Clinical effect of Salter osteotomy combined with femoral osteotomy in treatment of Tonnis type Ⅱ developmental dysplasia of the hip

Abstract:

Objective：To investigate the clinical effect of Salter osteotomy combined with femoral osteotomy in the treatment of Tonnis type Ⅱ developmental dysplasia of the hip. Methods：A retrospective analysis was performed for the clinical data of 52 children（57 hips） with Tonnis type Ⅱ developmental dysplasia of the hip who underwent surgical treatment in our hospital from January 2010 to December 2015，and among these children，28（33 hips） underwent Salter osteotomy combined with femoral osteotomy and 24（24 hips） underwent Salter osteotomy alone. A comparative analysis was performed for the two groups. Results：All children obtained follow-up，with a mean follow-up time of 26.8 months（range 12-64 months）. At the last follow-up，the Salter osteotomy-femoral osteotomy combination group had an acetabular index（AI） of 18.1°±5.2°，a center edge（CE） angle of 36.3°±36.1°，and a Sharp angle of 41.4°±4.7°，while the Salter osteotomy group had an AI of 15.7°±4.8°，a CE angle of 37.8°±11.6°，and a Sharp angle of 40.1°±5.0°. There was a significant difference in the incidence rate of femoral head necrosis between the Salter osteotomy-femoral osteotomy combination group and the Salter osteotomy group[2 hips（2/33） vs. 6 hips（6/24）， ?字2=4.131，P=0.042]. According to the Severin radiological classification，in the Salter osteotomy-femoral osteotomy combination group，15 hips were excellent，11 hips were good，6 hips were fairly good，and 1 hip was poor，while in the Salter osteotomy group，5 hips were excellent，14 hips were good，5 hips were fairly good，and no hip was poor；there was no significant difference between the two groups（Z=-1.277，P=0.202）. According to McKay’s hip function evaluation criteria，in the Salter osteotomy-femoral osteotomy combination group，17 hips were excellent，11 hips were good，5 hips were fairly good，and no hip was poor，while in the Salter osteotomy group，13 hips were excellent，7 hips were good，4 hips were fairly good，and no hip was poor；there was no significant difference between the two groups（Z=-0.107，P=0.915）. Conclusion：Salter osteotomy combined with femoral osteotomy has a good clinical effect in the treatment of Tonnis type Ⅱ developmental dysplasia of the hip and can effectively reduce the incidence rate of femoral head necrosis.