Tesis

Luaran Anatomis Dan Fungsional Pasien Developmental Dysplasia Of The Hip Yang Dilakukan Rekonstruksi Panggul Dengan Reduksi Terbuka, Rekonstruksi Tulang Femur Dan Acetabuloplasty = Anatomical And Functional Outcome Of Developmental Dysplasia Of The Hip Treated By Hip Reconstruction, Open Reduction, Femur Reconstruction And Acetabuloplasty.

Pendahuluan: Indonesia dengan kapasitas penapisan neonatus yang belum baik, memiliki angka kejadian developmental dysplasia of the hip (DDH) lambatdiagnosis yang cukup tinggi sehingga usia pasien saat dioperasi lebih besar dibanding negara maju. Hingga saat ini belum banyak penelitian yang dilakukan mengenai luaran pasca operasi DDH di Indonesia. Studi ini bertujuan untuk mengetahui luaran anatomis dan fungsional pasien DDH yang dilakukan operasi satu tahap dengan reduksi terbuka, rekonstruksi tulang femur, dan acetabuloplasty Metode: Studi ini mengikutsertakan 21 pasien (24 panggul) yang dioperasi antara Januari 2013 hingga Januari 2020. Prosedur operasi yang dilakukan adalah operasi satu tahap reduksi terbuka, rekonstruksi femur dan acetabuloplasty (Salter innominate atau Pemberton). Semua operasi dilakukan oleh satu orang ahli pediatrik orthopaedi yang sama. Luaran anatomis dievaluasi dengan klasifikasi Severin dan sudut acetabular index pasca operasi. Luaran fungsional diukur dengan kriteria McKay dan skor CHOHES (Children’s Hospital of Oakland Hip Evaluation Scores). Hasil: Rata – rata usia pasien saat operasi adalah 6 tahun dan rata – rata durasi follow up 43 bulan. Derajat Severin baik dan baik sekali pada 23 panggul, derajat McKay baik dan baik sekali pada 19 panggul serta skor CHOHES baik dan baik sekali pada 19 panggul. Acetabular index pasca operasi signifikan lebih baik dibanding pre operasi (p=0,01). Pasien dengan usia kurang dari 5 tahun memiliki luaran Severin dan McKay lebih baik dibanding yang lebih tua (p < 0,05). Derajat Severin berbanding lurus dengan derajat McKay (p=0,01) Kesimpulan: Operasi satu tahap dengan reduksi terbuka, rekonstruksi tulang femur, dan acetabuloplasty pada DDH memberikan hasil yang memuaskan baik dari segi anatomis maupun fungsional. Usia saat dilakukan intervensi merupakan faktor yang berpengaruh signifikan terhadap luaran pasca operasi.
Kata Kunci: Developmental dysplasia of the hip, DDH, acetabuloplasty, Pemberton, Salter Innominate, Severin, McKay, CHOHES, acetabular index.


Introduction: Indonesia, with its poor neonatal screening capacity, has a fairly high incidence of late-diagnosis developmental dysplasia of the hip (DDH) so that the patient's age at surgery is higher than in developed countries. Until now, not much research has been done on the postoperative outcome of DDH in Indonesia. This study aims to determine the anatomical and functional outcomes of DDH patients who underwent single-stage surgery with open reduction, femur reconstruction, and acetabuloplasty. Method: This study included 21 patients (24 hips) who undergone surgery between January 2013 and January 2020. The surgery was a single-stage procedure of open reduction, femoral reconstruction and acetabuloplasty (Salter innominate or Pemberton). All of the surgery was conducted by the same pediatric orthopaedic surgeon. Anatomical outcome was evaluated by Severin classification and postoperative acetabular index. Functional outcome was measured by McKay criteria and CHOHES (Children’s Hospital of Oakland Hip Evaluation Scores). Results: The mean age at the time of operation was 6 years and the average duration of follow up was 43 months.The Severin’s grade was good to excellent in 23 hips, the McKay’s score was good to excellent in 19 hips and the CHOHES score was good to excellent also in 19 hips. Postoperative acetabular index was significantly better than preoperative. (p=0,01). Patient younger than 5 years old had better grades of Severin and McKay (p < 0,05). Severin’s and McKay’s grade were directly proportional (p=0,01). Conclusion: Single-stage procedure of open reduction, femoral reconstruction, and acetabuloplasty in DDH gives satisfactory results both of anatomically and functionally. Age is the significant factor for better outcomes. Early diagnosis and intervention is therefore imperative in the successful treatment of patients suffering from DDH
Keywords: Developmental dysplasia of the hip, DDH, acetabuloplasty, Pemberton, Salter Innominate, Severin, McKay, CHOHES, acetabular index.