ACETABULAR DEVELOPMENT AFTER SUPRAACETABULAR TUNNELIZATION IN CHILDREN WITH HIP CONGENITAL DYSPLASIA

Introduction. The technology of wire tunnelization of joint elements is used at RISC “RTO” for treatment of young children (10-30 months) with the hip dysplasia of various forms. Aim - to assess the effect of supraacetabular tunnelization on the formation of dysplastic acetabula. Material and methods. The results of treatment 18 children (21 joints) with the hip congenital dysplasia of II (14 joints) and III (7 joints) degree according to Tonnis have been analyzed. Gradual closed reduction of the dislocation has been performed in all the cases. Mean age at the time of reduction was 8,2±0.56 months (5-14 months). Supraacetabular tunnelization was made six months after dislocation reduction. Indications for intervention were considered in view of the x-ray parameters and signs of acetabulum showing its potential developmental delay. Results. The initial value of the acetabular index on the side of dislocation amounted to 43±0.8°. The impairment of the shape of acetabular vault and its upper-and-outer edge of moderate (9 joints) and severe (12 joints) degree has been observed in all the joints involved. The mean value of the acetabular index amounted to 22.1±0.947° (P<0.01) 3 years after the first tunnelization procedure. In the mentioned period the pathological value of AI remained for seven joints, the value conformed to the norm in 11 observations, and it was considered as a boundary state in three cases. Correct vault shape recovered in 19 joints involved, formation of roof sharp-pointed upper-and-outer edge was observed in 14 cases. The signs of moderate acetabular roof underdevelopment remained in the other observations. Conclusion. The wire tunnelization of the supraacetabular parts adjacent to acetabular cartilage in the patient group analyzed had a stimulating effect on acetabulum development, which manifested itself in the roof slope decrease, the change in acetabular contour and upper-and-outer edge shape.

врожденная дисплазия тазобедренного сустава, туннелизация надацетабулярной области, congenital dysplasia of the hip, supraacetabular tunnelization