Vatsyan K C, Rangasamy K, Gopinathan N R, Sudesh P, Shinha A, Salaria A K
Department of Orthopaedics, Shri Lal Bahadur Shastri Government Medical College and Hospital, Mandi, India.
Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Malays Orthop J. 2025 Mar;19(1):77-85. doi: 10.5704/MOJ.2503.010.
MRI having the multiplanar capability is a good choice for pre-operative planning in developmental dysplasia of hip (DDH). Although few previous studies utilised MRI to quantify dysplasia, predict outcomes, and the procedure required, there are no defined pre-operative conclusive criteria on when to do Salter's osteotomy?
A prospective cohort study was conducted in unilateral idiopathic DDH cases those who underwent an open reduction in the age group of one to four years. Pre- and post-operative MRI was done to assess various acetabular and femoral parameters. Intra-operatively, osteotomy was planned. Based on stability assessment given by Zadeh Clinical follow-up assessment was done at three- and six-month post-op. Functional assessment using Modified McKay's criteria was done at six months follow-up.
Out of 15 cases, seven children underwent only open reduction (OR), whereas eight underwent OR with Salter's osteotomy. Based on pre-op acetabular index and anteversion, Salter's osteotomy should be done in 14 out of 15 cases, but intra-operative stability test precluded Salter's in 6 cases. Post-operative anterior sectoral angle and femoral head coverage percentage were better in OR with Salter's group than OR-only group, but not statistically significant. Functional assessment at final follow-up showed all OR with Salter's group cases were Grade I, whereas in OR-only group, 4 were Grade I and 3 were Grade II.
Three-dimensional dynamic assessment using intra-operative stability test predicts the best possible interrelation between the articular surface of the femoral head and acetabulum and the need for osteotomy rather than preoperative MRI.
具有多平面成像能力的MRI是发育性髋关节发育不良（DDH）术前规划的良好选择。尽管此前很少有研究利用MRI来量化发育不良、预测结果以及所需的手术，但对于何时进行Salter截骨术尚无明确的术前决定性标准。
对年龄在1至4岁接受切开复位的单侧特发性DDH病例进行前瞻性队列研究。术前行MRI检查以评估髋臼和股骨的各项参数。术中规划截骨术。根据Zadeh给出的稳定性评估结果，术后3个月和6个月进行临床随访评估。术后6个月采用改良麦凯标准进行功能评估。
15例病例中，7例儿童仅接受了切开复位（OR），而8例接受了切开复位加Salter截骨术。根据术前髋臼指数和前倾角度，15例中有14例应行Salter截骨术，但术中稳定性测试排除了6例。切开复位加Salter截骨术组术后前扇形角和股骨头覆盖百分比优于单纯切开复位组，但差异无统计学意义。最终随访的功能评估显示，切开复位加Salter截骨术组所有病例均为I级，而单纯切开复位组中，4例为I级，3例为II级。
术中稳定性测试的三维动态评估可预测股骨头与髋臼关节面之间的最佳相互关系以及截骨术的必要性，而非术前MRI。
