[Valgus Osteotomy in the Treatment of the Ischemic Necrosis of Femoral Head in Children: Part II - Clinical Evaluation of the Group.].
The authors present long-term results of the surgical treatment of ischemic necrosis of proximal femur resulting from the treatment of the developmental dysplasia. They used their own technique of intertrochanteric valgus osteotomy in 77 hip joints. The surgical technique was published in the first part of the work. It consists in valgus osteotomy which lengthens femoral neck and, consequently also the whole limb. At the same time a fusion of the physis of the greater trochanter was performed and the pathological antetorsion of the femoral neck corrected. Osteotomy was fixed with a special valgus angled blade plate. In cases where dysplastic acetabulum persists the authors supplement the operation with the shelf operation after Bosworth. All patients operated on for the ischemic necrosis of femoral head were originally treated conservatively. Of the operated on group of 77 hip joints, 69 hip joints were classified in type III after Bucholz-Ogden and 8 hip joints in type II (type II B after Thomas et al.). Valgus operation was performed in children at the age of 3 to 15 years. The patients were further followed up on average 15,4 years, the average age upon the termination of the follow-up was 24,7 years. Eight patients of the group underwent a revision surgery by the same technique for inadequate primary correction or for the loss of correction in the course of the further growth of the hip joint. In 4 patients the authors equalized the length of both limbs by shortening the contralateral femur, in 3 patients additional fusion of the physis of the greater trochanter was performed. In case of dysplastic acetabulum the shelf arthroplasty after Bosworth proved to be very suitable. On the basis of their experience and clinical results the authors recommend to perform the surgery at the age between 7 and 10 years as in earlier operations there may occur a loss of correction during the following period and in children operated on later the adaptation of the operated on hip joint decreases. A prerequisite of a good long-term result is a precise preoperative planning of the operation and its exact technical performance. Key words: developmental dysplasia of the hip joint, ischemic necrosis, valgus intertrochanteric osteotomy of femur.
Vávra
J
J
Ortopedicko-traumatologická klinika 3. LFUK a FNKV, Praha.
Cech
O
O
Zídka
M
M