A síndrome de Legg-Calvé-Perthes ou doença de Perthes é uma doença degenerativa da articulação da anca (quadril em Outros, Displasia fibrosa ( Monostótica, Poliostótica) · Fluorose óssea · cisto ósseo (Cisto ósseo aneurismático). Palavras-chave: Luxação congênita de quadril/patologia. r e s u m o. Objetivos: avaliar os resultados radiográficos de pacientes portadores de displasia do. Acadêmicas: Ana Carolina Correa Dhebora Souza Chao Fabíola Esteves Mariana Almeida Abrantes A incidência varia de acordo com fatores.
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To evaluate the radiographic results, the acetabular index and the Wiberg center-edge angle were measured, quadri the Severin and Kalamchi-MacEwen classifications were used. Descriptive and displaaia statistical analyses were used to evaluate the data. The most prevalent complication in the study group was avascular necrosis of the femoral head. Developmental dysplasia of the hip DDH comprises a spectrum of abnormalities during the development of this joint that vary according to the patient’s age and go from self-limiting defects without long-term consequences to dislocation that may lead to permanent deficiency.
When instituted within the first days of life, a high success rate and reduced complication rate are achieved. As the child grows, the anatomical alterations increase, which makes the treatment more difficult. In children over the age of 18 months, the treatment varies from closed reduction with plaster-cast immobilization to open reduction in association with osteotomy. Material and methods This was a retrospective descriptive study.
Treatment was provided for patients: Among the osteotomy cases, 11 patients 9. Among the remaining 91 patients Em todos os outros o material foi retirado. We analyzed 21 patients with bilateral DDH 42 hips operated. Of these, 19 The mean age at the time of diagnosis was 2. The mean length of follow-up was 5. The length of postoperative immobilization was six weeks.
Displasia Do to Do Quadril
The patients were treated by two surgeons. In two cases 9. The other patients In one patient, the osteosynthesis material was not removed because of technical difficulties.
In all the others, the materialwas removed. The mean length of time after the operation for this procedure to be performed was We used the Sestatnet software19 to analyze the data and the significance level was found to be 0. Results The mean preoperative AI was 38? There was no statistical difference in relation to this finding, which indicated that the sample was homogenous Table 1.
The mean AI sixweeks after the operationwas The mean for the right side was There was no significant difference Table 1.
Síndrome de Legg-Calvé-Perthes – Wikipédia, a enciclopédia livre
The quavril mean for the late postoperative AI was There was no statistically significant difference, but there was a significant difference in comparing the preoperative AI with the AI six week after the operation and with the late postoperative AI Table 1.
The degree of femoral head necrosis was evaluated.
There was no necrosis in eight patients, while two were affected bilaterally and eleven presented unilateral necrosis. Out of the 42 hips operated, 27 did not present necrosis In relation to the side affected, we did not find any statistically significant difference Table 2 Figs.
There was no significant difference between the sides Table 2. Out of the total number of hips, according to the classification of Severin17 Table 228 In comparing the sides, we did not find any statistically significant difference. The patients’ mean age at the time of the first surgical procedure was 3.
Another criterion analyzed was in relation to the patients who required femoral shortening. There was no statistically significant difference in any of the criteria analyzed: Surgical revision was necessary for four hips 9. Discussion The treatment for DDH has the basic premise of attaining stable concentric reduction of the hip into the functional weight-bearing position.
Instability of the reduction originates from poor positioning of the acetabulum in the anterior and lateral directions. Open reduction in association with Salter’s osteotomy of the iliac bone in order to redirect the acetabulum is today a classical treatment method. Many authors have recommended that open reduction in association with osteotomy of the innominate bone for correction of acetabular dysplasia should be performed on children at a minimum age of 18 months21 and that the technique described by Salter22 should be applied to patients at a maximum age of six years.
Several studies have clinically and radiographically evaluated the pre- and postoperative conditions of children with DDH who underwent open reduction and Salter’s osteotomy,2,11,20,21, but none of them used samples consisting only of patients affected bilaterally.
In the present study, 21 patients with bilateral DDH with a mean interval of 7.
The variation in the time between the procedures was due to the recovery of mobility in the hip that was operated first.
X-ray on August risplasia,two years and five months after operation on right hip and one year and six months after operation on left hip B. X-ray on October 2,three years and three months after operation on right hip and two years and eight months after operation on left hip, presenting type I necrosis of the femoral head C. Among the 10 patients with bilateral involvement, 10 jointswere operated between the ages of two and four years and the other ten joints between four and seven years of age, with a mean interval qudaril four months between the surgical procedures.
All of them underwent open reduction and Salter’s osteotomy, with or without associated rotational and varus osteotomy of the femur. In our sample, we did not perform varus correction.
Carvalho Filho et al.
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The surgerywas performed in a single procedure and the patients’ mean agewas 19 months. In these bilateral cases, quadeil mean time between the surgical procedures was six months.
X-ray in Januarythree months after operation on left hip and six months after operation on right hip B. X-ray in Octoberin the late postoperative period, seven years after operation on right hip and six years and nine months after operation on left hip, presenting type 4 necrosis of the femoral head C.
There were 22 bilateral cases, which were operated with an interval of six weeks. Bhuyan25 waited three to six months to perform the procedure on the contralateral hip.
Regarding the postoperative follow-up on the patients of the present study, the mean duration was 5. X-ray in July X-ray in Augustat the age of 15 years and 11 months: Many authors have described follow-ups on treated patients ranging from one year to 24 years and six months. Regarding the AI sixweeks after the operation, the mean valuewas found to be The mean for the late postoperative AIwas Therewas a statistically significant difference between the pre- and postoperative AIs p Carvalho Filho et al.
Although the valueswere higher, they also observed a significant difference from before to after the operation p Yagmurlu et al. The mean preoperative AI was Bhuyan26 reduced the AI from 42? Among 63 children, Chang et al. In our study, there was a decreasing trend in AI values with passage of time, changing to The postoperative Wiberg CE angle obtained in our analysis was Better results were found by Carvalho Filho et al.
Femoral shorteningwas performed on 24 hips, without any difference in the radiographic evaluation in relation to the cases without shortening. They suggested that femoral shortening should be used as an auxiliary surgical treatment method for DDH, since the final result depends on the procedures used in addressing the joint problem.
They reported that, because of the diminished or even absent potential for recovery of acetabular development, simple replacement procedures in children over the age of three years give rise to unsatisfactory medium and long-term results. Amongdislocated hips thatwere operated after the child had reached four years of age, the rate of satisfactory results decreased to In relation to the duration of immobilization after the operation, Rocha et al.
The time interval until removal of the synthesis material ranged from three months to five years and ten months, with a mean of Some complications from Salter’s osteotomy have been described, such as superficial and deep infection, subluxation, renewed dislocation, chondrolysis, neuropraxia of the sciatic nerve and avascular necrosis.
We did not find any cases of superficial or deep infection. There were three cases of renewed dislocation, which were resolved through a new surgical procedure. We noted that in the cases of avascular necrosis, especially those of types 3 and 4, seven They did not cite the classification used, or the likely cause of the event.
We considered that renewed dislocation and bone necrosis predisposed patients to poor functional and radiographic results.
These resultswere concordant with those of Holman et al. Conclusions Open reduction in association with osteotomy of the iliac bone as described by Salter presented a statistically significant improvement in the angular parameters measured on the patients’ radiographs, from before to after the operation.
There was no significant difference regarding the results between the sides operated. Avascular necrosis of the femoral head was the most prevalent complication in the group studied and this had a relationship with higher dislocation and patients of more advanced age. Conflicts of interest The authors declare no conflicts of interest. Wilkinson AG, Wilkinson S. Developmental dysplasia of the hip.
Data Trace Publishing Company; Acetabular dysplasia and familial joint laxity: A review of patients and their families.
J Bone Joint Surg Br. The anatomy and pathology of congenital dislocation of the hip.