Effects of sevoflurane and propofol on coagulation function and postoperative recovery in children with congenital dislocation of hip joint / 中国输血杂志

【Objective】 To investigate the effects of sevoflurane and propofol on coagulation function and postoperative recovery in children with congenital dislocation of hip joint. 【Methods】 A total of 92 children with congenital dislocation of hip joint admitted to our hospital from June 2017 to June 2020 were studied. According to the random sampling method, the subjects were divided into sevoflurane group and propofol group with 46 cases in each group, Sevoflurane and propofol were administered to the sevoflurane group and the propofol group during anesthesia induction and maintenance, respectively, The changes of hemodynamic index, body temperature, coagulation function before and after operation, postoperative outcome and the incidence of complication were compared between the two groups at different time points of anesthesia. 【Results】 Few significant differences in SBP, DBP, HR at different time points of anesthesia were noticed between the two groups (P>0.05). The body temperature of children in the study group at T1, T2 and T3 was significantly lower than that of the sevoflurane group (P0.05) between the two groups. In the propofol group, there was no statistically significant difference in coagulation indexes before and after surgery (P>0.05), while in the sevoflurane group, all coagulation indexes after surgery were significantly higher than before surgery (P<0.05). The retention time, wake time, extubation time and hospital stay length of the children in the propofol group were significantly shorter than those in the sevoflurane group (P<0.05). The incidence of complication in the propofol group was significantly lower than that of the sevoflurane group (P<0.05). 【Conclusion】 Compared with sevoflurane, propofol anesthesia maintenance is more beneficial to reduce the incidence of intraoperative hypothermia, and does not affect the hemodynamic indexes and coagulation function of the body, which is of positive significance for promoting postoperative anesthesia recovery and shortening the recovery time of children with congenital dislocation of hip joint.

Periacetabular osteotomy with concomitant hip arthroscopy: a case series with 24 months minimum follow-up

PURPOSE To describe patient-reported outcomes, radiological results, and revision to total hip replacement in patients with hip dysplasia that underwent periacetabular osteotomy as isolated treatment or concomitant with hip arthroscopy. METHODS Case series study. Between 2014 and 2017, patients were included if they complained of hip pain and had a lateral center-edge angle ≤ of 20°. Exclusion criteria included an in-maturate skeleton, age of 40 or older, previous hip surgery, concomitant connective tissue related disease, and Tönnis osteoarthritis grade ≥ 1. All patients were studied before surgery with an anteroposterior pelvis radiograph, false-profile radiograph, and magnetic resonance imaging. Magnetic resonance imaging was used to assess intraarticular lesions, and if a labral or chondral injury was found, concomitant hip arthroscopy was performed. The non-parametric median test for paired data was used to compare radiological measures (anterior and lateral center-edge angle, Tönnis angle, and extrusion index) after and before surgery. Survival analysis was performed using revision to total hip arthroplasty as a failure. Kaplan Meier curve was estimated. The data were processed using Stata. RESULTS A total of 15 consecutive patients were included; 14 (93%) were female patients. The median follow-up was 3.5 years (range, 2 to 8 years). The median age was 20 (range 13 to 32). Lateral center-edge angle, Tönnis angle, and extrusion index correction achieved statistical significance. Seven patients (47%) underwent concomitant hip arthroscopy; three of them (47%) were bilateral (10 hips). The labrum was repaired in six cases (60%). Three patients (15%) required revision with hip arthroplasty, and no hip arthroscopy-related complications are reported in this series. CONCLUSION To perform a hip arthroscopy concomitant with periacetabular osteotomy did not affect the acetabular correction. Nowadays, due to a lack of conclusive evidence, a case by case decision seems more appropriate to design a comprehensive treatment.

Realineamiento Proximal del Mecanismo Extensor en la Luxación Congénita de la Rótula en Niños y Adolescentes / Proximal Realignment of the Extensor Mechanism in Congenital Dislocation of the Knee in Children And Adolescents

Introducción La luxación congénita de la rótula (LCR) es una entidad poco frecuente. El diagnóstico precoz suele ser difícil porque la rótula en el recién nacido es pequeña y de difícil palpación. El tratamiento no quirúrgico ha demostrado ser ineficaz. El enfoque terapéutico de esta patología requiere de la liberación externa y extensa del cuádriceps, el avance del vasto interno oblicuo y de la transferencia o hemitransferencia del aparato extensor. Materiales y métodos se busca evaluar la funcionalidad de los pacientes tratados quirúrgicamente mediante realineamiento proximal del mecanismo extensor por la técnica descrita por Green y modificada por los autores. Desde el año 2000 hasta el año 2015 se recolectaron 15 pacientes (20 rodillas) con diagnóstico de LCR tratados quirúrgicamente mediante la técnica descrita. Resultados Los resultados postoperatorios fueron evaluados mediante el cuestionario Kujala: 93.8/100 en promedio. Discusión El tratamiento de la LCR es un desafío y más aún si se encuentra asociada a retracción idiopática del recto anterior. Los resultados clínicos y funcionales obtenidos sugieren que la recolocación anatómica y estable de la rótula dentro de la tróclea femoral permite una satisfactoria alineación extensora del cuádriceps, desapareciendo su acción flexora inicial, lo que permite la elongación progresiva del mecanismo extensor durante las fases postoperatorias de rehabilitación. La técnica quirúrgica descrita ofrece una buena alternativa para el tratamiento de esta infrecuente patología congénita de la rodilla.

Background Congenital dislocation of the patella (CDP) is a rare condition. The early diagnosis is difficult, as the patella in the newborns is small and also difficult to recognise. The therapeutic approach of this disorder requires the extended and external release of the quadriceps, the forward movement of the internal oblique vastus, and the transfer or hemi-transfer of the extensor compartment. Methods To review the functionality of those patients who have received surgical treatment with proximal realignment of the extensor mechanism using Green's surgical technique and the one modified by the author. Between the years 2000 and 2015, a total of 15 patients with 20 knees found to have had congenital dislocation of the patella, and had received the abovementioned surgical treatment. Results The post-operative results were evaluated using the Kujala questionnaire, which gave a mean result of 93.8 / 100. Discussion The CDP treatment is a challenge, and even more so if it is associated with an idiopathic retraction of the anterior rectus. The clinical and functional results obtained suggest that an anatomic and stable realignment of the patella in the femoral trochlea allows a satisfactory extensor alignment of the quadriceps. This leads to the disappearance its initial flexor action, which allows the gradual elongation of the extensor mechanism during the postoperative phases of rehabilitation. The surgical technique described offers a good alternative for the treatment of this rare congenital disorder of the knee.

Analysis Of Femoral Neck Anteversion In Dry Adult Bones: A Morphometric Study

Introduction: The femoral neck anteversion can be defined as the angle between femoral bicondylar plane and aplane passing through the centre of the neck and head of femur. Adult femoral anteversion has been documentedat the range between 7-16 degrees.This angle is widely recognized as an important factor for hip stability. Thepresent study aimed to evaluate the normal anteversion range in adult Indian femur which would be of great helpin explorative orthopedic procedures and in designing of hip prosthesis.Materials and Methods: Study conducted in 202 femurs of 94 male (48 right and 46 left) and 108female bones (52right and 56 left). And the angle was measured using Kingsley Olmsted Method.Observation and Results: The mean value of anteversion angle of femurwas 7.61 degrees for male and 12.71degrees for females.Mean anteversion angle for both male and female femur was 10.37 degrees. Retroversionwas observed in 10 femurs(5%) and neutral version was observed in12 femurs (5.9%).Conclusion:Determining the anteversion angle is crucial for the diagnostic and therapeutic planning of patientswith various pathologies such as hip development dysplasias, cerebral palsy, varum thigh, flat thigh,epiphysiolysis, congenital club foot, congenital dislocation of the hipand other development abnormalities.Statistical analysis revealed sexual dimorphism in anteversion in Indians being greater among females thanmales

High congenital hip dislocation in adults - arthroplasty and functional results / Luxações congênitas altas da anca no adulto - Artroplastia e resultados funcionais

ABSTRACT Objective: Retrospective case-control study on the authors' experience regarding arthroplasty in high congenital dislocations of the hip in adults. Methods: Sample with 11 high congenital hip dislocations (Hartofilakidis type C) that occurred in seven patients, who were submitted to hip arthroplasty by the same surgeon and with the same surgical technique. Mean follow-up period was 4.32 ± 2.67 years (minimum one year) and all patients were evaluated by the same examiner. Results: All the arthroplasties had cementless fixation, with application of screwed acetabular cups, conical femoral stems, and a metal-polyethylene articular pars. In every patient, shortening femoral osteotomies were performed at subtrochanteric or supracondylar locations. The mean Harris Hip Score at the last evaluation was 88.55 ± 4.50 (range 81-94). The mean time with high dislocation of the hip (42.91 ± 14.59 years, range 19-68) showed a significant inverse correlation with Harris Hip Score (r = 0.80; p = 0.003). All patients reported important relief of pain complaints and are capable of ambulation without any external support. In the unilateral dislocations, leg length discrepancies were fully corrected; in the bilateral cases, isometric limbs were achieved in all patients. All osteotomies consolidated, with a mean interval of 3.27 ± 0.47 months. There were complications in 18.18% of the sample: one iatrogenic intraoperative fracture of the greater trochanter and a transitory sciatic neurapraxia. Conclusion: Despite being a demanding surgery with a reportedly high complication rate, total hip arthroplasty in high congenital dislocations, when properly indicated and technically correctly performed, allows an improvement in function and quality of life.

RESUMO Objetivo: Estudo retrospectivo sobre a experiência dos autores no uso de artroplastias para o tratamento de luxações congênitas altas da anca. Métodos: Amostra com 11 luxações congênitas altas da anca (Hartofilakidis tipo C) verificadas em sete pacientes, que foram submetidos a artroplastia da anca pelo mesmo cirurgião com a mesma técnica cirúrgica. O tempo de seguimento médio foi de 4,32 ± 2,67 anos (mínimo um ano) e todos os pacientes foram avaliados pelo mesmo médico. Resultados: Todas as próteses tiveram fixação não cimentada, usaram-se cúpulas acetabulares aparafusadas, hastes femorais cônicas e par articular metal-polietileno. Em todos os pacientes foram efetuadas osteotomias de encurtamento femoral no nível subtrocantérico ou supracondiliano. O Harris Hip Score médio no momento da última avaliação clínica foi de 88,55 ± 4,50 (intervalo 81-94). O tempo de duração da luxação alta da anca (42,91 ± 14,59 anos, intervalo 19-68) demonstrou uma correlação inversa significativa com o Harris Hip Score (r = 0,80; p = 0,003). Todos os pacientes relataram alívio importante das queixas álgicas e todos são capazes de deambular sem qualquer apoio exterior. Nas luxações unilaterais, conseguiu-se correção completa da dismetria e nas bilaterais, membros isométricos em todos os pacientes. Todas as osteotomias consolidaram em tempo médio de 3,27 ± 0,47 meses. Verificaram-se complicações em 18,18% da amostra: uma fratura iatrogênica intraoperatória do grande trocânter e uma neuropráxia transitória do ciático. Conclusão: Apesar de ser uma cirurgia exigente e com elevado índice de complicações relatado, a artroplastia da anca na luxação congênita alta, quando devidamente indicada e tecnicamente bem executada, permite melhorar a funcionalidade e qualidade de vida dos pacientes.

Luxación congénita de rodilla: a propósito de un caso / Congenital knee dislocation: case report

Resumen: La luxación congénita de rodilla es una patología poco frecuente con una etiología desconocida. En algunos casos se le considera una patología aislada mientras que en otros pueden observarse patologías asociadas o síndromes. El tratamiento de la luxación congénita de rodilla depende de la gravedad y flexibilidad de la deformidad y en la bibliografía pueden encontrarse desde enyesados seriados o arnés de Pavlik hasta plastías del tendón cuadricipital u osteotomías femorales. Presentamos un caso de una luxación congénita que se trató mediante enyesado seriado y que evolucionó favorablemente.

Abstract: Congenital knee dislocation is an infrequent condition with unknown etiology. In some cases it occurs as an isolated condition, while in others it coexists with associated conditions or syndromes. The treatment of congenital knee dislocation is driven by the severity and flexibility of the deformity. The literature includes from serial casting or the Pavlik harness to quadriceps tendon plasty or femoral osteotomies. We report herein the case of a congenital dislocation treated with serial casting with a good outcome.

Artificial total hip arthroplasty and hip-self procedure in the treatment of congenital dislocation of hip / 中国组织工程研究

BACKGROUND:The effects of artificial joint replacement, osteotomy and reconstruction in the treatment of Crown Ⅳ-type congenital dislocation of hip in adult are not very satisfied. OBJECTIVE:To evaluate the effect of artificial total hip arthroplasty and hip-self procedure in the treatment of Crown Ⅳ-type congenital dislocation of hip in adult patients. METHODS:Twenty-three adult patients with Crown Ⅳ-type congenital dislocation of hip were treated with artificial total hip arthroplasty and hip-self procedure. There were 2 males and 21 females with an average age of (24.26±3.56) years ranging 20 to 35 years. The effect was evaluated according to the Harrris evaluation standard, and the statistical analysis was performed. RESULTS AND CONCLUSION:Al of the patients were fol owed-up for 12-60 months, averaged of (26.60±13.16) months. Statistical comparison with the SPSS 19.0 system showed there was significant difference of the Harrris scores between preoperation and postoperation period (P<0.05). The artificial total hip arthroplasty and hip-self procedure can be used to reconstruct the normal function of hip joint, relieve pain and increase the joint stability, which is considered as the best method for the treatment of Crown Ⅳ-type congenital dislocation of hip in adult.

Treatment for Bilateral Congenital Dislocation of the Patella Using Stanisavljevic Procedure / 대한정형외과학회잡지

Congenital dislocation of the patella is a rare clinical entity and is considered to result from a failure in internal rotation when the myotome develops, which forms the femur, the quadriceps muscle, and the extensor mechanism. Several authors have suggested various treatment methods, but there has been no consensus on treatment. A 12-year-old boy complained of knee pain and presented with a deformity due to bilateral congenital dislocation of the patella. The patient was treated with surgical management using the Stanisavljevic procedure. We report this case of congenital dislocation of the patella treated with this procedure that achieved a stable patellofemoral joint and satisfactory clinical results over 6.5 years of follow-up. In addition, we have included a review of the relevant medical literature.

Prevalence of talipes equinovarus, congenital dislocation of the hip, cleft lip/cleft palate, Down syndrome and neural tube defects among live newborns in Anuradhapura, Sri Lanka.

Objective To determine the prevalence of talipes equinovarus, congenital dislocation of the hip, cleft lip/cleft palate, Down syndrome and neural tube defects among live newborns at Anuradhapura General Hospital, Sri Lanka. Method Babies born from February 2002 to January 2003 were examined for the above five congenital anomalies. Anomalies were recorded in a register and live birth prevalence rate (LBPR) for each anomaly was calculated. Results 9105 newborns were examined for the 5 selected congenital anomalies. LBPR per 10,000 live births of the 5 anomalies were as follows: talipes equinovarus 31.8, congenital dislocation of hip 26.3, cleft lip/cleft palate 21.9, Down syndrome 20.8 and neural tube defects 13.2.

Treatment of Congenital Dislocation of the Knee by Conservative Management / 대한정형외과학회잡지

We reviewed twelve cases of congenital dislocation of the knee(CDK) which treated at Keimyung University from January 1992 to January 1997. All case were type II dislocation according to classification suggested by Ferris and reduced with minimal treatment. Dislocation were reduced within 4 days in minimum after treatment and 3 weeks in maximum. The period of follow up ranged from 6 months to 5 years. Clinical results were good. Early diagnosis followed by conservative treatment is important and enough to treatment of the type II congenital dislocation of the knee.

A Case of Congenital Dislocation of the Knee / 대한주산의학회잡지

Congenital dislocation of the knee is very rare skeletal deformity and was firstly described by Chatelaine in 1822. Since then there have been a few number of case reports and some series discussing the etiology and treatment. The tibia is displaced anteriorly in relation to the femur. It is generally subdassified as simple hyperextention, subluxation, and dislocation depending on the degree of the joint displacement and the severity of disease. Early gentle manipulation and serial splintage or plaster cast are recommended for treatment and were successful in the majority except the case of quadriceps contrarture or late correction. The authors experienced one case of congenital dislocation of the right knee and brief review of the related literatures was made.

Early X-ray Diagnosis of Congenital Dislocation and Developmental Dysplasia of the Hip in Newborn and Infant / 实用放射学杂志

Objective To study the diagnostic method with computed radiography for congenital dislocation of the hip(CDH) and developmental dysplasia of the hip(DDH) in early stage in newborn and infant.Methods Followed-up with computed radiography made a comparison between 47 abnormal hips (CDH and DDH ) in 26 infants ,and 60 normal hips in 30 infants.Results (1)The normal pattern of acetabulum in neonate and infant appeared as definite“—”,indefinite“—” was considered as abnormal,its sensitivity,specificity and accuracy was 100%,91.59 and 85% respectively,and statistical comparison P

Treatment of Congenital Dislocation of Hip in Children Under the Age of 2 Years / 대한정형외과학회잡지

The authors report a clinical experience of 95 patients (98 hips) with congenital dislocation of hip under the age of 2 years who were followed up at least 1 year at Chonnam University Hospital between 1979 and 1988. The result of clinical analysis are as follows; 1. The most patients were girls, comprising 87 girls (89 hips) and 8 boys (9 hips). 2. The age at treatment were under the age of 6 months in 49 hips, 7 to 12 months in 5, 13 to 18 months in 30 and 19 to 24 months in 14. 3. The initial treatment of the 98 hips were Pavlik harness in 49 hips, closed reduction in 18, and open reduction in 31. 4. Pavlik harness was applied to the patients under the age of 7 months and the results were acceptable in 37 hips (76%), uncertain in 4 (8%) and unacceptable in 8 (16%). The 8 unacceptable hips were retreated by closed reduction in 6 hips and open reduction in 2. 5. Closed reduction was applied to the patients ranging from the age of 4 months to 21 months and the results were acceptable in 14 hips(78%), unacceptable in 4 (22%). The 4 unacceptable hips were retreated by open reduction in 3 hips and Salter innominate osteotomy in l. 6. Open reduction was applied to the patients ranging from the age of 7 months to 20 months, and the results were acceptable in 26 hips (84%), uncertain in 3 (10%) and unacceptable in 2 (6%). The one of 2 unacceptable hips was retreated by Salter innominate osteotomy. 7. The overall results of 98 hips following initial treatment were acceptable in 77 hips (79%), uncertain in 7 (7%), and unacceptable in 14 (14%). The final results after secondary treatment were acceptable in 89 hips (91%), uncertain in 7 (7%), and unacceptable in 2 (2%).

Treatment of Congenital Dislocation of the Hip by Closed Reduction / 대한정형외과학회잡지

The closed reduction has made an important contribution to the treatment of children under the age of 24 months. The authors report a clinical experience of 20 patients(21 hips) with congenital dislocation of hip who were treated by closed reduction at the department of Orthopaedic Surgery of Chonnam University Hospital. There were total 230 patients(237 hips) disgnosed as having congenital dislocated hip for 10 years from 1978 to 1987 and 20 patients of them were included in this study. The follow-up period ranged from 1 year to 10 years with an average 3 years. The results are as follows: l. All but one were girls, comprising 19 (20 hips) of 20 patients. 2. The age at closed reduction were under 6 months in 2, 7 to 12 months in 4, 13 to 18 months in 10 and 19 to 24 months in 4. 3. Of the 21 hips treated by closed reduction, 17 hips achieved a satisfactory result(81%). The other four hips had redislocation(2 hips) and subluxation(2 hips). 4. Four additional treatments were open reduction in 3 and Salter innominate osteotomy in l. 5. The acetabular and center-edge angle improved from the averge 36.1 and

Combined Procedure of Open Reduction and Shortening of the Femur in Treatment of Congenital Dislocation of the Hips in Older Children / 대한정형외과학회잡지

Combined procedue of open reduction and shortening of femur for treatment of congenital hip dislocation in the older child is known to minmize the incidence of avascular necrosis, redislocation and stiffness. Thirty six hips in thirty three children were operated upon in the past six years with combined procedue of open reduction and shortening of femur. And twenty eight hips in twenty five children who were followed up more than one year were analysed. By the results, we obtained excellent in twenty nine percent, good in fifty three percent, fair in fourteen percent and poor in four percent.

Congenital Dislocation of the Knee: 2 Cases / 대한정형외과학회잡지

Congenital dislocation of the knee is very rare deformity and presents with anterior displacement of the tibia in relation to the femur. Early gentle manipulation and serial splintage or plaster cast is recommended for treatment and successful in the majority except the case of quadriceps contracture or late correction. We experienced two cases of bilateral congenital dislocation of the knee who had been treated with early gentle manipularion, immobilization with serial corrective dual splint, passive stretching and night splint. Our results are good in both cases.

The Innominate Osteotomy in Congenital Dislocation of the Hip / 대한정형외과학회잡지

Beyond the usual age of walking, the dysplasia of dislocated hip has become severe and its reversivility limited so that the reduced hip cannot maintained in stable position. The innominate osteotomy redirect cartilage of the hip and provide stability in the functional position of walking. The author have experienced 45 cases out of 42 patients with congenital dislocation of the hip who were treated by innominate osteotomy at Department of Orthopedic Surgery College of Medicine Yonsei University from Jan. 1979 to Dec. 1986. The analysis of result of operation has been Jan. 1979 at least 18 months follw-up study. 1. The mean age was 4.2 years ranging fron 18 months to 14 years.2. The mean value of parameters in preoperative evaluation, acetabular index was 37°, neck shaft angle 146°, CE angle −64° and leg length discrepency 1.5cm. After operation, actabular index was 20°, neck shaft angle 137° and CE angle 39° in average. And operated limb was longer as 0.5cm in average. 3. By anatomical assessment of NcKay, 17 cases were graded excellent, 19 cases good, 7 cases fair and 2 cases poor. Especially among the patients above 6 years old, only 6 cases were graded excellent or good. 4. As to the post-operative complication, limitation of motion was noted in 4 cases, redislocation in 2 cases, subluxation in 1 cases, avascular necrosis of femoral head in 1 case and infection in 1 case.

Treatment of Congenital Dislocation of the Hip with the Pavlik Harness / 대한정형외과학회잡지

The congenital dislocation. of the hip is a common congenital disease in the orthopedic field. It is well known that the early diagnosis and effective treatment is very important for the patient to provide a favorable function in the whole life. The Pavlik harness made an important contribution to the treatment of children before standing age. The authors report a clinical experience of 34 patients(35 hips) with congenital dislocation of hip who were treated with Pavlik harness at the Department of Orthopedic Surgery of Chonnam University Hospital. There were total 230 patients(237 hips) diagnosed as congenital dislocation of hip for 10 years from 1978 to 1987. Fifty-one patients(52 hips) of them were treated with Pavlik harness. Only 34 patients(35 hips) were included in this study excluding 17 patients(17 hips) because of inappropriate records or follow-up. The follow-up period ranged from 1 year to 6 years with an average of 2 years and 5 months. The results are as follows ; 1. The most patients were girls, comprising 33 girls and 1 boy. 2. The age of children was 124.6days in average ranging from 13 to 201 days. 3. Of the 35 hips treated with Pavlik harness, satisfactory reduction was obtsined in 30 hips(85.7%). For 5 failed cases, the authors performed closed reduction under the general anesthesia in 3 cases and open reduction in 2 cases. 4. The causes of reduction failure were impossible reduction in 3 cases, nonconcentric reduction in 1 case and repeated redislocation in 1 case. 5. The acetabular and metaphyseal-edge angle improved from the average 33 and 5.8 degrees at the first visit to the average 19.9 and 30.6 degree at the final follow-up (20.7 and 29.2 degrees in normal side). 6. When compared with the value of the 30 hips which were reduced successfully, the initial acetabular angle of 5 failed cases was similar but the metaphyseal-edge angle of them was very low. 7. There was no reduction failure in 27 hips which had metaphyseal-edge angle above 10 degrees. But 5 reduction failures were observed in 8 hips with below −11 degrees. 8. An avascular necrosis was observed in only one patient. In conclusion, the Pavlik harness proved to be a successful means in treating patients with congenital dislocation of hip under 7 months of age with particularly above −10 degrees in metaphyseal-edge angle.

Treatment of Congenital Dislocation of Hip by Open Reduction / 대한정형외과학회잡지

In the instance wherein concentric reduction cannot be achieved by closed method, open reduction is indicated. Prolonged and forceful attempts to reduce the refractory hips are not without risk to the circulation of the femoral head and open reduction is certainly a less traumatic way to obtain reduction in these hips. The authors performed clinical analysis in 30 patients with congenital dislocation of hip who were treated by open reduction between 1978 and 1987, The results are as follows :1. The results of treatment in 30 patients were acceptable in 22(73.3%), uncertain in 4(13. 3%), and unacceptable in 4 patients(13.3%). 2. Comparing the results depending on the presence of prior treatment or not, acceptable results were obtained in 86.4%(19 out of 22) of patients without prior treatment and in only 37.5%(3 out of 8) of patients with prior theatment by such as Pavlik harness and closed reduction. 3. The surgical approaches for open reduction were medial and anterior routes. The approach was selected depending on the age of patients and the severity of dislocation. The medial approach was used in patients under the age of 18 months. In mild degree of dislocation, the age limit of medial approach was extended to 24 months of age. The anterior approach was used in patients over 19 months of age.

A Clinical Analysis on Treatment of Congenital Dislocation of the Hip in Old Childhood / 대한정형외과학회잡지

It is well known the early diagnosis and early treatment is very important for the patient with congenital dislocation of the hip(CDH) to provide a favorable function in the whole life. However, despite screening programmes for the detection of CDH, children with dislocated hip continue to present late. While there has been general agreement as to the need for treatment of persistent acetabular dysplasia secondary to CDH, the appropriate treatment has been a matter of controversy for many years, and the surgical treatment of CDH in old children presents a more formidable technicalchallenge than in younger child. The author studied 26 cases in 23 patients of CHD aged between 6 years and 13 years at the Department of Orthopedic Surgery of Yonsei University during a 6 year period from January, 1979 to December, 1984. The aim of this study was to find out available surgical treatment for the old childhood with CDH and to assess the comparative results of age, degree of acetabular dysplasia and the station of femoral head displacement. The results of this study are are as follows; l. Among the 23 patients, female was 20 patients, male was 3 patients and 3 female patients show bilateral involvement. And among 26 cases, left hip involvement was 21 cases and right hip involvement was 5 cases. 2. Age at initial operation was 8 years and 10 months in average ranging from 6 years and 2 months to 13 years and 4 months, and average follow-up time was 3 years and 11 months ranging from 1 year 6 months to 5 years 2 months. 3. Attended type of surgery of the CDH in old childhood were 4 cases of Salter's innominate osteotomy, 5 cases of Sutherland's double innominate osteotomy, 5 cases of Salter's innominate osteotomy with femoral shortening and 12 cases of Klisic procedure. 4. Age of the patient as well as degree of acetabular dysplasia and station of femoral head displacement may influence on determination of type of the surgical procedure. 5. The older the age at initial operation and the more the displacement of femoral head, the results was less favorable. 6. As in young childhood, the clinical results of treatment are invariably better than the radiological results. 7. Overall final results of leg length discrepancy was 1.0cm in length and range of leg length discrepancy differs from type to type of surgical procedure. 8. Complications developed after treatment were avascular necrosis of femoral head in one case, fracture of the ipsilateral femure in 3 cases and wound infection in 1 case.