Publication: Spina bifidalı çocuklarda kalça instabilitesinin tedavisi
Abstract
Amaç: Kalça instabilitesi nedeniyle ameliyat edilen spina bifidalı çocuklarda cerrahi tedavi sonuçlan değerlendirildi. Çalışma planı: Kalça inştabilitesi (subluksasyon/çıkık) nedeniyle 26 hastanın (16 kiz, 10 erkek; ort. yaş 4.5; dağılım 3-6) 28 kalçası ameliyat edildi. Yirmi dört çocukta alçak seviye (L4-sakral) lezyon ve yürüme potansiyeli (2 olguda iki taraflı çıkık) vardı; bunların 16'sında tek taraflı çıkık yanı sjr ra bacak boyu eşitsizliği (>2 cm) ve kompansatuvar skolyoz görüldü. Yüksek seviye (torasik-L3) tutulum ve tek taraflı çıkık olan iki çocukta yürürne yoktu. Yüksek seviye tutulumu olan iki hastada ve alçak seviye lezyonlu hastaların bir kısmında (9/26 kalça) kalça fleksiyon kontraktürü de saptandı. Kalça stabilitesinin sağlanmasına yönelik olarak açık redüksiyon, pelvik osteotomi, gerektiğinde femoral osteotomi ve pelvipedal alçı uygulamasına başvuruldu. Hastalar ortalama 38 ay (dağılım 30-48 ay) süreyle klinik ve radyografik olarak izlendi. Sonuçlar: Bacak boyu eşitsizliği ve skolyoz olan 16 hastanın 14'ünde yürüme fonksiyonlarında gelişme görüldü; iki hastada eşitsizlik ve skolyoz devam etti. Diğer hastalarda, ameliyat öncesi fonksiyonel durumların ameliyat sonrasın¬da korunduğu görüldü. Ameliyattan sonra kalçaların ortalama hareket açıklığı azaldı, fakat hiçbirinde eklem sertliği gelişmedi. Üç olguda yüzeyel yara enfeksiyonu, iki olguda distal femoral diyafiz kırığı, dışında ameliyat sonrası erken dönemde komplikasyon gözlenmedi. Üç hastanın implantları, cilt altında belirginleşmeleri nedeniyle altıncı ayda çı¬kartıldı. Üç hastanın geç dönem radyografilerinde, girişim gerektirmeyen subluksasyon tekrarı gözlendi. Çıkarımlar: Spina bifidalı çocuklarda, yüksek seviye lezyonlara bağlı kalça sorunlarında cerrahi tedaviden genellikle kaçınmak gerekirken, alçak seviye lezyonlarla birlikte olan , kalça instabilitesinde başarılı sonuçlar alınabilmektedir
Objectives: We evaluated the results of surgical manaj ment of hip instability in children with spina bifida (SB). Methods: Twenty-eight hips of 26 patients (16 girls, 10 boy mean age 4.5 years; range 3 to 6 years) were surgically ma aged for hip instability (subluxation/dislocation) associat with SB. Twenty-four patients (2 bilateral dislocations) h low-level lesions (L4-sacral) and a potential to walk, of whi 16 patients presented with unilateral dislocation with fun tional problems including significant (>2 cm) limb-length d: crepancy and scoliosis. Two patients had high-level lesio (thoracic-]) associated with unilateral dislocations and we unable to walk. Those with a high-level lesion and sor patients (9/26 hips) with a low-level lesion also had hip fie ion contractures. Treatment included open reduction, pel\ osteotomy, proximal femoral osteotomy when necessary, ai a spica cast. The patients were clinically and radiographical monitored for a mean of 38 months (range 30 to 48 months Results: Of 16 patients with functional problems, 14 patier had improvement in their gait patterns, while limb-length di crepancy and scoliosis persisted in two. The remaining : patients maintained their preoperative functional statuses. Tl mean range of motion of the hips decreased postoperative however, none of them developed joint stiffness. Early properative complications included superficial wound infectio; in three patients, and distal femoral diaphyseal fractures in tv patients. Three patients required removal of the implants in tl sixth month due to subcutaneous prominence thereof. La radiographs of three patients showed recurrent subluxatior which did not require any intervention. Conclusion: Although surgical treatment of hip problen associated with high-level lesions may be unrewarding children with SB, those associated with low-level lesions ci be successfully managed with proper surgical indications.
Objectives: We evaluated the results of surgical manaj ment of hip instability in children with spina bifida (SB). Methods: Twenty-eight hips of 26 patients (16 girls, 10 boy mean age 4.5 years; range 3 to 6 years) were surgically ma aged for hip instability (subluxation/dislocation) associat with SB. Twenty-four patients (2 bilateral dislocations) h low-level lesions (L4-sacral) and a potential to walk, of whi 16 patients presented with unilateral dislocation with fun tional problems including significant (>2 cm) limb-length d: crepancy and scoliosis. Two patients had high-level lesio (thoracic-]) associated with unilateral dislocations and we unable to walk. Those with a high-level lesion and sor patients (9/26 hips) with a low-level lesion also had hip fie ion contractures. Treatment included open reduction, pel\ osteotomy, proximal femoral osteotomy when necessary, ai a spica cast. The patients were clinically and radiographical monitored for a mean of 38 months (range 30 to 48 months Results: Of 16 patients with functional problems, 14 patier had improvement in their gait patterns, while limb-length di crepancy and scoliosis persisted in two. The remaining : patients maintained their preoperative functional statuses. Tl mean range of motion of the hips decreased postoperative however, none of them developed joint stiffness. Early properative complications included superficial wound infectio; in three patients, and distal femoral diaphyseal fractures in tv patients. Three patients required removal of the implants in tl sixth month due to subcutaneous prominence thereof. La radiographs of three patients showed recurrent subluxatior which did not require any intervention. Conclusion: Although surgical treatment of hip problen associated with high-level lesions may be unrewarding children with SB, those associated with low-level lesions ci be successfully managed with proper surgical indications.