Comparative And Analytic Research On Two Intraoperative Measuring Methods Of Femoral Neck Anteversion’s Correction And Surgical Outcomes For Older Children With Developmental Dysplasia Of The Hip In Different Age Groups

Part Ⅰ: Comparative and analytic research on two intraoperative measuring methods: lineation method and angular method of femoral neck anteversion’s correction in children’s development dislocation of the hip.Objective To discuss the application of femoral neck anteversion’s correction,by using the two different measurement during femoral nearly section rotating osteotomy,in the treatment of children’s development dislocation of the hip.Methods Between January 2006 and June 2015,according to the X-ray or 3D-CT imaging findings,geometric measurement and the pathological condition in patients,32 patients(32 hips)with DDH were treated with pelvis osteotomy combined femoral nearly section rotating osteotomy,and the clinical data were retrospectively analyzed.The patients were divided into two groups according to the different intra-operative measurement of correction of femoral neck anteversion: 16 patients(16 hips)used the lineation method between January 2006 and December 2009;the others used the angular method between January 2010 and June 2015.Before the operations,FNA index were evaluated by X-ray and thin slice hip joint scan and 3D reconstruction to guide the osteotomy.After the operations,FNA index were rechecked.The general information and preoperative FNA index of affected side of two groups was not statistically significant(P>0.05).Results The cases were followed up for 12-48 months(mean,28 months).After operations,FNA of the affected side decreased substantially,and the FNA,in both groups,had significant difference with themselves before operations(P<0.01)and had no significant difference with the normal side(P>0.05).The difference of postoperative FNA index between the group of lineation method and the group of angular method was not statistically significant(P>0.05),suggesting that it is not enough to prove that the angular method of femoral neck anteversion’s correction was superior to the lineation method.Conclusion Both lineation method and angular method of femoral neck anteversion’s correction produce excellent results in pediatric developmental dislocation of the hip.Part Ⅱ: Surgical outcomes for older children with developmental dysplasia of hip in different age groupsObjective To investigate and compare the surgical outcomes of developmental dislocation of the hip(DDH)in different age groups in children older than 6 years.Methods From November 2006 to June 2014,91 patients(104 hips)with DDH were treated with Pemberton,Dega,or triple innominate osteotomy by S-P approach,and the clinical data were retrospectively analyzed.There were 13 males and 78 females with an average age of 8.8 years(range,6~15 years).Patients were divided into younger-age group(<10 years,n=61,70 hips)and elder-age group(≥10 years,n=30,34 hips).Patients in youngerage group received Pemberton osteotomy(n=31,35 hips),Dega osteotomy(n=20,21 hips),Triple innominate osteotomy(n=10,14 hips),respectively.While patients in elder-age group were given Pemberton osteotomy(n=10,12 hips),Dega osteotomy(n=11,12 hips),Triple innominate osteotomy(n=9,10 hips),respectively.Results The cases were followed up for about 2-8 years(mean,7.9 years).All patients in younger group received operation successfully,according to the Severin radiographic classification,the excellent and good outcomes rate of 91.43% was achieved in sub-group of Pemberton osteotomy(32/35),85.71% in sub-group of Dega osteotomy(18/21),85.71% in sub-group of Triple innominate osteotomy(12/14),respectively.While the rate in elderage group was 58.33% in sub-group of Pemberton osteotomy(7/12),50.00% in sub-group of Dega osteotomy(6/12),40.00% in sub-group of Triple innominate osteotomy(4/10),respectively.The results of Mckay clinical criteria for hip function assessing revealed that,in younger-age group,88.57% excellent and good outcomes had been achieved in subgroup of Pemberton osteotomy(31/35),85.71% in sub-group of Dega osteotomy(18/21),85.71% in sub-group of Triple innominate osteotomy(12/14),however,in elder-age group, the results were 58.33% in sub-group of Pemberton osteotomy(7/12),41.67% in subgroup of Dega osteotomy(5/12),40.00% in sub-group of Triple innominate osteotomy(4/10),respectively.Conclusions Older patients with DDH could still selectively receive the surgical treatment.However,early surgical treatment is the first choice to obtain better clinical results.