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Master Thesis

La luxation congénitale de hanche, résultats coxométriques et évaluation des traitements, à propos d'une série de 35 cas

Abstract : Congenital hip dislocation is characterized by abnormal femoroacetabular contact. It affects 2-20 per 1 000 children and can result in disability. We investigated the treatment of 35 patients aged 7 years at the time of most recent evaluation. 30 hips were orthopedically treated: 18 hips were plastered immediately and 12 hips were plastered after continuous traction. Eleven hips were treated surgically. To assess the hip joint dysplasia, we measure the acetabular index (HTE), the Wiberg's angle (VCE), the femoral shaft-neck angle (ACD), the Sharp's angle, the orientation of the epiphyseal angle (DIR) and the acetabular or femoral origin of the dysplasia (ACC) at 2 years, 4 years and at the time of most recent evaluation. Epiphyseal necroses were assessed by classification of Kalamchi-Mac Ewen. The score of Severin and the score of Postel Merle d'Aubigné (PMA) were evaluated. No difference was found between the 2 orthopedic therapies for the angles VCE, ACC, DIR and Sharp. The scores of Severin and PMA were very good to excellent. We observed 39% of epiphyseal necroses in the plastered group against 17% in the pulled-plastered group. Both treatments lead to a very satisfactory femoroacetabular remodeling and a decrease of dysplasia. The plaster therapy is more likely to involve ephiphyseal necrosis than a therapy combining plastering and continuous traction. No epiphyseal necroses were found in the surgically treated hips. The PMA score was 16.9 and for 91% of the patients, the Severin's score was good to excellent. Coxometric evaluation highlighted a significant improvement of the angles VCE and ACD after surgery. The characterization of the dysplasia by coxometry is thus an important element in the choice of the surgery (pelvic or femoral osteotomy).
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Submitted on : Monday, September 26, 2011 - 11:48:23 AM
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Emeline Bourgeois. La luxation congénitale de hanche, résultats coxométriques et évaluation des traitements, à propos d'une série de 35 cas. Médecine humaine et pathologie. 2010. ⟨dumas-00626453⟩

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