The Efficacy Of Modified Salter Pelvic Osteotomy For Developmental Hip Dysplasia In Children

Objective To evaluate the clinical efficacy of both modified Salter pelvic osteotomy and traditional Salter pelvic osteotomy in the treatment of developmental hip dysplasia in children.Methods Retrospective analysis of basic information and imaging data of children who underwent Salter pelvic osteotomy in Ningxia Medical University General Hospital from January 2016 to December 2021,a total of 65 cases with 76 hips.According to the different surgical methods,there were 27 cases(32 hips)in the traditional Salter group and 38 cases(44 hips)in the modified Salter group.To assess the degree of preoperative hip dislocation;to record the length of surgery and intraoperative bleeding;to measure the Acetabular index(AI),Center-edge angel(CEA),and Reimers index before surgery and at the last follow-up.Assessment of modified Severin imaging score and modified Mckay hip function score at the last follow-up visit of the child.To evaluate the occurrence of complications such as postoperative Avascular necrosis of femoral head(AVN),re-dislocation and hip stiffness in children.Paired t-test was used to compare AI,CEA and Reimers index before and after surgery in the conventional Salter group and modified Salter group.Independent samples t-test comparing the difference in operative time,intraoperative bleeding,and postoperative correction parameters between the conventional Salter group and the modified Salter group.The chi-square test evaluated the degree of preoperative dislocation,modified Severin imaging results,modified Mckay hip functional results,incidence of Avascular necrosis of femoral head,incidence of re-dislocation,and incidence of hip stiffness.Results(1)There was no statistically significant difference in the degree of preoperative hip dislocation between the traditional Salter group and the modified Salter group(P>0.05).(2)The mean operative time in the modified Salter group(245.05±29.45)min was shorter than that in the conventional Salter group(273.88±25.07)min,with a statistically significant difference(P<0.05),as assessed by the surgical approach.The mean intraoperative bleeding in the modified Salter group(156.82±18.74)ml was less than that in the conventional Salter group(183.44±24.31)ml,and the difference was statistically significant(P < 0.05).(3)Imaging indexes AI,CEA,and Reimers index were significantly improved in the conventional Salter group and the modified Salter group at the last follow-up compared to their respective preoperative periods(P < 0.05).(4)The mean AI correction was(20.57±3.18)° in the modified Salter group and(18.17±2.97)° in the conventional Salter group,with statistically significant differences between the two groups(P < 0.05).The comparison of CEA and Reimers index correction difference between the conventional Salter group and the modified Salter group was not statistically significant(P>0.05).(5)At the final follow-up,the excellent rate was 81.25% in the conventional Salter group and 84.09% in the modified Salter group according to the modified Severin imaging scale,with no statistically significant difference between the two groups(P>0.05).(6)According to the modified Macky hip function score standard,the excellent rate was 78.13% in the traditional Salter group and 81.82% in the modified Salter group,with no statistically significant difference between the two groups(P > 0.05).(7)Complications: comparing the postoperative AVN,recurrent dislocation and hip stiffness in the conventional Salter group and the modified Salter group,the differences were not statistically significant(P>0.05).Conclusion 1.Both traditional Salter pelvic osteotomy and modified Salter pelvic osteotomy are safe and effective surgical methods for treating children with developmental hip dysplasia from 18 months to 6 years of age,and both have a high rate of excellence.2.Modified Salter pelvic osteotomy simplifies operative steps,shortens the operation time,reduces the intraoperative bleeding,and obtains better acetabular index correction effect compared with the traditional Salter operation,which is worthy of clinical research and promotion.