The Evaluation And Related Study Of The Treatment About Adult Developmental Dysplasia Of The Hips

BACKGROUND： Developmental dysplasia of the hips is a commondevelopmental disease in the young. Bernese periacetabular osteotomy can treat itin the early term by rotating the acetabular which can increase the femoralcoverage. However, there is no clear conclusion that how the patients can get themost satisfactory effect postoperatively. For optimizing the clinical effects, thepatients who were treated by Bernese periacetabular osteotomy in ourorthopaedics department were followuped. Using the three-dimensional CTreconstruction datas of the hip,we analyse the femoral coverage in thethree-dimensional graphic and evaluate the effects postoperatively. In the sametime, we divise three implanted schemes of internal fixation and select one of theschemes which can fasten the bone fracture more stable after the mechanicexaminations.1. The follow-up of forepassed casesOBJECTIVE To evaluate the short term clinical effect of Bernese periacetabular osteotomy which is used to treat the developmental dysplasia ofthe hips in the early. METHODS The patients who have been treated byBernese periacetabular ostoeotomy in our orthopaedics department from August2007to April2011were followuped. Perioperatively and postoperatively, thepatients were requested to do some X-radiographics and hip jointthree-dimensional CT reconstruction.After that the centre-edge angle, theacetabulum roof angle, and the Sharp’s angle were measured and Harris hip scorewas also evaluated. RESULTS The mean follow-up time is1.7years (1.0-4.0years),the coverage of femoral head of most patients were improved obviouslyafter operation,and most of all the patients’ pain symptoms were eased ordisappeared. The mean CE angle was increased from12.4°（-7～24°） to26.6°（16～38°）. The mean AC angle was decreased from19.3°（7～36°） to11.2°（4～22°）. The mean Sharp’s angle was decreased from50.3°（42～59°）to38.8（°24～50°）. And the mean Harris hip score was improved from85.4（80～92） to95.3（61～99） at the lastest follow-up time. CONCLUSIONS Thecoverage of the acetabulum to the femoral head can be improved remarkably byPAO. The clinic effect of DDH patients who have been performed PAO isremarkable and it is stable on technically in our department.2. The image analysis of the treatment of the adults developmental dysplasiaof the hips by Bernese periacetabular osteotomyObjective To explore the value of evaluating the femoral head coverage foradult hip dysplasia patients with three-dimensional CT reconstruction image.Methods Totally7cases(7hips) undergoing Bernese periacetabular osteotomy inour Department from April2010to April2011were adopted in this study. In thisproject,there were2males(2hips) and5females(5hips), aged18-39years with a mean of25years. All the patients were requested to take pelvic X-radiographicsperform helical CT scan for the three-dimensional reconstruction preoperativelyand postoperatively. Using mimics10.01and autodesk3ds max2010softs toreappear hip joint images and make hip models.With the established models thesuperficial area that acetabular covers the femoral head can be measured. Inaddition, CE angle, AC angleand Sharp’s angle were measured on pelvicX-radiographics and Harris hip score were valued preoperatively andpostoperatively Results The mean follow-up time is1.4years (1.0～2.0years).The average CE angle of7cases was increased from17.7°（8°～22°） to25.4°（16°～30°） at the lastest follow-up time. The averageAC angle was decreasedfrom20.6°（7°～36°） to12.5°（4°～22°）. The average Sharp’s angle wasdecreased from49.1°（43°～59°） to40.9°（32°～45°）. The average Harris hipscore was increased from83.9（80～86） to97.0（95～99）. The average femoralhead coverage in Autodesk3ds max2010soft was increased from54.89%（48.32%～60.96%）to60.92%（52.87%～65.38%）. The average femoral headeffective coverage in Autodesk3ds max2010soft was increased from64.97%（48.54～71.05%）to71.88%（54.27～82.39%）. The average anterior coverageof femoral head was increased from22.05%（17.99～28.76%） to32.03%（26.29%～36.9%）. The average posterior coverage of femoral head wasdecreased from32.70%（25.66%～41.97%） to28.60%（21.08%～37.09%）.Conclusions In this study the part of coverage that the acetabular is useless tothe femoral head is rejected.It is closed to the actual condition.Also,the effectivecoverage and anterior coverage of femoral head which can be showneddirect-viewingly can response the hip function more reasonable than acetabularCE angle and acetabular coverage and it is more helpful to evaluate the clinicaleffect postoperatively. 3.The internal fixation divices and the mechanic examinationOBJECTIVE To ensure a scheme of internal fixation implant duringBernese periacetabular osteotomy which can make the bone fractures stably.METHODS Imitating Bernese periacetabular osteotomy on the pelvisspecimens and implanting three internal fixation schemes respectively which aredivised previously.Then, the specimens are measured the displacementchangement of the bone fracture on the mechanic tester. RESULTS There isno remarkble variation about the displacement changement of the fracturesbetween the three implants schemes in normal, but the displacement changementof the hip joint fractures in three-dimensional group is smaller than the other twogroups when the stress is much larger than normal. CONCLUSIONS Normally,there is no obviously difference of the hip joint fractures stability between thethree schemes.But it is more optimized for the hip joint fractures stability whichare fixed by the three-dimensional internal fixation scheme when the stress ismuch larger than normal.