Anteversion in developmental dislocation of the hip: Is it always pathologic

Abstract

In Iiterature, many authors have stated that, both femoral neck and acetabular anteversion are increased in developmental dislocation of the hip (DDH). We performed femoral neck and acetabular anteversion analyses in a Iarge group of children with and without DDH. In this study, there are 3 groups of children. The first group was comprised of children with DDH, the second group was comprised of children with normal side of unilateral DDH, and the third group was comprised of children with no hip pathology. There were 132 children (261 hips), 55 of the children were affected bilaterally and 74 of them were affected unilaterally. The remaining three children were also affected bilaterally but the degree of their deformity could only be measured at one site due to previous surgical procedures having been performed. The children involved includes 31 boys and 101 girls ranging in age form 1 to 6 years. A control group of 20 children (40 normal hips) included 12 girls and 8 boys (same age range). We utilized the Student -t test and Mann-Whitney U test. The average acetabular anteversion angle in children with DDH was 18.30° and average femoral neck anteversion was 35.40°. The average acetabular anteversion angle in children with normal site of unilateral DDH was 14.66°, and average femoral neck anteversion was 31. 70°. The average acetabular anteversion angle in children with normal hips was 12.40° and femoral neck angle was 25.67°. These values were compared statisticafly and marked differences were found. Femoral and acetabular excessive anteversion in DDH are not the rule, as 74% of the femoral neck and 51% of the acetabular anteversion were within normal ranges.

Özet

Gelişimsel kalça çıkıklı (GKÇ) hastalarda femoral ve asetabuler anteversiyon değerlerinin artmış olduğu bilinmekteydi. Ancak GKÇ daki artmış bu değerlerin normal kalçalarda Bilgisayarlı Tomografi (BT) ile yapılan ölçümlerle karşılaştırılması bugüne kadar yapılmamıştır. Çalışmamızda 1-6 yaş arası 132 GKÇ lı çocuğun çıkık olan 187, ünilateral sağlam 74 kalçası ile, 20 normal çocuğun 40 kalçasında BT ile Femoral Anteversiyon (FA) ve Asetabuler anteversiyonları (AA) ölçülerek normal kalçalarda Stabilite indeksi (Sİ) ve patolojik kalçaIarda instasbilite indeksleri (İİ) hesaplandı. GKÇ lı 187 kalçada ortalama FA 35.40°, AA 18.30°, İİ 53.70° olarak ölçüldü. Ünilateral sağlam 74 kalçada ortalama FA 31.73°, AA 14.66°, Si 46.39° bulundu. Kontrol grubu olarak kullanılan 40 normal kalçada ise ortalama FA 25.67°, AA 12.40°, Sİ ise 38.07° olarak hesaplandı. GKÇ lı, üniIateral sağlam ve normal kalçaların FA, AA ve Si ile İİ nin istatistiksel karşılaştırlması yapılarak birbirlerinden anlamlı derecede farklı oldukları bulundu. Ancak GKÇ lı kalçalarda anteversiyonun her olguda artmış olmadığı FA nun % 74, AA nın %49 ve İİ nin %57 olguda normal değerler arasında olduğu belirlendi.