Department of Orthopedics and Traumatology, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital,University of Health Sciences, Ankara, Turkiye.
Turk J Med Sci. 2024 Jul 12;54(5):1060-1070. doi: 10.55730/1300-0144.5885. eCollection 2024.
BACKGROUND/AIM: This study aimed to compare the results of Pemberton osteotomy (PO), Salter innominate osteotomy (SO), open reduction (OR), and closed reduction (CR) applied in the treatment of developmental dysplasia of the hip (DDH).
Included in the study were 101 hips of 82 patients treated at our orthopedic clinic between 2017 and 2023. The patients were evaluated preoperatively, postoperatively, and at the final follow-up. The results were evaluated based on Barret's clinical and Severin's radiological classifications. Those who developed avascular necrosis (AVN) were evaluated based on Bucholz-Ogden's classification.
In terms of the preoperative acetabular angles (AAs), those for hips treated with PO were significantly higher than those of the other three, and those treated with SO were significantly higher than those of the other two (OR and CR) (p < 0.001). There was a significant difference in the final follow-up AAs of those treated with SO and PO compared to those treated with OR and CR (p < 0.001). The best corrections were achieved with PO (average: 27.94 ± 4.89°). There was a significant difference between PO and OR, and PO and CR in terms of the preoperative collodiaphyseal angles (CDAs) (p < 0.05). The greatest decrease was in those treated with PO (average: 22.44 ± 9.45°). AVN developed at various stages in 15 of 79 hips (14.85%) that were treated surgically. While AVN developed at a rate of 22.22% with PO, 18.18% with SO, and 17.85% with OR, no AVN developed in the 22 hips treated with CR.
Understanding normal and abnormal values by age is essential for selecting appropriate treatments. Acetabulum-related surgeries should be planned for patients over 1.5 years of age with an AA above 30°. Early diagnosis and CR treatments yield excellent results and low AVN rates. Various DDH treatments in our clinic have shown low AVN rates, indicating safety and efficacy.
背景/目的：本研究旨在比较 Pemberton 截骨术（PO）、Salter 骨盆截骨术（SO）、切开复位（OR）和闭合复位（CR）治疗发育性髋关节发育不良（DDH）的结果。
纳入了 2017 年至 2023 年期间在我院骨科门诊治疗的 82 例 101 髋 DDH 患者。对患者进行术前、术后和最终随访评估。根据 Barret 临床和 Severin 放射学分类评估结果。对发生缺血性坏死（AVN）的患者，根据 Bucholz-Ogden 分类进行评估。
术前髋臼角（AA）方面，PO 治疗组明显高于其他三组，SO 治疗组明显高于其他两组（OR 和 CR）（p<0.001）。SO 和 PO 治疗组与 OR 和 CR 治疗组在最终随访时 AA 有显著差异（p<0.001）。PO 治疗组的矫正效果最好（平均：27.94±4.89°）。PO 与 OR、PO 与 CR 在术前骺干角（CDA）方面有显著差异（p<0.05）。PO 治疗组下降幅度最大（平均：22.44±9.45°）。79 髋中有 15 髋（14.85%）接受手术治疗后出现不同阶段的 AVN。PO 治疗组的 AVN 发生率为 22.22%，SO 治疗组为 18.18%，OR 治疗组为 17.85%，而 22 髋接受 CR 治疗的髋无一例发生 AVN。
了解按年龄划分的正常和异常值对于选择合适的治疗方法至关重要。对于 AA 大于 30°、年龄超过 1.5 岁的患者，应计划进行髋臼相关手术。早期诊断和 CR 治疗可获得良好的效果和较低的 AVN 发生率。本诊所的各种 DDH 治疗方法均显示出较低的 AVN 发生率，表明其安全有效。
