Aim: To investigate the long term results of the patients followed till the skeletal maturity and treated with Salter innominate osteotomy. Patients and Methods: 85 hips of 63 patients whom were operated by the same s...Aim: To investigate the long term results of the patients followed till the skeletal maturity and treated with Salter innominate osteotomy. Patients and Methods: 85 hips of 63 patients whom were operated by the same surgeon between the years 1985 and 1991 were evaluated retrospectively. 34 hips of 25 patients who did not have enough follow-up or did not reach skeletal maturity at their last radiographic control were excluded from the study. So, 51 hips of 38 patients were included into our study. Mean age of the patients at the time of operation was 3 years 2 months (1.5 - 11 years), mean follow-up time was 16 years 6 months (10 - 23 years) and mean age at the last control was 19 years 7 months (15 - 27 years). Results: The overall clinical results were favorable (excellent or good) in 48 hips (94.1%) according to the modified McKay clinical evaluation scale. Avascular necrosis was evaluated with the Kalamchi-McEven classification at the last follow up and 45 hips (88.2%) had no avascular necrosis. The radiographic results were assessed by the Severin classification system and 10 hips (19.6%) were stage 1a;10 hips (19.6%) were stage 1b;and 30 hips (58.8%) were stage 2. Upon the analysis of our radiographic results according to Stulberg classification system, we found out that only 2 (3.9%) of our patients were Stulberg stage 5, whereas 36 cases (70.6%) were Stulberg stage 1 and 2 (spherical congruency). According to Croft’s classification of hips for degenerative changes, 36 (70.6%) patients were stage 0;6 (11.8%) patients were stage 1;5 (9.8%) patients were stage 2 and 4 patients (8.7%) were stage 3. Conclusion: When appropriate soft tissue balance is provided, the complications of Salter Innominate Osteotomy are decreased and thus, it provides an excellent functional and radiological result.展开更多
We have reviewed 17 patients (18 hips) who required repeated open reduction for recurrent or persistent dislocation after a previous attempt at zigzag osteotomy combined with fibular allowgraft for developmental dyspl...We have reviewed 17 patients (18 hips) who required repeated open reduction for recurrent or persistent dislocation after a previous attempt at zigzag osteotomy combined with fibular allowgraft for developmental dysplasia of the hip (DDH). The purposes of this study were to examine predictors of redislocation and to evaluate the long-term outcomes after revision surgery. The mean age at primary open reduction was 24 months (13 to 36). The median time to the recognition of failure was 4.6 months. The second reduction was performed at a mean age of 26.3 months (17 to 42) and the mean age at final follow-up was 79.7 months (58 to 105) and the mean time follow-up was 42.4 months (37 to 76). We treated the hips with a new open reduction through an anteromedial approach. A constricted anteromedial capsule was always found as the main factor;all had an intact anteromedial capsule, and there was an inverted transverse ligament in five cases and a very tight psoas tendon in another four cases, eversion of the limbus in six cases, densing anterior capsule in five cases. We perform with the condition that all hips were cleared of scar tissue;five hips had adductor tenotomy;four hips required release of the psoas tendon, five eversion of the limbus. Release of the transverse ligament was required in five cases each. All hips with Kirschner wire through the femoral head into the acetabulum. Three hips required femoral shortening (average of 1.5 cm);a derotation varus osteotomy was performed in two hips from ten and twelve weeks after repeated open reduction. Postoperative results according to modified McKay criteria for clinical: excellent: 3 of 18 hips (16.7%);good: 8 of 18 hips (44.4%);fair: 6 of 18 hips (33.3%);and poor: 1 of 18 hips (5.6%). We suggest that technical failure is usually the cause for redislocation with all that has an intact anteromedial capsule. There was an inverted transverse ligament, tight psoas tendon, eversion of the limbus, and densing anterior capsule. We believe that abnormal femoral version and femoral head dysplasia are also important factors for redislocation too.展开更多
文摘Aim: To investigate the long term results of the patients followed till the skeletal maturity and treated with Salter innominate osteotomy. Patients and Methods: 85 hips of 63 patients whom were operated by the same surgeon between the years 1985 and 1991 were evaluated retrospectively. 34 hips of 25 patients who did not have enough follow-up or did not reach skeletal maturity at their last radiographic control were excluded from the study. So, 51 hips of 38 patients were included into our study. Mean age of the patients at the time of operation was 3 years 2 months (1.5 - 11 years), mean follow-up time was 16 years 6 months (10 - 23 years) and mean age at the last control was 19 years 7 months (15 - 27 years). Results: The overall clinical results were favorable (excellent or good) in 48 hips (94.1%) according to the modified McKay clinical evaluation scale. Avascular necrosis was evaluated with the Kalamchi-McEven classification at the last follow up and 45 hips (88.2%) had no avascular necrosis. The radiographic results were assessed by the Severin classification system and 10 hips (19.6%) were stage 1a;10 hips (19.6%) were stage 1b;and 30 hips (58.8%) were stage 2. Upon the analysis of our radiographic results according to Stulberg classification system, we found out that only 2 (3.9%) of our patients were Stulberg stage 5, whereas 36 cases (70.6%) were Stulberg stage 1 and 2 (spherical congruency). According to Croft’s classification of hips for degenerative changes, 36 (70.6%) patients were stage 0;6 (11.8%) patients were stage 1;5 (9.8%) patients were stage 2 and 4 patients (8.7%) were stage 3. Conclusion: When appropriate soft tissue balance is provided, the complications of Salter Innominate Osteotomy are decreased and thus, it provides an excellent functional and radiological result.
文摘We have reviewed 17 patients (18 hips) who required repeated open reduction for recurrent or persistent dislocation after a previous attempt at zigzag osteotomy combined with fibular allowgraft for developmental dysplasia of the hip (DDH). The purposes of this study were to examine predictors of redislocation and to evaluate the long-term outcomes after revision surgery. The mean age at primary open reduction was 24 months (13 to 36). The median time to the recognition of failure was 4.6 months. The second reduction was performed at a mean age of 26.3 months (17 to 42) and the mean age at final follow-up was 79.7 months (58 to 105) and the mean time follow-up was 42.4 months (37 to 76). We treated the hips with a new open reduction through an anteromedial approach. A constricted anteromedial capsule was always found as the main factor;all had an intact anteromedial capsule, and there was an inverted transverse ligament in five cases and a very tight psoas tendon in another four cases, eversion of the limbus in six cases, densing anterior capsule in five cases. We perform with the condition that all hips were cleared of scar tissue;five hips had adductor tenotomy;four hips required release of the psoas tendon, five eversion of the limbus. Release of the transverse ligament was required in five cases each. All hips with Kirschner wire through the femoral head into the acetabulum. Three hips required femoral shortening (average of 1.5 cm);a derotation varus osteotomy was performed in two hips from ten and twelve weeks after repeated open reduction. Postoperative results according to modified McKay criteria for clinical: excellent: 3 of 18 hips (16.7%);good: 8 of 18 hips (44.4%);fair: 6 of 18 hips (33.3%);and poor: 1 of 18 hips (5.6%). We suggest that technical failure is usually the cause for redislocation with all that has an intact anteromedial capsule. There was an inverted transverse ligament, tight psoas tendon, eversion of the limbus, and densing anterior capsule. We believe that abnormal femoral version and femoral head dysplasia are also important factors for redislocation too.
