Radical surgery in the treatment of the congenital dislocation of the hip

Abstract

In this study, we reviewed the results of one-stage surgical treatment in 25 hips of 22 patients. Between October 1987 and April 1994, we had operated 52 patients who were 3 years or older and had complete dislocation of the hip. Out of these patients 22 of them had attended to their last follow-up. The average age at operation was 60.9 months and the average follow-up was 52.5 months. None of the children had had previous treatment for the dislocation. Open reduction, femoral derotation with shortening, pelvic osteotomy and capsulorrhaphy were performed as a one-stage procedure. Preliminary traction was not used in any patient. The acetabular index averaged 36.3¡ preoperatively and 16.1¡ at last follow-up. The center-edge angle averaged 26.2¡ at follow-up. Avascular necrosis was observed in 14 (56%) hips; 11 (44%) of these hips were found to be consistant with Type I classification of Kalamchi-McEwen. 7 patients had average 2.5 cm of limb-lenght discrepancy at last follow-up. 25 hips of 22 patients were reviewed with respect to the radiological criteria of Severin and modified clinical criteria of McKay. Radiologically 12 (48%) of the hips were rated as Severin Grade I; 6 (24%), as Grade II; 4 (16%), as Grade III; and 3 (12%), as Grade IV. Clinically 14 (56%) of the hips were rated as excellent, 9 (36%) were rated as good, and 2 (8%) were rated as fair. We think, the late diagnosed congenital dislocation of the hip can be successfully treated with one-stage operation without the need of preliminary traction.

Özet

Bu çalışmada kliniğimizde tedavi edilen, 3 yaşım geçmiş D.K.Ç. li olguların sonuçlarının incelenerek aktarılması amaçlandı. Çalışmamızın konusunu; Ekim 1987-Nisan 1994 tarihleri arasında tek seansta radikal girişim yapılan, 3 yaşını geçmiş 52 D.K.Ç. hastasından son kontrole gelen 22 sinin daha önce hiç tedavi görmemiş 25 kalçası oluşturmaktadır. Hastaların ameliyat sırasında ortalama yaşı 60.9 ay ortalama takip süremiz ise 52.5 aydı. Prosedür, sırasıyla, açık redaksiyon, femoral osteotomi, pelvik osteotomi ve kapsülorafiden oluşmaktadır. Hiçbir hastaya preoperatif fraksiyon uygulanmamıştır. Ameliyattan sonra, kalaçanın pozisyonu stabil ve güvenli bölgede kalacak şekilde pelvi-pedal alçı yapıldı. Alçıdan sonra Denis-Browne abduksiyon cihazına geçildi. Son kontrolümüzde klinik olarak kalçaların 23 ü (%92) çok iyi ve iyi sonuç olarak değerlendirildi. Gecikmiş D.K.Ç. tedavisinde tek seansta radikal cerrahi girişimin başarılı ve yüzgüldürücü olduğu inancındayız.