| Objective:The after a median follow-up of Pemberton Transiliac osteotomy in the treatment of children with DDH,evaluate pelvic Pemberton osteotomy surgery effect and analysis of its impact on acetabular growth and development.And to analyze the related factors that influence the final effect of the children.Methods:A retrospective analysis of 57 patients who underwent Pemberton osteotomy of the Children’s Hospital of Chongqing Medical University.The clinical results were evaluated according to the modified Mckay standard,and the imaging was evaluated according to the Severin standard.All children were measured before and after the operation of AI,depth of acetabulum and acetabular top width,the operation of unilateral hip dislocation in children after adding to measure acetabular head index and CE angle,and statistical analysis, measurement data to average±standard deviation( ? x±s) express,using SPSS 22.0 were statistically analyzed,before and after surgery by t-test and good side and sick side contrast using paired t test,with P<0.05 as the difference has statistical significance.According to the last follow-up, we will all curative effect is divided into good prognosis and poor prognosis of two groups. Any person who meets any of the following criteria will be classified as poor prognosis group:last follow-up AI>21°、center-edge angle<20°、clinical effect of Mckay standard is assessed as medium or poor、The evaluation of imaging Severin is medium or poor,include any one of these.The rest are good prognosis group.The two groups of hip joint respectively according to the operation of children with age<3.5 years old and ≥3.5 years old,preoperative AI<31 degrees and ≥31 degrees, preoperative hip Tonnis type below III and IV compared statistically analysis, using chi square test,P<0.05 for the differences have statistically significant.Results: 57 cases of children with 76 hips followed up. Patients were followed up for an average of 3 years(1.0 ~ 7.2 years). Mean age at operation was 3.8 years(1.3 years to 12 years), at the time of the last follow-up average age of 6.8 years(3.5 years old to 18 years old), 4acetabular epiphysis has closed, 1 person appear acetabular "Y" shaped cartilage closed early. Avascular necrosis of the femoral head was 3, found no hip joint collision appears. At the last follow-up clinical efficacy evaluation: excellent 36 cases, good 16 cases, fair 3 cases, poor 2 cases,excellent and good rate was 91.2%. The imaging evaluation: excellent 41 hips, good 26 hips, fair 7 hips, poor 2 hips, excellent and good rate was88.1%.57 cases of 76 hips with preoperative AI 34.83°±6.39°(25°-50.7°), the last time the AI is 15.51°±4.92°(4.1°-36.7°), P<0.05, the difference was statistically significant,indicating that postoperative children with AI has been rectified effectively.Preoperative acetabular depth is8.79mm±1.94mm(3.6mm-14.5mm).Postoperative last follow-up acetabular depth 13.07mm±1.97mm(8.36mm-22.96mm), P<0.05, the difference has statistical significance;preoperative acetabular roof width is15.77mm±4.48mm(4.2mm-12.7mm),Postoperative acetabular roof width is25.90mm±4.28mm(17.47mm-48.84mm),P<0.05,the difference has statistical significance. Description of postoperative acetabular both in width and in depth have been significantly improved.38 cases of unilateral hip dislocation with preoperative AI was35.82°±1.04°(25.0°-50.7°),postoperative first check the affected side AI was 17.27°±1.04°(5.1°-39.1°),P<0.05,the difference has statistical significance,explain postoperative children with AI has been rectified effectively.The contralateral AI was 18.19°±3.71°(12.0°-28°), compared with the postoperative first check AI,P>0.05,the difference was not statistically significant,indicating that children with acetabular through operation basically reached contralateral level.At the time of the last follow-up, the affected side AI was 15.89°±8.08°(4.1°-36.7°),the contralateral AI was 15.47°±4.05°(6.7°-27.7°);the acetabular depth of the affected side was 14.86mm±2.85mm(8.59mm-19.71mm),the contralateralacetabular depth was 15.16mm±3.50mm(9.71mm-18.79mm);the CE angle of the affected side was 37.55°±17.20°(4°-67.6°),the contralateral CE angle was 33.24°±8.25°(18.80°-47.6°), all of the P values were greater than 0.05, the differences were not statistically significant. There was no significant difference between the ipsilateral hip joint and the healthy side.At the time of the last follow-up, the acetabular roof width of the affected side was 29.21mm±5.17mm(19.84mm-46.71mm),the contralateral was26.39mm±6.24mm(17.47mm-42.57mm);the acetabular head index of the affected side was 0.93±0.22(0.60-2.1), contralateral acetabular head index was 0.81±0.09(0.63-0.94),P<0.05,the difference was statistical significance.Surgical correction of the width of the acetabular roof is larger, the femoral head is better.Good postoperative effect group and postoperative effect were compared, the number of children with hip surgery age < 3.5 years for 55 hips, 9 hips(16.4%) for the poor, the number of hip surgery aged 3.5 years for 21 hips, 8 hips(38%) for the poor, P < 0.05, the difference was statistically significant, younger children showed better recovery effect;preoperative AI hip number less than 31 degrees have 24 hips, 2 cases(8.3%) for the poor, preoperative AI more than 31 degrees have 52 hips, 15hips(46.8%) postoperative effect were poor, P<0.05, the difference was statistically significant, the preoperative AI was larger, and the operation effect was slightly worse.; preoperative degree of dislocation Tonnis gradebelow III was 34 hips, 6 hips(17.6%) the effect was poor, type Ⅳ 42 hips,11 hips(26.1%) effect were poor,P>0.05,the difference was not statistically significant, there was no significant correlation between the degree of preoperative dislocation and the effect of operation;after the first inspection of AI is less than 18 degrees in 45 hips, 3 hips(6.7%) effect is poor, AI is more than 18 degrees in 31 hips, 14 hips(45.6) effect is poor,P<0.05,the difference was statistically significant, it shows that the recovery effect is poor when the operation is not enough.Conclusions:Pemberton pelvic osteotomy for the treatment of DDH is effective method to change the acetabulum, femoral head inclusive, correct operation will not affect the normal development of the acetabulum, it is worthy of popularization and application. Preoperative AI is greater than 31 degrees and postoperative AI is greater than 18 degrees, the prognosis is poor, the operation should be as far as possible to let the AI to 18 degrees below. There is no obvious correlation between the Tonnis classification and the operation effect. However, the effect will be better if the operation is performed before 3.5 years old. |
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