Evaluation of Experienced Surgeons' Decisions Regarding the Need for Secondary Surgery in Developmental Dysplasia of the Hip
Evaluation of Experienced Surgeons' Decisions Regarding the Need for Secondary Surgery in Developmental Dysplasia of the Hip
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DOI：
10.1097/bpo.0b013e31823db06b
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发表时间：
2012-01-01
影响因子：
1.7
通讯作者：
Tumer, Yucel
中科院分区：
文献类型：
--
作者：
Omeroglu, Hakan;Agus, Haluk;Tumer, Yucel
背景：我们的目的是评估经验丰富的外科医生对于 5 至 7 岁发育性髋关节发育不良 (DDH) 是否需要二次手术的决定。方法：我们从 17 名患者中选择了 21 个髋关节，这些患者有中期和骨骼成熟的 X 光片，并且在 18 个月前进行了初次 DDH 软组织手术后，在骨骼成熟之前既没有并发症，也没有进行二次手术。 20 名经验丰富的骨科医生对这些髋关节的中期随访 X 光片进行了评估，以确定是否需要进行二次手术。 结果：根据中期随访观察者的处理分级，在骨骼成熟时最终恢复正常的髋关节中，不必要手术处理的风险为 12%。髋部不进行所需手术的风险为 40%，最终会在骨骼成熟时出现发育不良。外科医生的多年经验对管理决策没有显着影响。中心边缘角、髋臼指数角（AIA）、股骨头覆盖百分比、Shenton线和Sharp髋臼角是中期随访时评估是否需要二次手术最常用的5个影像学参数。中心边缘角、AIA、股骨头覆盖率和 Shenton 线相关，而髋臼角与外科医生基于中期 X 线照片的定量处理决策没有显着相关。 结论：即使存在轻微异常的 X 线摄影测量，经验丰富的外科医生更有可能选择对 5 至 7 岁时未显示缺血性变化或不稳定性的髋关节进行非手术治疗。 AIA 被认为是决定 5 至 7 岁 DDH 是否需要二次手术的最佳放射学参数。
Background: We aimed to evaluate experienced surgeons' decisions regarding the need for secondary surgery in developmental dysplasia of the hip (DDH) at 5 to 7 years of age.Methods: We selected 21 hips from 17 patients who had midterm and skeletally mature radiographs and who had neither had complications nor secondary surgery until skeletal maturity after having an initial soft tissue surgery for DDH before the age of 18 months. Twenty experienced orthopaedic surgeons evaluated the mid-term follow-up radiographs of these hips in terms of their need for secondary surgery.Results: On the basis of management grading of the observers at mid-term follow-up, the risk of unnecessary surgical management was 12% in hips that would eventually be normal at skeletal maturity. The risk of not performing needed surgery was 40% in hips that would eventually become dysplastic at skeletal maturity. Experience of the surgeons in terms of years had no significant effect on the management decisions. The center-edge angle, the acetabular index angle (AIA), percentage of femoral head coverage, Shenton line, and the acetabular angle of Sharp were the 5 most commonly used radiographic parameters at mid-term follow-up to assess whether a secondary surgery would be needed. Center-edge angle, AIA, femoral head coverage, and Shenton line correlated, whereas the acetabular angle did not significantly correlate with surgeons' quantitative management decisions on the basis of mid-term radiographs.Conclusions: Experienced surgeons are more likely to opt for nonoperative management in hips that show no ischemic changes or instability at 5 to 7 years of age even in the presence of slightly abnormal radiographic measurements. AIA is considered the best radiographic parameter for making decisions regarding the need for secondary surgery in DDH at 5 to 7 years of age.