DS) patients.
Ten hips in seven children with DS suffering from hip dislocation were included. All patients included in this study had hip dislocation in the habitual phase and painless mobile hip to full abduction. All patients were firstly subjected to FVDO. An additional DO was added if intraoperative assessment demonstrated posterior instability. The mean age at time of surgery was 5.6 years (3 to 7). There were three male and four female patients. All patients were followed up after two years with a mean follow-up of 3.27 years (2 to 5). All operations were performed by the first author.
There was improvement of neck shaft angles (130° to 175°, median = 160° preoperatively, to 120° to 140°, median =130° postoperatively). The Shenton line was restored in all our cases. There was also improved percentage of the femoral head uncovered by the lateral wall of the acetabulum (25° to 100° with median = 45° preoperatively, to 0° to 15° with median = 5° postoperatively) and improved posterior acetabular coverage, which was assessed by CT.
FVDO combined with DO without -capsulorrhaphy is efficient in the management of hip instability in DS, as it corrects hip biomechanics and increases posterior acetabular coverage.
IV - retrospective case series.
本病例系列研究旨在报告在唐氏综合征（DS）患者髋关节不稳定的治疗中，股骨内翻旋转截骨术（FVDO）联合德加截骨术（DO）后的中期结果。
纳入7例患有髋关节脱位的DS患儿的10个髋关节。本研究纳入的所有患者均处于习惯性髋关节脱位阶段，髋关节无痛且可完全外展。所有患者均首先接受FVDO。如果术中评估显示后方不稳定，则增加额外的DO。手术时的平均年龄为5.6岁（3至7岁）。有3例男性患者和4例女性患者。所有患者在术后两年进行随访，平均随访3.27年（2至5年）。所有手术均由第一作者完成。
颈干角有所改善（术前为130°至175°，中位数=160°，术后为120°至140°，中位数=130°）。所有病例的Shenton线均恢复正常。髋臼外侧壁未覆盖股骨头的百分比也有所改善（术前为25°至100°，中位数=45°，术后为0°至15°，中位数=5°），并且通过CT评估发现髋臼后方覆盖情况得到改善。
FVDO联合DO且不进行关节囊缝合术在DS患者髋关节不稳定的治疗中是有效的，因为它可纠正髋关节生物力学并增加髋臼后方覆盖。
IV级——回顾性病例系列。
