ACETABULAR DEVELOPMENT AFTER SUPRAACETABULAR TUNNELIZATION IN CHILDREN WITH HIP CONGENITAL DYSPLASIA

Abstract

Introduction. The technology of wire tunnelization of joint elements is used at RISC “RTO” for treatment of young children (10-30 months) with the hip dysplasia of various forms. Aim - to assess the effect of supraacetabular tunnelization on the formation of dysplastic acetabula. Material and methods. The results of treatment 18 children (21 joints) with the hip congenital dysplasia of II (14 joints) and III (7 joints) degree according to Tonnis have been analyzed. Gradual closed reduction of the dislocation has been performed in all the cases. Mean age at the time of reduction was 8,2±0.56 months (5-14 months). Supraacetabular tunnelization was made six months after dislocation reduction. Indications for intervention were considered in view of the x-ray parameters and signs of acetabulum showing its potential developmental delay. Results. The initial value of the acetabular index on the side of dislocation amounted to 43±0.8°. The impairment of the shape of acetabular vault and its upper-and-outer edge of moderate (9 joints) and severe (12 joints) degree has been observed in all the joints involved. The mean value of the acetabular index amounted to 22.1±0.947° (P

References

[1] Патент 311884 РФ МПК7А61В17/56. Способ лечения врожденной дисплазии вертлужной впадины. Макушин В.Д., Логинова Н.Г., Тепленький М.П. ; РНЦ "ВТО" им. акад. Илизарова. № 2006113051 ; Заявл. 18.04.06. ; опубл. 10.12.07. Бюл № 34.

[2] Шевцов В.И., Макушин В.Д., Тепленький М.П., Атманский И.А. Лечение врожденного вывиха бедра. Курган: Зауралье; 2006. 1000 с.

[3] Boniforti F.G., Fujii G., Angliss R.D., Benson M.K. The reliability of measurements of pelvic radiographs in infants. J Bone Joint Surg Br. 1997;79(4):570-575.

[4] Chen I.H., Kuo K.N., Lubicky J.P. Prognosticating factors in acetabular development following reduction of developmental dysplasia of the hip. J. Pediatr. Orthop. 1994;14(1):3-8.

[5] Cherney D.L,. Westin G.W. Acetabular development in the infant's dislocated hips. Clin. Orthop. Relat Res. 1989;(242):98-103.

[6] Connolly P Weinstein S. The natural history of acetabular development in developmental dysplasia of the hip. Acta OrthopTraumatolTurc. 2007;41 Suppl.1:1-5.

[7] Greenhill B.J., Hainau B., Ellis R.D., el-Sayed R.M. Acetabular changes in an experimental model of developmental dysplasia of the hip (DDH). J. Pediatr. Orthop. 1995;15(6):789-793.

[8] Inan. M..[Current approaches to the treatment of developmental dysplasia of the hip. Acta Orthop. Traumatol. Turc. 2007;41 Suppl. 1:68-73.

[9] Kim H.T., Kim J.I., Yoo C.I. Acetabular development after closed reduction of developmental dislocation of the hip. J. Pediatr. Orthop. 2000;20(6):701-708.

[10] Kitoh H., Kitakoji T., Katoh M., Ishiguro N. Prediction of acetabular development after closed reduction by overhead traction in developmental dysplasia of the hip. J. Orthop. Sci. 2006;11(5):473-477.

[11] Lindstrom J.R., Ponseti I.V., Wenger D.R. Acetabular development after reduction in congenital dislocation of the hip. J. Bone Joint Surg. Am. 1979;61(1):112-118.

[12] Mladenov K., Dora C., Wicart P., Seringe R. Natural history of hips with borderline acetabular index and acetabular dysplasia in infants. J. Pediatr. Orthop. 2002;22(5):607-612.

[13] Portinaro N.M., Matthews S.J., Benson M.K. The acetabular notch in hip dysplasia. J. Bone Joint Surg. Br. 1994;76(2):271-273.

[14] Race C., Herring J.A. Congenital dislocation of the hip: an evaluation of closedreduction. J. Pediatr. Orthop. 1983;3(2):166-172.

[15] Saisu T., Kamegaya M., Wada Y., Takahashi K., Mitsuhashi S., Moriya H., Maier M. Acetabular augmentation induced by extracorporeal shock waves in rabbits. J. Pediatr. Orthop. B. 2005;14(3):162-167.

[16] Salter R.B., Dubos J.P. The first fifteen year's personal experience with innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. Clin. Orthop. Relat. Res. 1974;(98):72-103.

[17] Schuster W. Radiologic criteria for evaluation of dysplasia of hips. In: Progress in orthopaedic surgery. Vol 2. Acetabular dyspasia and skeletal dysplasia in childhood. Heidelberg: Springer; 1978. p.77-84.

[18] Tasnavites A., Murray D.W., Benson M.K. Improvement in acetabular index after reduction of hips with developmental dysplasia. J. Bone Joint Surg. Br. 1993;75(5):755-759.

[19] Tönnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin. Orthop. Relat. Res. 1976;(119):39-47.

[20] Tönnis D. Surgical treatment of congenital dislocation of the hip. Clin.Orthop. Relat. Res. 1990;(258):33-40.