TRIPLE PELVIC OSTEOTOMY AND HIP JOINT THREE-DIMENSIONAL RECONSTRUCTION IN ADOLESCENT WITH PERTHES DISEASE

Abstract

The purpose of the research: demonstration of a hip caput matrix modeling opportunities, restoration of a joint stability and joint anatomy improvement in three planes after triple osteotomy of the pelvic by A.M.Sakalouski with Perthes disease patients.

Patients and methods: From 1998 to 2007 years were performed 37 triple pelvic osteotomy in 36 patients at 4 to 18 (average age 11 years) with unfavorable course of Perthes disease. In 28 cases patients were male and in 8 cases patients were female. We have observed patients clinically and with radiological methods, including computer tomography with 3D-reconstruction. Indications for pelvic osteotomy include signs of poor prognosis at stages II–III. Radiological signs of risk. The indication to triple pelvic osteotomy on residual stages - this is a secondary acetabular dysplasia and decentration.

If the head of a hip is hardly deformed (flat) by the first stage us carried out back or forward rotation hips osteotomy with turn on 70°–90°, and then triple pelvic osteotomy.

Results: The triple osteotomy of the pelvic prevented deformation of the head of a hip at e at 2–3 stages as a result remodeling of femoral caput by spherical acetabulum. At late stages operation has provide to avoid hip arthrosis. Medialization of the hip joint which led to reducing the joint reactive force. In all cases the head centration and stability of a joint are restored. The angle of Wiberg has increased from 15° to 35°, index Eyre-Brook has increased on 20°, an index acetabular coverage – from 72% to 100%. In all cases clinically the lengthening of sick finiteness has been received with 0,5–1 cm and a gait of patients has improved. The volume of movements in a joint was on the average: flexion 110°, extension 10°, abduction 23°, adduction 30°, external rotation 37° degrees, internal rotation 13°. The stop of trochanter growth at a level of the center head rotation hip or slightly above.

Conclusion: So, triple pelvis osteotomy is the way modern surgical treatment of Perthes disease, it provides preventive maintenance of deformation of the head of a hip – if operative intervention is carried out at early stages of illness when the head has potential to remolding or preventive arthrosis – at residual stages.