Hüftgelenkserkrankungen bei Kindern mit dem Down Syndrom
Die Behandlung der Hüftgelenksinstabilität bei Kindern mit dem Down-Syndrom ist eine große Herausforderung, die mit zunehmender Lebenszeitverlängerung dieser Patientengruppe, nicht zuletzt durch die guten Therapiemöglichkeiten der häufig lebenszeitlimitierenden internistischen Begleiterkrankungen, j...
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The treatment of hip instability in patients with Down syndrome is challenging. We have performed different pelvic osteotomies and corrections at the proximal femur for this indication. The retrospective study was conducted to evaluate the clinical and radiological outcome of each intervention. All in all, 166 patients with Down syndrome were treated at our orthopedic department in the observation period. Problems related to the hip joint were diagnosed in 63 of those patients. Only patients who underwent surgery were included in this study. Charts and X-rays of these 31 patients were evaluated with respect to the following parameters: incidence of the hip problem, concomitant diseases, progress, kind of operation method and date, during of stay in the hospital, aftercare, follow-on surgery related to complications, AC angle, CE angle, ACM angle, CCD angle, index of migration according to Reimers, classification of Bauer and Kerschbaumer and general morphology of the femoral head. The group was compared with an age-matched group of 18 patients with hip dysplasia. Those patients underwent the same sort of operation in the same year. In Morbus Down group, we performed surgery for preservation of the hip in 49 cases. This included 13 osteotomies according to Chiari, 11 triple osteotomies according to Tönnis, 10 corrections by femoral varus derotation osteotomy, 8 pelvic osteotomies according to Pemberton, 5 pelvic osteotomies according to Salter and 2 open reductions of the hip. With respect to the moment of the disorders appearance and surgery, we detected three peaks of age. There was no difference in course of disease and quantity of complications between the groups. Satisfactory results concerning clinical and radiological outcome were achieved predominantly by complete redirectional acetabular osteotomies. Half of the patients who were solely treated by femoral varus derotation osteotomy needed follow-on surgery in the form of pelvic osteotomy. Comparison of preoperative and postoperative range of motion of the hip joint between groups detected capsular insufficiency, increased ligamentous laxity and muscular hypotonia in patients with Down´s syndrome. Comparison of pelvic radiographs demonstrated significant improvement concerning measured angles in both groups. Preoperative values for ACM angle were comparable between both groups. Hypermobility and secondary dislocation of the hip joint is a common problem in patients with Down syndrome, which often requires surgical intervention at early stage. According to our data and clinical results we suggest a complete redirectional acetabular osteotomy in combination with capsular plication for treatment of this challenging condition. As well we suggest, that children with Down syndrome need to be examined standardized at the age of 3-4 months by clinical examination and ultrasound, as well as at the age of 2 years, 4 years, 6 years, 8 years and 14 years by clinical examination and radiographics in order to recognize hypermobile, instable and dislocated hips and other orthopedic issues. This would allow an early treatment and arrest the progression of the disorder.