نویسندگان
دانشگاه علوم پزشکی جندی شاپور اهواز، اهواز، ایران
چکیده
خلاصه
پیشزمینه: دیسپلازی تکاملی مفصـل هیـپ (Developmental dysplasia of thehip) (DDH)طیف گستردهای از اختلالات ناشی از تکامل غیرطبیعی هیپ را شامل می‌شود که می‌تواند در هر زمان از جمله دوره جنینی، شیرخوارگی و یا کودکی آشکار شود. هدف از این مطالعه بررسی نتایج بالینی و رادیوگرافی بیماران مبتلا به دیسـپلازی تکاملی هیـپ است که تحت درمان با ادکتورتناتومی و جااندازی بسته قرار گرفته بودند
مواد و روشها: مطالعه به صورت گذشته‌نگر روی 30 کودک (33 مفصل) مبتلا به دیسپلازی تکاملی هیپ، در بیمارستان رازی اهواز، بین سال‌های 94 تا 96 انجام شد. معیارهای ورود ابتلا به DDH در محدوده سنی زیر 2 سال بوده است. معیارهای خروج بیماری‌های بافت هم بند، دررفتگی ثانویه ناشی از عفونـت پیشـین و دیسپلازی استابولوم در زمینه سندرم خاص بودند. بیماران پس از عمـل بـه لحـاظ بالینی، میزان دررفتگی کامل یا نیمه دررفتگی مفصل هیپ، همواری مفصل هیپ و یافته‌های رادیـوگرافی، بـه ترتیب بـراساس معیارهای Severin،Tonnis grading ،McKay و شاخص استابولار مورد ارزیابی قرار گرفتند.
یافتهها: میانگین ایندکس استابولار پس از جراحی (15/2 ± 06/27 درجه) در مقایسه با میزان آن قبل از جراحی (27/3 ± 54/36 درجه) به‌طور قابل توجهی کاهش یافت. براساس معیار McKay پس از جراحی در 9/90% بیماران نتایج درمانی عالی و خوب گزارش شد. بر اساس معیار Tonnis، پس از جراحی 9/93% از بیماران در طبقهبندی I & II قرار داشتند. در ارزیابی‌های رادیوگرافیکی پس از جراحی، براساس معیار Severin ، 9/96% از بیماران در Class Ia & Ib قرار گرفتند. در یک بیمار (03/3 %) نکروز استخوانی(استئونکروزیس) در سر، در دو بیمار(06/6 %) لنگش و نقص در راه رفتن، و در سه بیمار (09/9 %) نقص در نشستن مشاهده شد. همه بیماران بررسی شده در این مطالعه زن بودند.
نتیجه‌گیری: براساس نتایج درمانی و ارزیابی‌های بالینی انجام شده در این مطالعه، روش جااندازی بسته به همراه ادکتورتناتومی می‌تواند در اولین اقدام درمانی به عنوان یک تکنیک مناسب جهت درمان بیماران مبتلا به دیسپلازی تکاملی هیپ در سنین پایین استفاده شود.
کلیدواژه‌ها
عنوان مقاله [English]
Closed Reduction with Adductor Tenotomy for Developmental Dysplasia of the hip in children below 2 years
نویسندگان [English]
- Hanon Sadoni
- Saeed Tabatabaei
- Hamidreza Arti
- Mohammadreza Ghasemi
- Shahab Yousefifar
چکیده [English]
Abstract
Background: Developmental dysplasia of the hip (DDH) includes a wide range of abnormalities of the hip that can emerge at any time including embryonic period, infancy, or childhood. The purpose of this study was to examine the clinical and radiographic outcomes of patients with DDH, treated with adductor tenotomy and closed reduction.
Methods: The study was retrospectively performed on 30 children (33 joints) with DDH,who were treated with adductor tenotomy, closed reduction and SpicaCast in Ahvaz Razi Hospital during 2015-2017. Inclusion criteria were patients diagnosed with DDH and below 2 years of age. Exclusion criteria were connective tissue diseases, secondary dislocation due to previous infection and acetabulum dysplasia in the context of specific syndrome. After the operation, the patients were evaluated for the severity of injuries associated with dislocation or subluxation of hip joint and hip joint congruity. Theradiographic results were studiedbased on Severin, Tonnis grading, McKay and acetabularindices.
Results: The preoperative mean acetabular index of36.54 ± 3.27 degrees significantly dropped to postoperativeof 27.06 ± 2.15 degrees. According to McKay criteria, 90.9% of the patients had excellent and good therapeutic results after the surgery. According to Tonnis criteria, 93.9% of patients were in Class I and II after the surgery. Moreover, in radiographic evaluations,96.9% of the patients were in Class Ia and Ib based on Severin criteria.In 1 patient (3.03%), osteonecrosis of the head was found, in 2 patients (6.06%), walking and lameness impaired walking, and in 3 patients (9.09%), sitting was reported. All patients were female in this study.
Conclusion: According to the clinical results and evaluations of this study, closed reduction along with adductor tenotomy can be used as an appropriate technique for the treatment of patients with DDH at an early age.
کلیدواژه‌ها [English]
- Keywords: adductor tenotomy
- developmental dysplasia of the hip (DDH)
- Closed Reduction
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