Ludloff Medial Açık Redüksiyon Uygulanan Gelişimsel Kalça Displazili Hastaların Klinik Ve Radyolojik Sonuçları

Year 2022, Volume: 6 Issue: 1, 100 - 106, 27.03.2022

Sedat Demir , Baki Volkan Çetin , Ahmet Yiğit Kaptan , Emrah Vatansever , Mehmet Ok , Mehmet Akif Altay

https://doi.org/10.30565/medalanya.940443

Abstract

 Amaç: Bu çalışmanın amacı, 18 aylıktan küçük, gelişimsel kalça displazisi olan hastalarda Ludloff medial açık redüksiyon cerrahisinin klinik ve radyolojik sonuçlarını değerlendirmektir.

Yöntem: 2013-2020 yılları arasında GKD nedeniyle Ludloff medial yaklaşımı ile tedavi edilen 18 aylıktan küçük 35 hastanın (49 kalça) radyolojik ve klinik sonuçları retrospektif olarak değerlendirildi. Ameliyat öncesi, son kontrol asetabular indeks açıları ve medial açıklıklar McCay kriterlerine göre ölçüldü, Tonnis sınıflaması, Kalamchi-MacEwen sınıflaması, IHDI sınıflaması ve Severin sınıflaması analiz edildi.

Bulgular: Son kontrolde en genç 27 ay, en yaşlı 88 ay ve ortalama yaş 43.90 ± 14.17 ay idi. Takip süresi minimum 12 ay, maksimum yaş 72 ay ve ortalama takip süresi 24.81 ± 17.17 ay idi. Tönnis sınıflamasına göre 40 kalça Tönnis sınıflama tip 1 (%81,63), 4 kalça Tip 2 (%8,16), 3 kalça Tip 3 (%6,12) ve 2 kalça Tip 4 (%4,08) idi. McCay klinik değerlendirme kriterlerine göre 38 kalça (%79.59) derece 1 idi ve bu da mükemmel sonuçlara tekabül ediyordu. Kalamchi ve MacEwen AVN klinik değerlendirme kriterlerine göre 49 kalçanın 38'inde (%77,55) derece 0 (nekroz yok) saptandı. Severin sınıflamasına göre; 49 kalçanın 32'sinde (%65.31) tip 1, 9 kalçada tip 2 (%18.37), 1 kalçada tip 3 (%2.04) ve 7 kalçada tip 4 (%14.29) tespit edildi. Ortalama CE açısı 18,56 ± 9,93 olarak bulundu. 6 hastanın 8 kalçasına ek cerrahi müdahale gerekti.

Sonuç: Ludloff medial açık redüksiyon tekniği ile 18 aydan küçük GKD hastalarında klinik ve radyolojik olarak tatmin edici sonuçlar elde edildi.

Keywords

Gelişimsel Kalça Displazisi, Açık Redüksiyon, avascular necrosis.

Clinical And Radiological Results Of Ludloff Medial Open Reduction Technique In Patients Wıth Developmental Hip Dysplasia

Abstract

Aim: The aim of this study was to evaluate the clinical and radiological results of Ludloff medial open reduction surgery in patients with the developmental of hip dysplasia, younger than 18 months old.

Methods: The radiological and clinical results of 35 patients (49 hips), younger than 18 months of age treated with Ludloff medial approach due to DDH between the years 2013 and 2020 were retrospectively evaluated. Preoperative, final control acetabular index angles and medial apertures were measured according to the McCay criteria, Tönnis classification, Kalamchi-MacEwen classification, IHDI classification and Severin classification were analysed.

Results: At the last control, the youngest age was 27 months, the oldest was 88 months and the mean age was 43.90 ± 14.17 months. The follow-up period was performed at a minimum age of 12 months, a maximum age of 72 months, and the mean follow-up period was 24.81 ± 17.17 months. According to the Tönnis classification, 40 hips were Tönnis classification type 1 (81.63%), 4 hips were Type 2 (8.16%), 3 hips were Type 3 (6.12%) and 2 hips were Type 4 (4.08%) in the follow-up visit. According to McCay clinical evaluation criteria, 38 hips (79.59%) were grade 1 which equates to excellent results. Grade 0 (no necrosis) was detected in 38 (77.55%) of 49 hips according to the Kalamchi and MacEwen AVN clinical evaluation criteria. According to the Severin classification, type 1 results were observed in 32 (65.31%) of 49 hips, type 2 in 9 hips (18.37%), type 3 in 1 hip (2.04%) and type 4 in 7 hips (14.29%). The mean CE angle was found to be 18.56 ± 9.93. Additional surgical intervention was required in 8 hips of 6 patients.

Conclusion: Clinically and radiologically satisfactory results were obtained in DDH patients with Ludloff medial open reduction technique, below the age of 18 months.

Keywords

open reduction, Developmental hip dysplasia, avascular necrosis.

References

• 1. Yorgancıgil H, Aslan A, Demirci D, Atay T. Effect of Age and Surgical Procedure on Clinical and Radiological Outcomes in Children with Developmental Dysplasia of the Hip: A Comparative Study. J Acad Res Med 2016;6:177-182. Doi: 10.5152/jarem.2016.1024
• 2. Ertürk C., Büyükdoğan H. Etiology and Diagnosis in Developmental Hip Dysplasia (I), İKSSTD, 2019;11(2):61-9. DOI: 10.5222/iksstd.2019.20982.
• 3. Tümer Y, Ağuş H, Biçimoğlu A. When should secondary procedures be performed in residual hip dysplasia? Acta Orthop Traumatol Turc. 2007;41 Suppl 1:60-7. PMID: 17483625.
• 4. Ertürk C, Büyükdoğan H. Treatment in Developmental Dysplasia of the Hip. İKSSTD. 2020;12(2):93-9. DOI: 10.5222/iksstd.2020.65807.
• 5. Tönnis D. General radiography of the hip joint. In: Congenital Dysplasia and Dislocation of the Hip in Children and Adults, New York: Springer; 1987. p. 100-42.
• 6. Wenger DR, Bomar JD. Human hip dysplasia: evolution of current treatment concepts. J Orthop Sci. 2003;8(2):264-71. DOI: 10.1007/s007760300046.
• 7. Narayanan U, Mulpuri K, Sankar WN, Clarke NMP, Hosalkar H, Price CT. Reliability of a New Radiographic Classification for Developmental Dysplasia of the Hip, Pediatr Orthop. 2015;35(5):478-84. DOI: 10.1097/BPO.0000000000000318.
• 8. McKay DW. A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip. Clin Orthop Relat Res. 1974;(98):124-32. DOI: 10.1097/00003086-197401000-00013.
• 9. Kalamchi A, Mac Ewen GD: Avasculer necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1980;62(6): 876-88. PMID: 7430175.
• 10. Severin E. Contribution to knowledge of congenital dislocation of hip joint: Late results of closed reduction and arthrographic studies of recent cases. Acta Chir Scand 1941;84 (Suppl 63): 1-142.
• 11. Omeroğlu H, Kaya A, Güçlü B. [Evidence-based current concepts in the radiological diagnosis and follow-up of developmental dysplasia of the hip]. Acta Orthop Traumatol Turc. 2007;41 Suppl 1:14-8. Turkish. PMID: 17483618.
• 12. Pişkin A, Karaismailoğlu TN, Sığırcı A. [Open Reduction Through a Medial Approach for Developmental Dysplasia of the Hip in Children]. O.M.Ü Tıp Dergisi, 2005;22(1):18–24.
• 13. L. Di Mascio, R. Carey-Smith, K. Tucker. Open reduction of developmental hip dysplasia using a medial approach: A review of 24 hips. Acta Orthop. Belg. 2008,74(3):343-8. PMID: 18686459.
• 14. Ward WT, Vogt M, Grudziak JS, et al: Severin classification system for evaluation of the results of operative treatment of congenital dislocation of the hip joint. Bone and Joint Surg Am. 1997;79(5):656–63. DOI: 10.2106/00004623-199705000-00004.
• 15. İyetin Y, Türkmen İ, Sağlam Y, Akçal MA, Ünay K, Ünsaç B. Modified surgical approach of the hip in children: Is it safe and reliable in patients with developmental hip dysplasia? J Children's Orthop. 2015;9(3):199-207. DOI: 10.1007/s11832-015-0659-7.
• 16. Farsetti P, Caterini R, Potenza V. Ippolito E. Developmental Dislocation of the Hip Successfully Treated by Preoperative Traction and Medial Open Reduction: A 22-year Mean Followup. Clin Orthop Relat Res. 2015;473(8):2658-69. DOI: 10.1007/s11999- 015-4264-3.
• 17. Okano K, Yamada K, Takahashi K, Enomoto H, Osaki M, Shindo H. Long-term outcome of Ludloff's medial approach for open reduction of developmental dislocation of the hip in relation to the age at operation, Int Orthop. 2009;33(5):1391-6. DOI: 10.1007/s00264-009-0800-7.
• 18. Biçimoğlu A, Ağuş H, Omeroğlu H, Tümer Y. Posteromedial limited surgery in developmental dysplasia of the hip. Clin Orthop Relat Res. 2008;466(4):847-55. DOI: 10.1007/s11999-008-0127-5.
• 19. Koizumi W, Moriya H, Tsuchiya K at all. Ludloff’s medial approach for open reduction of congenital dislocation of the hip. A 20-year follow up. J Bone Joint Surg Br. 1996;78(6):924-6. DOI: 10.1302/0301-620x78b6.6885.
• 20. Işıklar ZU, Kandemir U, Uçar DH at all. Is concomitant bone surgery necessary at the time of open reduction in developmental dislocation of the hip in children 12-18 months old? Comparison of open reduction in patients younger than 12 months old and those 12-18 months old. J Pediatr Orthop B. 2006;15(1):23-7. DOI: 10.1097/01202412- 200601000-00005.
• 21. Zamzam, M. M. Khosshal, K. I. Abak, A. A. Bakarman, K. A. AlSiddiky, A. M. M. AlZain, K. O. & Kremli, M. K. (2009). One-stage bilateral open reduction through a medial approach in developmental dysplasia of the hip. J Bone Joint Surg Br. 2009;91(1):113-8. DOI: 10.1302/0301-620X.91B1.21429.
• 22. Yorgancıgil H, Aslan A. Comparison of the clinical and radiological outcomes of open reduction via medial and anterior approach in devleopmental dysplasia of the hip. Eklem Hastalik Cerrahisi. 2016;27(2):74-80. DOI: 10.5606/ehc.2016.17.
• 23. Yamada K, Mihara, H. Fujii, H. Hachiya M. A long-term follow-up study of open reduction using Ludloff’s approach for congenital or developmental dislocation of the hip. Bone Joint Res. 2014;3(1):1-6. DOI: 10.1302/2046-3758.31.2000213.