Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1109_Библиотеки_им_академика_М_И_Перельмана

not keep the femoral head in the acetabulum. The rst prophylactic treatment of acetabular dysplasia begins at this stage, and this is when the treatment is easy and most effective. Because keeping the femoral head in acetabu­lum by preventing the dislocation of the head or with the reduction of a dislocated head applies pressure to the triradiate cartilage, and acetabu­lum starts to reshape and develop. This often results in a gradual deepening and decrease in the inclination of the acetabulum. However, this is not always the case, and the acetabulum can remain shallow and inclined (acetabular dyspla­sia) more than normal ranges. Hip ultrasonogra­phy is now being routinely performed for newborns, usually 6 weeks after birth for the DDH survey. Graf type 2b, c, and d hips are dysplastic hips and need to be treated prophy­lactically to prevent further deterioration of the hip joint [27]. Using a Pavlik harness for 6weeks is the most preferred way of the treat­ment [28]. The aim is still the same; directing the femoral head to the acetabulum with the harness and keeping it in the acetabulum. Although there are several different opinions, closed reduction with or without adductor tenotomy and preservation of the reduction in a hip spica cast (pelvipedal) for 3months is the most preferred treatment choice for children between the 6 and 12months old with persistent or newly diagnosed dysplasia. If a closed reduc­tion cannot be achieved, an open reduction

using a medial approach is performed at this stage [29]. The closed reduction generally may not be effective to reduce the hip after 12 months. Thus, an open reduction using a medial, anterior, or anteromedial incision is used to intervene in the soft tissues that hinder the concentric reduction of the hip. The pre­ferred approach is the anterior incision. After the procedure, the reduction must be preserved in a hip spica cast for 3months. For dysplasia that persists after 18months, both bone and soft tissue interventions are required. The goal is to increase the anterolateral acetabular coverage, and the need for additional procedures like cap­sulorrhaphy and other interventions are per­formed according to the severity of the case [30]. Although many different types of osteoto- mies have been dened, Salter and Dega oste­otomy is the most performed osteotomy in this stage (Fig. 35.7). However, Pemberton, Pembersal, and many other osteotomy tech­niques can also be used for this age group. All these techniques have special indications and are used for particular cases until the age of 8. Even though there are controversies about the age limit, it is assumed that simple iliac osteoto­mies may not be sufcient to provide coverage due to the closed triradiate cartilage after 8years of age. Thus, after the closure of the tri­radiate cartilage in any age, osteotomization of three pelvic bones (ilium, ischium, and pubis) is needed for the redirection of the acetabulum.