Análise radiográfica dos fatores prognósticos no tratamento do quadril displásico inveterado

Abstract

Citation: Cordeiro EF, Matsunaga FT, Costa MP, Felizola M, Dobashi ET, Ishida A, Milani C. Radiographic analysis of prognostic factors in ddh treatment after walking age. Acta Ortop Bras. [online]. 2010; 18(4):218-23. Available from URL: http://www.scielo.br/aobAll the authors declare that there is no potential conflict of interest referring to this article. INTRODUCTIONThere is no doubt about the need for therapy in patients with Developmental Dysplasia of the Hip (DDH). However, there is still controversy regarding the best treatment methodology among the various existing protocols, both surgical and non-surgical. [1][2][3][4][5][6] Those that support closed methods base their opinion on the occurrence of remodeling of the articular surfaces of the dislocated hip after the performance of reduction. 7,8 However, there are those that advocate the use of surgical treatment, as these allege that the anatomical alterations already established, especially in children over 18 months of age, could not determine satisfactory future results. Among the advocates of surgical methods, we find authors that perform femoral surgeries with the intention of minimizing rates of necrosis of proximal femoral epiphysis, demonstrating good results with the use of this resource. 9-11Iliac osteotomies provide additional stabilization to open reduction, thus preventing re-dislocation and promoting adequate development of the hip. Therefore, we conducted this study in order to radiographically ABSTRACT Objective: To evaluate the results of surgical treatment of Developmental Dysplasia of the Hip (DDH) treated in the walking age. Methods: We evaluated 33 hips in 30 patients operated between November of 1992 and September of 1997. The mean age was 4 years and 5 months at surgical period and the mean age at the last evaluation was 11 years and 7 months. The mean follow up time was 10 years and 2 months. We performed femoral shortening, open reduction and pelvic osteotomy (Salter or Chiari). Radiographic assessment considered: acetabular index; acetabular angle; Shenton's line; Hilgenreiner's line; the c/b, c/h, acetabulum-center and acetabulum-head ratios; the width of the triradiate cartilage; the trochanter and femoral head relationship; femoral head sphericity; Wiberg angle; avascular necrosis and leg length discrepancy. These parameters were measured and compared in pre-operative, early and late post-operative period. Results: After statistical analysis we observed a significant decrease in these parameters from pre-operative period to immediate post-operative period (p=0.0001) and those have not changed between the immediate post-operative period and late post-operative period (p=0.5958). Conclusion: By the classification used we observed 23 (69.70%) good, 5 (15.15%) regular and 5 (15.15%) poor results. None of these radiographic parameters were relevant to predicting final results.

Bilateral developmental dysplasia of the hip treated with open reduction and Salter osteotomy: analysis on the radiographic results

“…Many authors have recommended that open reduction in association with osteotomy of the innominate bone for correction of acetabular dysplasia should be performed on children at a minimum age of 18 months 21 and that the technique described by Salter 22 should be applied to patients at a maximum age of six years. Several studies have clinically and radiographically evaluated the pre- and postoperative conditions of children with DDH who underwent open reduction and Salter's osteotomy, 2 , 11 , 20 , 21 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 but none of them used samples consisting only of patients affected bilaterally.…”

“…Many authors have described follow-ups on treated patients ranging from one year to 24 years and six months. 11 , 20 , 21 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 …”