| PrefaceThe developmental dislocation of the hip ( DDH) is the common disorder in pediatric orthopedics. The deformities of acetabulae is often more severe than proximal femur. The acetabular deformities is well documented by using radiograph and computed tomograph. But they are all two - dimensional imaging. Because the acetabulum is complex three - dimensional construction in space, the three - dimensional computed tomographic imaging ( 3 DCT) can apparently show the more anatomic details in acetabular deformities. The purpose of this study is trying to demonstrate the more details about deformities of acetabulum in DDH by using 3 DCT imaging and combined the analysis of computed tomograph and X - ray imaging. Based on the 3DCT results, we try to search the new classification system according to the radiograph of acetabulum, although DDH can be classified as complete dislocation, subluxation, and dysplasia according to the relationship between acetabulum and femoral head. The current classification system based on the acetabulum all focus on part of deformity. There are no a classifying method according to the whole acetabular deformities. The other purpose of this study is to explore the new classifying method according to the whole acetabular deformities for guiding to clinical therapy. Because the number of patients with late diagnostic DDH is high in our medicine center, and their acetabular deformities were severe than residual dysplasia and subluxation of the hip. The Pemberton osteotomy is difficult to correct the severe deformities of the acetabulum in these patients with late diagnostic DDH. So we changed osteotomymethod based on Pemberton technique, and used this modified technique to treat some patients with DDH. Our purpose is to evaluate results of this technique.MethodsWe retrospectively review the 3DCT, 2DCT, and X - ray imaging of 69 hips in 44 patients with DDH (mean age 5. 9 years, range 1-14 years). The patients were categorized three groups; complete dislocation (35 hips) , sublux-ation (25 hips) , and dysplasia (9 hips). And these patients were further classified three subgroups: 1 - 3 years old ,3-8 years old, and more than 8 years old. The 19 normal hips in patients with unilateral DDH was as control group. The whole acetabular deformities was observed qualitatively. Some parameters were employed including the acetabular rim deficiency, the protrusion of acetabular floor and ischium, the appearance of acetabular fossa in 3DCT imaging, the ischial appearance in 2DCT imaging, and the teardrop figure in X - ray film. In 2DCT imaging, some quantitive parameters were also employed to evaluate the acetabulum including the acetabular index of axial - plane, the acetabular anteversion, the width of acetabulum, the thickness of center acetabular wall, and the distance between acetabular center and the vertical phalange of tri-radiate cartilage between pubis and ischium.We reviewed the anterioposterior X - ray films of 144 hips in 92 patients with DDH retrospectively. Some parameters were employed including the acetabular index ( AI) , the angle of teardrop ( AT) , the ratio of acetabular rim length to diameter of femoral head ( RAH ). We developed a new classification system based on the AT and RAH. It was observed that the distribution of the acetabular type based on the new classification system in complete dislocation, subluxation, and dysplasia.We retrospectively reviewed the clinical and radiograph data of 48 patients with DDH at pre - , postoperative, and follow - up time. All patients were underwent the modified Pemberton osteotomy in our medical center. The morphological course of reductive hips were observed, and the function of the hips andcomplications were also evaluated.ResultsIn 3DCT imaging, the acetabulum of all patients with DDK lost regular socket in appearance. Of complete dislocation of the hip, the acetabular rim deficiency is mainly type IV of Kim classification system, and the severity of this deficiency is increasing with the age growth, an...
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