Staged Management of Osteonecrosis with Open Reduction and Hinged Distraction After a Slipped Capital Femoral Epiphysis: A Case Report.
Staged Management of Osteonecrosis with Open Reduction and Hinged Distraction After a Slipped Capital Femoral Epiphysis: A Case Report.
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股骨头骨骺滑脱后采用切开复位和铰链牵引对骨坏死进行分期治疗：病例报告。
DOI：
10.2106/jbjs.cc.m.00064
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发表时间：
2014
影响因子：
--
通讯作者：
R. Maheshwari
中科院分区：
文献类型：
--
作者：
S. Madan;R. Maheshwari
股骨头骨骺滑脱（SCFE）最常见于青少年，可发生在高达25%的患者双侧。它是青春期髋关节疼痛的最常见原因，由软骨膜环的薄弱和股骨近端骨骺通过生长板肥大区滑动引起1。SCFE的发病率约为每100，000人中有2至3人2。并发症包括骨坏死、软骨溶解、退行性关节疾病、慢性疼痛、步态异常和畸形3。我们报告一个外伤后并发骨坏死的病例。我们采用Ganz入路4切开复位内固定，然后延迟铰链式牵引外固定，取得了良好的效果。
患者及其父母被告知将提交病例相关数据以供发表，他们提供了知情同意书。
一个体重指数为21的10岁女孩在学校打橄榄球时扭伤了右腿。她能立即承重，但有点瘸。几天后，右腿瘫痪，她无法承重。她被送到急诊室，随后被转诊到创伤和骨科。X线片显示重度SCFE（图1）。她在发病后24小时内（受伤后约一周）接受了右侧SCFE的原位单螺钉固定（图2）。
图1
入院时的初始X线片显示重度右侧SCFE。
图2
图2螺钉原位固定术中影像增强片。
在术后X线片上，螺钉的位置大多位于后方，而不是中央。CT显示螺钉位于股骨头后半部分，未完全固定。
A slipped capital femoral epiphysis (SCFE) is most often seen in adolescents and can occur bilaterally in up to 25% of patients. It is the most common cause of hip pain in adolescence and is caused by weakness of the perichondrial ring and slippage of the proximal femoral epiphysis through the hypertrophic zone of the growth plate1. SCFE has an incidence of approximately two to three per 100,000 people2. Complications include osteonecrosis, chondrolysis, degenerative joint disease, chronic pain, gait abnormalities, and deformity3. We report a case of delayed presentation of SCFE following trauma, complicated by osteonecrosis. We managed this case with open reduction through the Ganz approach4 and internal fixation, followed by delayed hinged distraction with external fixation, achieving an excellent result.
The patient and her parents were informed that data concerning the case would be submitted for publication, and they provided consent.
A ten-year-old girl with a body-mass index of 21 twisted her right leg while playing rugby at school. She was able to bear weight immediately but had a limp. A few days later, the right leg gave way and she was unable to bear weight. She presented to the emergency room and was subsequently referred to the Trauma and Orthopaedics Department. Radiographs revealed a severe SCFE (Fig. 1). She underwent an in situ single screw fixation of the right SCFE within twenty-four hours of presentation (at approximately one week after the injury) (Fig. 2).
Fig. 1
Initial radiograph on admission showing a severe right SCFE.
Fig. 2
Fig. 2 Intraoperative image intensifier film of the in situ screw fixation.
On postoperative radiographs, rather than being central, the position of the screw was mostly posterior. Computed tomography (CT) demonstrated that the screw, which was in the posterior half of the femoral head, had not …