| Objective Developmental dysplasia of the hip (DDH), as a common developmental disease in adolescents, is viewed as an important cause of secondary osphyarthrosis of adults. DDH is characterized by a shallow acetabulum with out-migration of the femoral head and a significant increase of the local stress between them. This consequently accelerates the detriment of the cartilage of hip joint and eventually develops to osteoarthritis. At present, the question about which type of the osteotomy should be apply on treating the serious DDH patients still exists a huge controversy. Excitedly, Bernese osteotomy, as an effective operation on curing DDH, has been widely accepted and operated in the worldwide, which has won the satisfied clinical results in recent years. This research collected the case histories and 1 year follow-up results of 22 DDH adult patients who accepted Bernese osteotomy therapy and aimed to investigate the effectiveness of Bernese osteotomy for the treatment of DDH in adults.Methods Between August 2012 and April 2015,22 patients in Anhui provincial hospital with DDH were treated with Bernese osteotomy by Smith-Peterson(S-P) approach. There were 10 males and 12 females with an average age of 27.8 years (range,18-35 years). The left side was involved in 9 cases and the right side in 13 cases, VAS score was (4.8±0.5)points, and the Harris hip score was (81.2±5.4)points. The lateral center edge (CE) angle the was (6.5±8.7)′; the acetabular incline(AI) angle was (25.6±5.9)°;and the femoral head extrusion index was 36.5%±6.5%. According to the Tonnis osteoarthritis classification,17 hips were rated as Grade 0,4 hips as Grade I, and 1 hip as Grade Ⅱ.Results The operation time was90-135 minutes in average; the blood loss during intra-and post-operation was 400-800ml in average; 10 patients were transfused blood about 200-600ml(mean 400ml); The postoperative drainage volume was 100-300ml(mean 200ml). The hospitalization time was 7-12 days (mean,9 days). All the cases achieved primary healing of incision with no early complications. Two cases had numb in the lateral femoral cutaneous nerve innervating area feel. All patients were followed up 12-26 months (mean,20 months). The X-ray examination showed osseous healing at osteotomy site, and the healing time was 12-16 weeks (mean,13.5 weeks). No acetabulum fracture, heterotopic ossification, osteonecrosis and internal fixation loosening occurred during follow-up. No progression of osteoarthritis or acetabular cystic change was observed. At last follow-up, the lateral CE angle was (27.7±6.8)°; the AI angle was (16.2±4.8)°; The femoral head extrusion index was 19.7%±5.3%; VAS pain score was (0.8±0.3)points; The Harris hip score was(96.8±6.7)points; and all showed statistically significant differences when compared with preoperative ones (P<0.05).According to the imaging results, Bernese osteotomy can significantly improve patients femoral head’s outside coverage, horizontal tilt angle, and the coverage rate of femoral head after operation. VAS score and Harris hip score showed that Bernese osteotomy promptly relieved patients’ postoperative pain and improved their joint function effectively.Conclusion For DDH adults, Bernese osteotomy can effectively correct the hip deformity, increase tolerance of acetabular coverage of the femoral head, further reduce the local stress, improve the joint function, and delay progression of osteoarthritis. The short-term curative effect of this operation method is satisfactory. |
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