Journals / Acta Orthopaedica et Traumatologica Turcica / 2007 / Cilt: 41 - Sayı: 5
Treatment of acetabular dysplasia by triple pelvic osteotomy and its short-term results
- Pages
- 355–366
- DOI
- —
Abstract
Objectives: We evaluated the effect of triple pelvic osteotomy on acetabular coverage and its clinical implications by clinical and radiographic parameters in patients with acetabular dysplasia. Methods: Triple pelvic osteotomy was performed in 21 hips of 19 patients (13 females, 6 males; mean age during operation 16.3 years; range 8 to 32 years). Acetabular dysplasia was bilateral in two, and unilateral in 17 patients. Etiology was developmental dysplasia of the hip in 12 patients, Legg- Calve-Perthes disease in five patients, and diplegic and quadriplegic cerebral palsy in two patients, respectively. The patients were clinically evaluated by the modified Merle d’Aubigne-Postel system, and radiographical assessments were made using nine parameters. The mean follow-up period was 27.7 months (range 14 to 60 months). Results: According to the modified Merle d’Aubigne-Postel system, preoperative and postoperative clinical scores were 13.14 and 15.29, respectively (p<0.001). The Trendelenburg test was positive in all (94.7%) but one patient preoperatively. At final follow-up, it was positive in six hips (28.6%), delayed positive in 12 hips (57.1%), and negative in three hips (14.3%). Of radiographical parameters, the mean corrections obtained in the center-edge angle, femoral head coverage, acetabular angle, and acetabular index angle were 21.6° (p<0.05), 18% (p<0.05), 14.5° (p<0.05), and 16.4° (p<0.05), respectively, with an increase in lateralization (1.7 mm; p<0.05) and a decrease in cranialization (3.8 mm; p>0.05). The ratio of acetabular depth to width remained unchanged (p>0.05). Conclusion: Triple pelvic osteotomy is successful in correcting biomechanics of the hip joint in most of the patients with acetabular dysplasia.
Özet
Amaç: Asetabuler displazili hastalara uygulanan üçlü pelvik osteotomi ameliyatının asetabuler örtünme üzerine etkisi ve klinik yansıması klinik ve radyografik parametrelerle değerlendirildi. Çalışma planı: Asetabuler displazisi olan 19 hastanın (13 kadın, 6 erkek; ameliyat tarihinde ort. yaş 16.3; dağılım 8- 32) 21 kalçasına üçlü pelvik osteotomi yapıldı. İki hastada iki taraflı, 17 hastada tek taraflı tutulum vardı. Etyoloji, 12 hastada gelişimsel kalça displazisi, beş hastada Legg-Calve- Perthes hastalığı, iki hastada ise biri diplejik diğeri kuadriplejik tutulumlu serebral felçti. Klinik değerlendirme modifiye Merle d’Aubigne-Postel sistemine göre yapıldı. Radyografik değerlendirmede dokuz parametre kullanıldı. Ameliyat sonrası takip süresi ortalama 27.7 ay (dağılım 14-60 ay) idi. Sonuçlar: Modifiye Merle d’Aubigne-Postel klinik değerlendirme toplam puanları ameliyat öncesi ve sonrasında sırasıyla 13.14 ve 15.29 bulundu (p 0.05) saptandı. Asetabuler derinlik/genişlik oranı ameliyat öncesi döneme göre farklılık göstermedi (p>0.05). Çıkarımlar: Üçlü pelvik osteotomi kalça ekleminin biyomekaniğini düzelterek asetabuler displazili hastaların büyük çoğunluğunda başarılı olmaktadır.