Reichel H, Hein W
Orthopaedic Clinic of Martin-Luther the University Halle-Wittenberg, Germany.
Clin Orthop Relat Res. 1996 Feb(323):234-42. doi: 10.1097/00003086-199602000-00032.
Between 1973 and 1984, 70 modified Dega acetabuloplasties done simultaneously with intertrochanteric osteotomies in 51 patients with developmental dysplasia of the hip were reviewed for long-term results and analyzed for causes of failure. Mean patient age at operation was 2.9 years (range, 8 months-8 years), and mean followup time was 15.2 years (range, 10-19 years). Topical investigations were based on clinical criteria of the Severin classification and radiologic criteria of the Commission for the Study of Hip Dysplasia of the German Society of Orthopaedics and Traumatology. The review of clinical documents and investigations very good and good results in 80% of the hips. The Trendelenburg sign was a useful clinical indicator for problematic cases. Measurements on radiographs were classified into deviation grades from the normal range. Values of the acetabulum and the acetabulum to head relation were normal or slightly abnormal in >80% of hips. Measurements of the femoral head and neck were in the low normal range. The lowest percentage of normal values was in 24 cases with coxa valga after acetabuloplasty combined with derotational varus osteotomy. Poor clinical and radiologic outcome usually was the result of avascular necrosis of the femoral head or recurring valgus deformity after derotational varus osteotomy. The rate of avascular necrosis as a consequence of the operation was 5.7%. The risk of avascular necrosis caused by derotational varus osteotomy is lower than the risk of later development of deformities in the proximal femur.
1973年至1984年间，对51例发育性髋关节发育不良患者同时进行的70例改良德加髋臼成形术及转子间截骨术的长期结果进行了回顾，并分析了失败原因。手术时患者的平均年龄为2.9岁（范围8个月至8岁），平均随访时间为15.2年（范围10至19年）。局部检查基于Severin分类的临床标准以及德国骨科与创伤学会髋关节发育不良研究委员会的放射学标准。对临床资料和检查的回顾显示，80%的髋关节结果为非常好和良好。Trendelenburg征是判断问题病例的有用临床指标。X线片测量结果被分类为与正常范围的偏差等级。超过80%的髋关节髋臼及髋臼与股骨头关系的值正常或略异常。股骨头和颈部的测量值处于正常低限范围。髋臼成形术联合去旋转内翻截骨术后出现髋外翻的24例中正常值的比例最低。临床和放射学结果不佳通常是股骨头缺血性坏死或去旋转内翻截骨术后复发性外翻畸形的结果。手术导致的缺血性坏死发生率为5.7%。去旋转内翻截骨术引起缺血性坏死的风险低于股骨近端后期出现畸形的风险。
