| Pelvic osteotomy is a common surgical procedure for the treatment of developmental dysplasia of the hip. Various pelvic osteotomies have been developed and have undergone substantial modifications. Especially, Dega osteotomy and Steel osteotomy are commonly used to treat older children of DDH. So far, the differences between the two surgical treatments are unclear.Aim:In the present paper, we present a detailed review of previous cases of DDH in older children. We assessed the difference between Dega osteotomy and Steel osteotomy before and after surgery. The aim of this study is to provide new guidance and new targets for clinical treatment of DDH in older children.Methods:From 2006 to 2012,43 older children (48 hips) with DDH underwent Dega osteotomy and 45 older children (52 hips) underwent Steel osteotomy. The average age of the patients with Dega osteotomies was 8.2 (6-10) years old. Sixteen hips were male and 32 hips were female. Based on Tonnis classification,8 hips were grade Ⅰ,17 grade Ⅱ,15 grade III and 8 grade IV. There were 22 patients (26 hips) with different degree of limition of external abduction,35 patients with leg length discrepancy (1-3.3 cm) and 10 patients (14 hips) once treated conservatively. With regard to Steel osteotomy, average age of patients at the time of surgery was 8.4 (6-10) years old. Nineteen hips were male and 33 hips were female. Based on Tonnis classification,10 hips were grade I,18 grade II,16 grade III and 8 grade IV. There were 2 patients (3 hips) with different degree of ischemic necrosis of femoral head (AVN),23 patients (28 hips) with different levels of limition of abduction and 9 patients (14 hips) once treated conservatively. The preoperative values and the corresponding postoperative values of acetabular index angle (AI), center-edge angle (CEA) and acetabular-head index (AHI) were respectively evaluated on anteroposterior (AP) X-ray images. Statistical analysis was performed using Spss Statistics 19.0 and Graphpad Prism 6.0 with a P value of< 0.05 considered significant. The different outcomes of two osteotomies are analysed and compared.Result:All the patients were followed up successfully, and the mean follow-up period was 3.3 (1.5-6.5) years. The plain radiography showed AI (19.1°±4.7°) decreased by 15.5°, CEA (27.3°±4.6°) and AHI (89.8°±7.1°) were improved by 53.1°and 62% respectively, when average preoperative values compared with the corresponding postoperative values in Dega osteotomy groups. As regard to Steel osteotomy, the plain radiography showed AI (15.1°± 3.4°) decreasd by 19.2°, CEA (30.0°±3.3°) and AHI (94.1°±7.9°) were improved by 55.3° and 67.8%. The AI, CEA and AHI of the two kinds of osteotomies were all improved, and the differences were statistically significant (P<0.05) according to student’s test. According to R*C x2 test, there are no significant differences between the two kinds of osteotomies in age(Age was divided into 2 groups, one group of patients are younger than 8 years old, the other group of patients are older than 8 years old) at surgry, gender, side, degree of dislocation, the excellent & good rate of Mackay and the rate of joint stiffness. According to the analysis of independent-samples T test, post-operative values of AI or CEA among the patients of younger than 8 years old have no significant differences between the two kinds of osteotomies (P>0.05), post-operative and final follow-up values of AI or CEA among the patients of older than 8 years old have significant diffirences (P<0.05) between the two kinds of osteotomies.Conclusions:The outcome of Dega and Steel osteotomy for DDH in older children(6-10 years old) is satisfied and has no obvious difference. However, as for patients older than 8 years old, Steel osteotomy is superior to Dega osteotomy in the correction of AI and CEA.Meaning:We found that the clinical results of Dega and steel osteotomy for DDH were satisfactory and they should be considered as alternative surgical in older children with DDH. It is helpful to provide guidance for clinical surgical of DDH in older children. |
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