genortГений ортопедииGenij Ortopedii1028-44272542-131XЦЕНТР ИЛИЗАРОВА10.18019/1028-4427-2021-27-3-345-350genort-2644Research ArticleОригинальные статьиOriginal articlesТехнология закрытого вправления вывиха бедра по Г.А. Илизарову при лечении детей с врожденной дисплазией тазобедренного суставаThe Ilizarov technology of closed reduction of hip dislocation in children with developmental hip dysplasiaТепленькийМ. П.TeplenkyM. P.

д. м. н.,

г. Курган

M.D., Ph.D.,

Kurgan

teplenkiymp@mail.ruОлейниковЕ. В.OleinikovE. V.

к. м. н.,

г. Курган

M.D., Ph.D.,

Kurgan

orto-kgn@mail.ruБуновВ. С.BunovV. S.

к. м. н.,

г. Курган

M.D., Ph.D.,

Kurgan

bvsbunov@yandex.ruФГБУ «НМИЦ ТО имени академика Г.А. Илизарова» Минздрава РоссииРоссияIlizarov National Medical Research Centre for Traumatology and OrthopedicsRussian Federation202128062021273№ 3 (2021)345350Copyright © Тепленький М.П., Олейников Е.В., Бунов В.С., 20212021Тепленький М.П., Олейников Е.В., Бунов В.С.Teplenky M.P., Oleinikov E.V., Bunov V.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ilizarov-journal.com/jour/article/view/2644Введение

Введение. Возможность применения постепенного закрытого вправления вывиха бедра у детей старше 1,5 лет признается сомнительной.

Цель

Цель. Анализ отдаленных результатов применения методики постепенного закрытого вправления по Г.А. Илизарову в комбинации с реконструкцией суставных компонентов.

Материалы и методы

Материалы и методы. Изучены исходы лечения 62 детей (81 сустав) с врожденным вывихом бедра в срок от 5 до 16 лет. Методика лечения включала закрытое вправление вывиха по технологии, предложенной Г.А. Илизаровым, и последующую реконструкцию суставных компонентов. Пациенты разделены на две группы с учетом возраста. В первую группу включено 33 пациента (43 сустава) в возрасте до 5 лет. Вторую группу составили 29 пациентов (38 cуставов) в возрасте 5–8 лет.

Результаты

Результаты. Закрытое вправление не удалось осуществить в пяти наблюдениях. Рецидив вывиха после закрытого вправления составил 5,3 %. Удельный вес асептического некроза после закрытой репозиции был 9,7 %. Хорошие функциональные исходы констатированы в 87,7 %. Они были достоверно лучше у пациентов младшей группы. Удельный вес хороших анатомических результатов не зависел от возраста и в целом составил 77 %. Неудовлетворительные результаты отмечены в 8,8 %.

Выводы

Выводы. Анатомо-функциональные исходы и количество осложнений при использовании описанной методики было сопоставимо с другими методами постепенного закрытого вправления вывиха. При этом описанная нами методика расширяет возрастные ограничения к ее применению.

Introduction

Introduction. The possibility of gradual closed reduction of hip dislocation in children over 1.5 years old is considered doubtful.

Purpose

Purpose. Analysis of long-term results of applying the Ilizarov technique of gradual closed reduction in combination with the reconstruction of the hip joint components.

Methods

Methods. The outcomes of treatment of 62 children (81 joints) with congenital hip dislocation in the follow-up period from 5 to 16 years were studied. The treatment method included closed reduction of the dislocation using the technology proposed by G.A. Ilizarov and subsequent reconstruction of the joint components. The patients are divided into two groups based on their age. The first group included 33 patients (43 joints) under the age of 5 years. The second group consisted of 29 patients (38 joints) aged 5–8 years.

Results

Results. Closed reduction failed in five cases. The recurrence of dislocation after closed reduction was 5.3 %. The rate of aseptic necrosis after closed reduction was 9.7 %. Good functional outcomes were reported in 87.7 %. They were significantly better in the younger group. The proportion of good anatomical results did not depend on age and was 77 % in general. Poor results were obtained in 8.8 %.

Conclusion

Conclusion. The anatomical and functional outcomes and the number of complications by using the technique described were comparable to other methods of gradual closed reduction of hip dislocation. But the technique we have described expands the age restrictions for its use.

закрытое вправлениескелетное вытяжениеметод Илизароваостеотомия тазадеротационная остеотомия бедренной костиclosed reductionskeletal tractionIlizarov techniqueinnominate osteotomyfemoral derotation osteotomyReferencesTreatment options for developmental dislocation of the hip after walking age / R. Ganger, C. Radler, G. Petje, H.M. Manner, G. Kriegs-Au, F. Grill // J. Pediatr. Orthop. B. 2005. Vol. 14, No. 3. P. 139-150. DOI: 10.1097/01202412-200505000-00001Ganger R., Radler C., Petje G., Manner H.M., Kriegs-Au G., Grill F. Treatment options for developmental dislocation of the hip after walking age. J. Pediatr. Orthop. B, 2005, vol. 14, no. 3, pp. 139-150. DOI: 10.1097/01202412-200505000-00001Treatment of late-presenting developmental dislocation of the hip by progressive orthopedic reduction and innominate osteotomy. Our results with more than 30 years of follow up / C. Morin, J. Bisogno, S. Kulkarni, G. Morel // J. Child. Orthop. 2011. Vol. 5, No 4. P. 251-260. DOI 10.1007/s11832-011-0346-2Morin C., Bisogno J., Kulkarni S., Morel G. Treatment of late-presenting developmental dislocation of the hip by progressive orthopedic reduction and innominate osteotomy. Our results with more than 30 years of follow up. J. Child. Orthop., 2011, vol. 5, no. 4, pp. 251-260. DOI 10.1007/s11832-011-0346-2Closed reduction in late-detected developmental dysplasia of the hip: indications, results and complications / P. Wicart, R. Seringe, C. Glorion, A. Brassac, V. Rampal // J. Child. Orthop. 2018. Vol. 12, No 4. P. 317-322. DOI 10.1302/1863-2548.12.180088Wicart P., Seringe R., Glorion C., Brassac A., Rampal V. Closed reduction in late-detected developmental dysplasia of the hip: indications, results and complications. J. Child. Orthop., 2018, vol. 12, no. 4, pp. 317-322. DOI 10.1302/1863-2548.12.180088Morel G. The treatment of congenital dislocation and subluxation of the hip in the older child // Acta Orthop. Scand. 1975. Vol. 46, No 3. P. 364-399.Morel G. The treatment of congenital dislocation and subluxation of the hip in the older child. Acta Orthop. Scand., 1975, vol. 46, no. 3, pp. 364-399.Лечение врожденного вывиха бедра. Новые технологии остеосинтеза модулями аппарата Илизарова / В.И. Шевцов, В.Д. Макушин, М.П. Тепленький, И.А. Атманский. Курган : Зауралье, 2006. 1000 с.Shevtsov V.I., Makushin V.D., Teplenky M.P., Atmansky I.A. Lechenie vrozhdennogo vyvikha bedra. Novye tekhnologii osteosinteza moduliami apparata Ilizarova [Treatment of congenital dislocation of the hip. New osteosynthesis technologies with the Ilizarov fixator modules]. Kurgan, Zaurale, 2006, 1000 p. (in Russian)Tönnis D. Surgical treatment of congenital dislocation of the hip // Clin. Orthop. Relat. Res. 1990. No 258. P 33-40.Tönnis D. Surgical treatment of congenital dislocation of the hip. Clin. Orthop. Relat. Res., 1990, no. 258, pp. 33-40.McKay D.W. A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip // Clin. Orthop. Relat. Res. 1974. No 98. P. 124-132. DOI: 10.1097/00003086-197401000-00013McKay D.W. A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip. Clin. Orthop. Relat. Res., 1974, no. 98, pp. 124-132. DOI: 10.1097/00003086-197401000-00013Тепленький М.П., Макушин В.Д., Чиркова Н.Г. Закрытое вправление вывиха бедра аппаратом Илизарова у детей дошкольного возраста // Гений ортопедии. 2011. № 2. С. 65-69.Teplenky M.P., Makushin V.D., Chirkova N.G. Zakrytoe vpravlenie vyvikha bedra apparatom Ilizarova u detei doshkolnogo vozrasta [Closed reposition of the hip dislocation using the Ilizarov fixator in children of pre-school age]. Genij Ortopedii, 2011, no. 2, pp. 65-69. (in Russian)Ezirmik N., Yildiz K. Advantages of single-stage surgical treatment with Salter innominate osteotomy and Pemberton pericapsular osteotomy for developmental dysplasia of both hips // J. Int. Med. Res. 2012. Vol. 40, No 2. P. 748-755. DOI: 10.1177/147323001204000240Ezirmik N., Yildiz K. Advantages of single-stage surgical treatment with Salter innominate osteotomy and Pemberton pericapsular osteotomy for developmental dysplasia of both hips. J. Int. Med. Res., 2012, vol. 40, no. 2, pp. 748-755. DOI: 10.1177/147323001204000240Guarniero R. Dysplasia of hip development: Update // Rev. Bras. Ortop. 2015. Vol. 45, No 2. P. 116-121. DOI: 10.1016/S2255-4971(15)30279-2Guarniero R. Dysplasia of hip development: Update. Rev. Bras. Ortop., 2015, vol. 45, no. 2, pp. 116-121. DOI: 10.1016/S2255-4971(15)30279-2Danielsson L. Late-diagnosed DDH: a prospective 11-year follow-up of 71 consecutive patients (75 hips) // Acta Orthop. Scand. 2000. Vol. 71, No 3. P. 232-242. DOI: 10.1080/000164700317411816Danielsson L. Late-diagnosed DDH: a prospective 11-year follow-up of 71 consecutive patients (75 hips). Acta Orthop. Scand., 2000, vol. 71, no. 3, pp. 232-242. DOI: 10.1080/000164700317411816Salter R.B., Dubos J.P. The first fifteen year’s personal experience with innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip // Clin. Orthop. Relat. Res. 1974. No 98. P. 72-103. DOI: 10.1097/00003086-197401000-00009Salter R.B., Dubos J.P. The first fifteen year’s personal experience with innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. Clin. Orthop. Relat. Res., 1974, no. 98, pp. 72-103. DOI: 10.1097/00003086-197401000-00009Weinstein S.L., Dolan L.A. Proximal femoral growth disturbance in developmental dysplasia of the hip: what do we know? // J. Child. Orthop. 2018. Vol. 12, No 4. P. 331-341. DOI: 10.1302/1863-2548.12.180070Weinstein S.L., Dolan L.A. Proximal femoral growth disturbance in developmental dysplasia of the hip: what do we know? J. Child. Orthop., 2018, vol. 12, no. 4, pp. 331-341. DOI: 10.1302/1863-2548.12.180070Thomas S.R., Wedge J.H., Salter R.B. Outcome at forty-five years after open reduction and innominate osteotomy for late-presenting developmental dislocation of the hip // J. Bone Joint Surg. Am. 2007. Vol. 89, No 11. P. 2341-2350. DOI: 10.2106/JBJS.F.00857Thomas S.R., Wedge J.H., Salter R.B. Outcome at forty-five years after open reduction and innominate osteotomy for late-presenting developmental dislocation of the hip. J. Bone Joint Surg. Am., 2007, vol. 89, no. 11, pp. 2341-2350. DOI: 10.2106/JBJS.F.00857Closed reduction with traction for developmental dysplasia of the hip in children aged between one and five years / V. Rampal, M. Sabourin, E. Erdeneshoo, G. Koureas, R. Seringe, P. Wicart // J. Bone Joint Surg. Br. 2008. Vol. 90, No 7. P. 858-863. DOI: 10.1302/0301-620X.90B7.20041Rampal V., Sabourin M., Erdeneshoo E., Koureas G., Seringe R., Wicart P. Closed reduction with traction for developmental dysplasia of the hip in children aged between one and five years. J. Bone Joint Surg. Br., 2008, vol. 90, no. 7, pp. 858-863. DOI: 10.1302/0301-620X.90B7.20041Surgical treatment of late developmental displacement of the hip. Results after 33 years / R. Angliss, G. Fujii, E. Pickvance, A.M. Wainwright, M.K. Benson // J. Bone Joint Surg. Br. 2005. Vol. 87, No 3. P. 384-394. DOI: 10.1302/0301-620x.87b3.15247Angliss R., Fujii G., Pickvance E., Wainwright A.M., Benson M.K. Surgical treatment of late developmental displacement of the hip. Results after 33 years. J. Bone Joint Surg. Br., 2005, vol. 87, no. 3, pp. 384-394. DOI: 10.1302/0301-620x.87b3.15247Terjesen T., Horn J., Gunderson R.B. Fifty-year follow-up of late-detected hip dislocation: clinical and radiographic outcomes for seventy-one patients treated with traction to obtain gradual closed reduction // J. Bone Joint Surg Am. 2014. Vol. 96, No 4. P. e28. DOI: 10.2106/JBJS.M.00397Terjesen T., Horn J., Gunderson R.B. Fifty-year follow-up of late-detected hip dislocation: clinical and radiographic outcomes for seventy-one patients treated with traction to obtain gradual closed reduction. J. Bone Joint Surg Am., 2014, vol. 96, no. 4, pp. e28. DOI: 10.2106/JBJS.M.00397Morin C., Rabay G., Morel G. Retrospective review at skeletal maturity of the factors affecting the efficacy of Salter's innominate osteotomy in congenital dislocated, subluxed, and dysplastic hips // J. Pediatr. Orthop. 1998. Vol. 18, No 2. P. 246-253.Morin C., Rabay G., Morel G. Retrospective review at skeletal maturity of the factors affecting the efficacy of Salter's innominate osteotomy in congenital dislocated, subluxed, and dysplastic hips. J. Pediatr. Orthop., 1998, vol. 18, no. 2, pp. 246-253.Revision of failed open reduction of congenital dislocation of the hip / C.J. Kershaw, H.E. Ware, R. Pattinson, J.A. Fixsen // J. Bone Joint Surg. Br. 1993. Vol. 75, No 5. P. 744-749. DOI: 10.1302/0301-620X.75B5.8376431Kershaw C.J., Ware H.E., Pattinson R., Fixsen J.A. Revision of failed open reduction of congenital dislocation of the hip. J. Bone Joint Surg. Br., 1993, vol. 75, no. 5, pp. 744-749. DOI: 10.1302/0301-620X.75B5.8376431Long-term outcome after open reduction through an anteromedial approach for congenital dislocation of the hip / J.A. Morcuende, M.D. Meyer, L.A. Dolan, S.L. Weinstein // J. Bone Joint Surg. Am. 1997. Vol. 79, No 6. P. 810-817. DOI: 10.2106/00004623-199706000-00002Morcuende J.A., Meyer M.D., Dolan L.A., Weinstein S.L. Long-term outcome after open reduction through an anteromedial approach for congenital dislocation of the hip. J. Bone Joint Surg. Am., 1997, vol. 79, no. 6, pp. 810-817. DOI: 10.2106/00004623-199706000-00002Single-stage medial open reduction and Pemberton acetabuloplasty in developmental dysplasia of the hip / M.E. Baki, C. Baki, H. Aydin, B. Ari, M. Özcan // J. Pediatr. Orthop. B. 2016. Vol. 25, No 6. P. 504-508. DOI:10.1097/BPB.0000000000000360Baki M.E., Baki C., Aydin H., Ari B., Özcan M. Single-stage medial open reduction and Pemberton acetabuloplasty in developmental dysplasia of the hip. J. Pediatr. Orthop. B, 2016, vol. 25, no. 6, pp. 504-508. DOI:10.1097/BPB.0000000000000360Analyses of outcomes of one-stage operation for treatment of late-diagnosed developmental dislocation of the hip: 864 hips followed for 3.2 to 8.9 years / B. Ning, Y. Yuan, L. Yao, S. Zhang, J. Sun // BMC Musculoskelet. Disord. 2014. Vol. 15. P. 401. DOI: 10.1186/1471-2474-15-401Ning B., Yuan Y., Yao J., Zhang S., Sun J. Analyses of outcomes of one-stage operation for treatment of late-diagnosed developmental dislocation of the hip: 864 hips followed for 3.2 to 8.9 years. BMC Musculoskelet. Disord., 2014, vol. 15, pp. 401. DOI: 10.1186/1471-2474-15-401Closed reduction of developmental dislocation ofthe hip in children olderthan 18 months/ P. Schoenecker, P.A. Dollard,J.J. Sheridan,W.B. Strecker // J. Pediatr. Orthop. 1995. Vol. 15, No 6. P. 763-767. DOI: 10.1097/01241398-199511000-00008Schoenecker P.L., Dollard P.A., Sheridan J.J., Strecker W.B. Closed reduction of developmental dislocation of the hip in children older than 18 months. J. Pediatr. Orthop., 1995, vol. 15, no. 6, pp. 763-767. DOI: 10.1097/01241398-199511000-00008Malvitz T.A., Weinstein S.L. Closed reduction for congenital dysplasia of the hip. Functional and radiographic results after an average of thirty years // J. Bone Joint Surg. Am. 1994. Vol. 76, No 12. P. 1777-1792. DOI: 10.2106/00004623-199412000-00004Malvitz T.A., Weinstein S.L. Closed reduction for congenital dysplasia of the hip. Functional and radiographic results after an average of thirty years. J. Bone Joint Surg. Am., 1994, vol. 76, no. 12, pp. 1777-1792. DOI: 10.2106/00004623-199412000-00004Olney B., Latz K., Ashner M. Treatment of hip dysplasia in older children with a combined one-stage procedure // Clin. Orthop. Relat. Res. 1998. No 347. P. 215-223.Olney B., Latz K., Ashner M. Treatment of hip dysplasia in older children with a combined one-stage procedure. Clin. Orthop. Relat. Res., 1998, no. 347, pp. 215-223.Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old / M.E. Berkeley, J.H. Dickson, T.E. Cain, M.M. Donovan // J. Bone Joint Surg. Am. 1984. Vol. 66, No 3. P. 412-420.Berkeley M.E., Dickson J.H., Cain T.E., Donovan M.M. Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old. J. Bone Joint Surg. Am., 1984, vol. 66, no. 3, pp. 412-420.Huang S.C., Wang J.H. A comparative study of nonoperative versus operative treatment of developmental dysplasia of the hip in patients of walking age // J. Pediatr. Orthop. 1997. Vol. 17, No 2. P. 181-188. DOI: 10.1097/00004694-199703000-00009Huang S.C., Wang J.H. A comparative study of nonoperative versus operative treatment of developmental dysplasia of the hip in patients of walking age. J. Pediatr. Orthop., 1997, vol. 17, no. 2, pp. 181-188. DOI: 10.1097/00004694-199703000-00009Simultaneous open reduction and Salter innominate osteotomy for developmental dysplasia of the hip / R.K. Haidar, R.S. Jones, D.A. Vergroesen, G.A. Evans // J. Bone Joint Surg. Br. 1996. Vol. 78, No 3. P. 471-476.Haidar R.K., Jones R.S., Vergroesen D.A., Evans G.A. Simultaneous open reduction and Salter innominate osteotomy for developmental dysplasia of the hip. J. Bone Joint Surg. Br., 1996, vol. 78, no. 3, pp. 471-476.Combined Femoral and Acetabular Osteotomy in Children of Walking Age for Treatment of DDH; A Five Years Follow-Up Report / M. Mazloumi, F. Omidi-Kashani, M.H. Ebrahimzadeh, H. Makhmalbaf, M.M. Hoseinayee // Iran. J. Med. Sci. 2015. Vol. 40, No 1. P. 13-18.Mazloumi M., Omidi-Kashani F., Ebrahimzadeh M.H., Makhmalbaf H., Hoseinayee M.M. Combined Femoral and Acetabular Osteotomy in Children of Walking Age for Treatment of DDH; A Five Years Follow-Up Report. Iran. J. Med. Sci., 2015, vol. 40, no. 1, pp. 13-18.Outcomes of Open Reduction for Developmental Dysplasia of the Hip: Does Bilateral Dysplasia Have a Poorer Outcome? /T.M. Wang, K.W. Wu, S.F. Shih, S.C. Huang, K.N. Kuo // J. Bone Joint Surg. Am. 2013. Vol. 95, No 12. P. 1081-1086. DOI: 10.2106/JBJS.K.01324Wang T.M., Wu K.W., Shih S.F., Huang S.C., Kuo K.N. Outcomes of Open Reduction for Developmental Dysplasia of the Hip: Does Bilateral Dysplasia Have a Poorer Outcome? J. Bone Joint Surg. Am., 2013, vol. 95, no. 12, pp. 1081-1086. DOI: 10.2106/JBJS.K.01324Тепленький М.П., Олейников Е.В. Реконструкция тазобедренного сустава у детей школьного возраста с врожденным вывихом бедра // Гений ортопедии. 2013. № 1. С. 36-39.Teplenky M.P., Oleinikov E.V. Rekonstruktsiia tazobedrennogo sustava u detei shkolnogo vozrasta s vrozhdennym vyvikhom bedra [Reconstruction of the hip in school-age children with congenital hip dislocation]. Genij Ortopedii, 2013, no. 1, pp. 36-39. (in Russian)Тепленький М.П., Олейников Е.В., Бунов В.С. Хирургическое лечение детей с дисплазией тазобедренного сустава, осложненной асептическим некрозом головки бедренной кости // Ортопедия, травматология и восстановительная хирургия детского возраста. 2019. Т. 7, № 1. С. 25-34.Teplenky M.P., Oleinikov E.V., Bunov V.S. Khirurgicheskoe lechenie detei s displaziei tazobedrennogo sustava, oslozhnennoi asepticheskim nekrozom golovki bedrennoi kosti [Surgical treatment of children with the hip dysplasia, complicated by aseptic necrosis of the femoral head]. Ortopediia, Travmatologiia i Vosstanovitelnaia Khirurgiia Detskogo Vozrasta, 2019, vol. 7, no. 1, pp. 25-34. (in Russian)

The authors declare that there are no conflicts of interest present.