| Objective:To assess the clinical efficacy and safety of open reduction accompanied by pelvic acetabuloplasty through the Pemberton or Dega osteotomy with femoral shortening simultaneously and bilaterally for the treatment of bilateral DDH in children.To compare the blood transfusion rate,the costs of treatment,hospitalization time,anesthesia time and the clinical efficacy between simultaneous operation and two separate consecutive operations of One-stage combined surgery in the treatment of bilateral developmental hip dysplasia in children.Methods:The 40 children with bilateral developmental dysplasia of the hip,who were treated in our hospital from October 2015 to October 2020,had been retrospectively analyzed.All the children were treated with open reduction accompanied by pelvic acetabuloplasty through modified Pemberton or Dega osteotomy with femoral shortening.They(80 hips)were divided into Group A(Simultaneous bilateral operation)and Group B(Consecutive bilateral operations),which was based on the different staging of osteotomies.The Acetabular index(AI)and Center edge angle(CEA)before operation,after operation and the last follow-up were measured,then the reoperative and postoperative changes with the postoperative and last follow-up changes were compared between the groups.The blood loss,blood transfusion rate,the costs of treatment,total hospitalization period,anesthesia time,heterotopic ossification of intertrochanters,Severin criteria of hip X-ray and occurrence of Proximal femoral growth disturbance(PFGD)and Harris score of hip joint function after surgery were noted for each patient.Results:Comparatively,the total hospitalization period was 9.00(8.00-11.50)days for group A,whereas it was 19.00(16.00-21.00)days for group B(P<0.05);the anesthesia time was 320.00(312.50-387.50)minutes for group A,whereas it was450.00(415.00-513.00)minutes for group B(P<0.05);the costs of treatment in group A was 56013.00(50767.00-62937.00)yuan,whereas the costs of treatment in group B was 60765.00(59024.00-67217.00)yuan(P<0.05),the blood transfusion rate was52.94% for group A,whereas it was 17.39% for group B(P<0.05),differences were statistically significant.The bleeding volume was 130.00(100.00-225.00)ml in group A,and it was 180.00(120.00-200.00)ml in group B(P=0.432);the reoperative AI was36.41±6.89° in group A,and it was 36.30 ± 4.90° in group B(P=0.938);the postoperative AI was 13.62±6.03° in group A,and it was 14.80±7.10 in group B(P=0.304);the last follow-up AI was 13.79±7.69° in group A,and it was 13.13±5.92°in group B(P=0.676);ΔAI was 22.79±7.96° in group A,and it was 21.50±6.67° in group B(P=0.445);ΔAI’was-0.18±6.90° in group A,and it was 1.67±6.53° in group B(P=0.229);the postoperative CEA was 43.82±8.01° in group A,and it was42.63±10.62° in group B(P=0.546);the last follow-up CEA was 32.79±12.06° in group A,and it was 33.02±8.08° in group B(P=0.918);ΔCEA was 11.03±12.27° in group A,and it was 9.61±10.82° in group B(P=0.592),differences about group A and group B were not statistically significant(P>0.05).In groups A and B,hip imaging Evaluation satisfaction rate was 79.41% in group A,and it was 84.78% in group B(P=0.122);the incidence of postoperative PFGD was 17.65% in group A,and it was17.39% in group B(P=0.976);clinical hip function excellent and good rate was88.3% in group A,and it was 87.0% in group B(P=0.861);the differences were not statistically significant between the two group(P>0.05).Conclusions:Compared with bilateral sequential surgery,simultaneous bilateral surgery saves the costs of treatment,reduces total anesthesia time and hospitalization time,and has similar clinical efficacy,but increases the rate of surgical transfusion.For skilled surgeons,it is an option to perform one-stage open reduction accompanied by pelvic acetabuloplasty through the Pemberton or Dega osteotomy with femoral shortening simultaneously and bilaterally for the treatment of bilateral DDH in children. |
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