Dega
Enviado por jorgevalderrama • 4 de Febrero de 2014 • Informes • 4.664 Palabras (19 Páginas) • 305 Visitas
Dega Osteotomy for the Correction of Acetabular
Dysplasia of the Hip: A Radiographic Review
of 21 Cases
Ahmed Al-Ghamdi, MD, FRCSC,* Juan Sebastian Rendon, MD,w Fareed Al-Faya, MD, FRCSC,*
Neil Saran, MD, MSc, FRCSC,*wz Thierry Benaroch,MD, MSc, FRCSC,*wz and
Reggie C. Hamdy, MD, MSc, FRCSC*wz
Background: The Dega osteotomy is a versatile procedure that is
widely used to treat neuromuscular hip dysplasia. There is a
paucity of the English language literature on its use in acetabular
dysplasia seen in developmental dysplasia of the hip (DDH).
Methods: A retrospective radiographic and chart review was
performed for all patients diagnosed with DDH who underwent
a modified Dega osteotomy between March 1995 and December
2008 at the Shriners Hospital for Children or the Montreal
Children’s Hospital (Montre´ al, Canada) by 2 orthopaedic
surgeons. Radiographic parameters were measured at the
preoperative, immediate postoperative, and final follow-up time
points. These parameters included the acetabular index, center
edge angle, Reimer’s extrusion index, Shenton line, and grading
by the Severin classification.
Results: A total of 20 patients (21 hips), of which 18 were female,
underwent a modified Dega osteotomy at an average age of 55.6
months (range, 20 to 100 mo). Of the 21 hips (1 bilateral and 19
single cases), 9 hips involved the right side and 12 hips involved
the left side. Before surgery, 9 patients had a subluxated hip, 7
patients had a dislocated hip, and 5 patients had a dysplastic
hip. Ten hips underwent concomitant procedures including 10
open reductions with capsulorraphy. The acetabular index
improved from 37 degrees (SD 8) preoperatively to 19 degrees
(SD 8) on the date of last visit. The center edge angle improved
from 2 (SD 17) to 25 degrees (SD 12).
Conclusions: The results of this study demonstrate that the
modified Dega osteotomy produces near-normal lateral coverage
parameters in children with DDH.
Level of Evidence: Therapeutic study, clinical case series: level IV.
Key Words: congenital dislocation, pelvic osteotomy, acetabulum,
open reduction
(J Pediatr Orthop 2012;32:113–120)
Acetabular dysplasia seen in developmental dysplasia
of the hip (DDH) is characterized by typical
morphologic features. Salter’s 1 simple yet elegant porcine
experiments showed that acetabular dysplasia was secondary
to a malpositioning of the hip and was characterized
by a maloriented and hypoplastic acetabulum. Additional
associated characteristics have been described by Wedge2
as “combinations of maldirection, marginal erosion,
torsion, hypoplasia (localized or global deficiency), abnormal
shape, and decreased surface area of the acetabulum
available for bearing articular cartilage to articulate with the
frequently misshapen femoral head.”
Various surgical techniques have been described to
treat acetabular dysplasia. Although redirectional innominate
osteotomies such as the Salter innominate
osteotomy,3 Sutherland double innominate osteotomy,4
and Steel triple5 and To¨ nnis et al triple6 osteotomies
reorient the hip, acetabuloplasty procedures such as the
Pemberton,7 Dega,8 and San Diego9 are felt to address
both the malorientation and the hypoplasia by
“reshaping” and improving the volume of the acetabulum.
10,11 The San Diego (modified Dega) osteotomy has
been shown to be a useful versatile osteotomy in which
coverage can be directed to match the specific deficiency.9
Although large case series on the utility of the Dega and
modified Dega in treating spastic hip dysplasia exist,9,12
there are limited publications in the English literature
regarding the use of this technique on patients diagnosed
with DDH.12–14
This study describes and analyzes the radiographic
outcome of 21 cases diagnosed with DDH and treated
with a modified Dega osteotomy. The principal aim was
to assess the impact of this surgical technique on the
acetabular index (AI) at final follow-up. Secondary aims
included assessing the impact of the surgical technique on
the center edge angle (CEA),15 AI of Sharp,16 Reimer’s
extrusion index,17 and the continuity of the Shenton
line,18 and grading the results of the treatment at final
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