Operation For Developmental Dislocation Of The Hip

Objective: Developmental dislocation of the hip is a common clinical pediatric lower limb congenital malformation. It is caused by abnormal development of hip joint, and the infant had multiple anomalies, which pathogeny is not very clear so far, but genetic and environmental factors are connected with DDH. The slight dysplasia of some babies may disappear, but other untreated hip deformity will increase or lead to pain, limited mobility, abnormal gait. Finally, the DDH may lead to adult degenerative arthritis. The initial symptoms is realted with age and degree of the patient. The severe untreated DDH may appear in the youth and will lead to a series of degenerative symptoms of the hips.The consequences of delayed or not treated for dislocation of the hip is very serious, so many experts[1,2] consider that is necessary with the newborn screening for DDH. Once the infant is diagnosed as DDH after birth, it is should be intervened as soon as possible.The early conservative treatment of DDH can achieve good clinical results, but developmental dislocation of the hip cases of lated conservative treatment or delayed the best time which may require the operative corrective treatment. In this study, the cases of DDH are operated in our hospital, our intention is to investigate and observe the curative effect of operation for children with developmental dislocation of hip and discuss the methods of operation and clinical curative effect.Methords: In the period between 1993 and 2003, we deployed three different pelvic osteotomies which included Salter, Pemberton and Chiari or combined subtrochanteric of femoral rotational osteotomy to treatment developmental dislocation of the hip with 889 cases (1044 hips). Because of some reasons only 108 patients (129 hips) were accepted a long-term follow-up. In this study, the clinical data of the children in the age of 3～13 years old with developmental dislocation of the hip (DDH) who were managed in our department from 1993 to 2003 retrospectively analyzed. The data of hip joint function and X-ray were collected and finished. The common evaluation criteria of developmental dislocation of the hip (Zhou Yongde)[3] (table 3) was applied to score for the children, so we can get the long-term effect of different surgical treatment of DDH.Results: 108 patients with 129 hips were followed up for 7 to 17 years(an average of 11.5 years) and evaluated for the hips with 78.29% reporting excellent and good results in this study. The different clinical efficacy was due to different surgical procedures (table 1). There were excellent 69 hips (26~30 points), good 32 hips (21~25 points), fair 16 hips (16~20 points) and poor 12 hips (less than or equal to 15 points).Conclusions: The patients of developmental dislocation of the hip (DDH), in particular, which missed the best time for conservative treatment or failed to conservative treatment, whose acetabulum and the femoral head have different degrees of pathological changes, and the pathological changes are distinctive because of different ages. It is satisfactory of the effect for DDH by Salter or Pemberton osteotomy than Chiari. So according to the age and pathological changes of the DDH in children, a correct method of operation is the basic of the best results.