Surgical Approaches for Triple Pelvic Osteotomy in Children With Hip Dysplastic Instability: Assessment of Muscle Damage

Abstract

Background. The invasiveness of surgical approaches for hip surgeries is primarily determined by the severity of the muscle injury. To date, surgeons use from one to three surgical approaches for osteotomy of the pelvic bones and acetabulum reorientation. An analysis of the scientific literature showed the lack of studies comparing the muscle trauma at different surgical approaches for triple pelvic osteotomy in children.

The aim of this study — to evaluate the degree of muscle injury during triple pelvic osteotomy through various surgical approaches in patients with developmental dysplasia of the hip (DDH).

Methods. The study included 70 patients (70 hip joints) aged 12–18 years (15.2±1.4) with Crowe type I DDH treated between 2020 and 2021. All children were divided into two groups: group I consisted of 35 patients (35 hip joints) who underwent triple pelvic osteotomy using an anterolateral approach, group II — 35 patients (35 hip joints) who underwent triple pelvic osteotomy through two approaches (medial and bikini). In addition to standard radiometry of hip joints, pain severity based on the visual analog scale (VAS) and blood markers levels of muscle injury (lactate dehydrogenase, creatine phosphokinase, aspartate aminotransferase and C-reactive protein) were evaluated before and at 3^rd and 7^th days after surgery.

Results. Pain severity assessment by VAS was more pronounced (p<0.05) in patients who underwent surgery using an anterolateral access. Values of CPK and C-reactive protein significantly (p<0.05) exceeded those in patients who underwent triple pelvic osteotomy through two surgical approaches. The results of the study indicate greater hip muscles trauma during the anterolateral approach for triple pelvic osteotomy.

Conslusion. The use of anterior-lateral approach when performing triple pelvic osteotomy in children with Crowe type I DDH causes more (p<0.05) muscle tissue trauma compared to two surgical approaches (medial and bikini). This is evidenced by a significant increase of creatine phosphokinase and C-reactive protein, as well as a more severe pain syndrome in the immediate postoperative period.

Keywords

developmental dysplasia of the hip / surgical approaches / triple pelvic osteotomy / pain syndrome / biochemical markers of muscle trauma

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Funding

Министерство здравоохранения Российской ФедерацииMinistry of Health of the Russian Federation(121031700122-6)

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