The Evaluation Of Staging Surgical Therapy For Bilateral Developmental Dysplasia Of Hip

Background:Developmental dysplasia of the hip(DDH)is a common disease affecting children all over the world.Due to congenital defects and the continuing effects of acquired factors,children with hip joints have acetabular dysplasia,subluxation of the hip joint and complete dislocation of the hip joint DDH can cause shallow development of acetabulum,delayed development of femoral head,contraction of surrounding muscles and soft tissues,and subsequent serious consequences such as osteoarthritis and even limb disability.Early diagnosis and timely treatment are the principles for the treatment of DDH,but there are still some children diagnosed with DDH after walking age,and the pathological changes of the hip joint are more complicated.Patients with bilateral DDH is believed tend to have a worse prognosis than unilateral DDH with the optimal treatment unclear.Some scholars adopted bilateral simultaneous surgical treatment,the excellent and good rate was only 75-80%,and there were many complications.Object:The low good rate and more complications of bilateral simultaneous surgery prompted the exploration of better treatment methods.To analyze the results from patients with bilateral DDH diagnosed after walking age who underwent staging surgical treatment with an interval of six months and evaluated the effect of staging surgery for bilateral DDH.Method:A retrospective review of five patients(ten hips)who underwent staging surgery for bilateral DDH diagnosed after walking age.Three hips were Tonnis stage ? and seven hips were stage ?.The average interval between the two surgery was 6 months.Eight hip joints were treated with open reduction,femoral shortening and rotary osteotomy combined with Salter osteotomy of the pelvis,and one hip joint was only treated with open reduction and Salter pelvic osteotomy.The last one was treated with open reduction,proximal femoral shortening and rotary osteotomy combined with Pemberton pelvic osteotomy.To evaluate the results with radiographic parameter,McKay's clinical criteria and Sever's radiological criteria.Results:The average age of the patients at the first operation was 3 years and 4 months(1.5 to 6 years)and the average age of the patients at the second operation was 3 years and 10 months(2.1 to 6.5 years).The interval between two operations was about 6 months.The average acetabular index of the hip joint decreased from 37.4°preoperative to 26.1°after surgery with the average acetabular index reached 17.7 ° at the last follow-up.Significant difference between preoperative AI and AI after operation with a P value<0.01.At the time of the latest follow-up,based on Severin's radiological criteria,eight hips were graded as grade I,one hip as Grade ?,and one hip as Grade ?,and the average CE angle was 29°.According to McKay 's criteria,the results were grouped as great in eight hips,with two good hips.Conclusions:According to our treatment experience,staged surgery has a good effect on bilateral DDH diagnosis after walking age,it is shows great performance on various hip functional evaluation indicators.The effect of staged surgery on bilateral DDH is worthy of recognition.By controlling the operation interval,the length of the proximal femur osteotomy and the rotation angle were controlled to achieve the concentric reduction of bilateral hip joints.Staging surgery can achieve better results,and reduce the incidence of complications,the treatment of bilateral developmental dislocation of the hip joint is a good method.