Patwardhan Sandeep, Madegowda Arkesh, Sancheti Parag
Department of Paediatric Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra India.
Indian J Orthop. 2021 Sep 22;55(6):1583-1590. doi: 10.1007/s43465-021-00527-x. eCollection 2021 Dec.
The growth and development of the acetabulum in children with developmental dysplasia of hip (DDH) depends upon the extent of concentric reduction. Children in walking age often need open reduction with or without additional osteotomies to obtain congruous, stable reduction. The purpose of this study was to evaluate acetabular development in late diagnosed DDH treated by open reduction with or without femoral osteotomy.
This is a retrospective study of 29 children (40 hips) with idiopathic DDH, previously untreated managed by open reduction with or without femoral osteotomy. We analyzed preoperative and yearly postoperative radiographs up to 6 years of age for acetabular development by measuring acetabular index. Acetabular remodeling was assessed with a graphical plot of serial mean acetabular index. Those with AI < 30° at outcome measure point of 6 years of patient age were considered to have satisfactory acetabular remodeling.
Mean age of surgery was 26.8 months. Open reduction alone was done in 14 hips and open reduction with concurrent femoral osteotomy done in 26 hips. The mean acetabular index pre operatively was 36.6° ± 5.9° which reduced to 29.7° ± 6° at 1-year follow-up and to 26.6° ± 5.9° at 2-year follow-up. 28 out of 40 hips were available for evaluation at outcome measure point of 6 years of age, which showed satisfactory remodeling in 24 hips with mean AI of 22.7° ± 5.7°. Maximum acetabular development was seen at 2 years post-surgery and better remodeling was seen in children operated at less than 2 years of age. 5 hips had changes of avascular necrosis of femoral head. There was no incidence of redislocation/subluxation at latest follow-up.
Open reduction in late-diagnosed developmental dysplasia of hip has potential for favourable acetabular development. Femoral osteotomy when required along with open reduction may suffice to address acetabular dysplasia found in the initial years of management of DDH.
发育性髋关节发育不良（DDH）患儿髋臼的生长发育取决于同心圆复位的程度。学步期儿童通常需要切开复位，可伴有或不伴有附加截骨术，以实现一致、稳定的复位。本研究的目的是评估晚期诊断的DDH患儿经切开复位（伴或不伴股骨截骨术）治疗后的髋臼发育情况。
这是一项对29例（40髋）特发性DDH患儿的回顾性研究，这些患儿此前未经治疗，采用切开复位伴或不伴股骨截骨术进行处理。我们通过测量髋臼指数，分析术前及术后每年直至6岁时的X线片以评估髋臼发育情况。通过绘制连续平均髋臼指数的图表来评估髋臼重塑情况。在患儿6岁的结局测量点时，髋臼指数（AI）<30°的患儿被认为髋臼重塑满意。
手术平均年龄为26.8个月。14髋仅行切开复位，26髋行切开复位同时行股骨截骨术。术前平均髋臼指数为36.6°±5.9°，1年随访时降至29.7°±6°，2年随访时降至26.6°±5.9°。40髋中有28髋在患儿6岁的结局测量点时可供评估，其中24髋显示重塑满意，平均AI为22.7°±5.7°。髋臼发育在术后2年时最大，2岁以下接受手术的患儿重塑效果更好。5髋出现股骨头缺血性坏死改变。在最新随访时无再脱位/半脱位发生。
晚期诊断的发育性髋关节发育不良切开复位有实现良好髋臼发育的潜力。在DDH治疗的最初几年，必要时与切开复位同时进行的股骨截骨术可能足以解决髋臼发育不良问题。
