Información del artículo
Abstract
Introduction
Open reduction by means of a medial approach (adductors) is used in non-ambulating patients under 13 months, diagnosed with hip dislocation and managed with early closed reduction in unstable non concentric hips.
Material and methodThe present retrospective study includes a series of cases that illustrate the authors’ experience. The results of 548 hips (367 patients) operated over a period of 12 years (1995-2007) are reported.
ResultsComplications occurred in 62 hips. The most frequent were epiphysitis (2.9%), partial or total necrosis of the femoral head (6.3%) and redislocation (2%).
ConclusionsWe describe a modification to the surgical technique originally reported by Ludloff, whereby the adductor brevis is not split; instead, the latter is detached and the pectineus muscle is pushed distally. In this way, the surgeon has a good view of the circumflex vessels, which protects them from injury. Also, the tension generated between the pectineus and the psoas by the abduction maneuvers is relaxed.
Keywords:
Open reduction
Medial approach
Congenital hip dislocation
Resumen
Introducción
la reducción abierta por vía interna (aductores) se emplea, en pacientes no ambulantes con diagnóstico de luxación de cadera, menores de 13 meses, manejados con reducción cerrada temprana en caderas inestables, no concéntricas.
Material y métodoel presente trabajo es una serie de casos, retrospectivo, donde se presenta la experiencia de los autores y se describen los resultados de 548 caderas (367 pacientes) durante un periodo de 12 años (1995-2007).
Resultadosse presentaron complicaciones en 62 caderas, las más frecuentes son: epifisitis (2,9%), necrosis parcial o total de la cabeza femoral (6,3%) y reluxación (2%).
Conclusionesse describe una modificación del abordaje a la técnica quirúrgica descrita originalmente por Ludloff evitando separar el aductor brevis, en vez de ello, se desinserta y rechaza distalmente el músculo pectíneo, asíse logra visualizar los vasos circunflejos, se evita su lesión y disminuye la tensión generada entre el pectíneo y el psoas con las maniobras de abducción.
Palabras clave:
Reducción abierta
Vía interna
Luxación congénita de cadera
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