Subcapital correction osteotomy for malunited slipped capital femoral epiphysis.
Subcapital correction osteotomy for malunited slipped capital femoral epiphysis.
复制标题
股骨头骨骺畸形愈合滑脱的股骨头下矫正截骨术。
DOI：
10.1097/bpo.0b013e31827d7e06
复制
发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Peters,ChristopherL
中科院分区：
文献类型：
--
作者：
Anderson,LucasA;Gililland,JeremyM;Pelt,ChristoperE;Peters,ChristopherL
背景：股骨头骨骺滑脱（SCFE）会导致股骨头后下方移位和后倾，是股骨髋臼撞击的公认病因，并可能导致年轻人过早关节炎。畸形 SCFE 的治疗仍存在争议。手术脱位和头下矫正截骨术（SCO）被认为是矫正近端股骨畸形的有效方法。方法：2003年1月至2010年1月，11例（12髋）因SCFE畸形愈合而导致股骨骺闭合且有症状的股骨髋臼撞击症患者接受手术脱位和SCO治疗。我们对患者病史、体格检查、手术结果以及术前和术后前后位（AP）和腹股沟外侧（GLat）X线照片进行了回顾性审查。平均随访时间为61个月。结果：SCO患者中女性4例，男性7例，平均年龄15岁。在 AP X 线照片上，平均股骨头下位移（AP 骨骺颈角）显着改善（− 26 至− 6 度，P < 0.001）。在 GLat X 线照片上，平均后股骨头位移（外侧骨骺颈角）显着改善（− 45 至− 3 度，P < 0.001）。两个视图的平均 α 角也显着改善（AP：85 至 56 度，P < 0.001；GLat：85 至 46 度，P < 0.001）。手术结果包括 1 例股骨骨软骨缺损、8 例 Outerbridge 3 至 4 级髋臼软骨病变和 10 例盂唇病变。在最近的随访中发现平均哈里斯髋关节评分显着改善（54 至 77，P = 0.016）。 12例中4例出现并发症，其中2例股骨缺血性坏死，1例术后Harris髋关节评分恶化，1例翻修切开复位内固定成功治疗固定失败。结论：SCO作为手术脱位和骨软骨成形术的辅助手段，可用于矫正SCFE畸形合并股骨近端畸形。股骨近端解剖结构的正常化可能会推迟严重骨关节炎的进展，从而延迟年轻患者群体对关节置换术的需要。然而，外科医生和患者应意识到该手术在该人群中的风险很大。证据级别：IV 级——治疗研究。股骨头骨骺滑脱 (SCFE) 是一种青春期早期的病症，其中股骨骨骺从近端股骨颈“滑落”，通常导致股骨头相对于股骨颈后下方移位和后倾。在没有明显重塑的情况下，由此产生的畸形会导致运动范围缩小和严重的股骨髋臼撞击（FAI）。 1 与 SCFE 相关的 FAI 会导致年轻人软骨损伤和过早关节炎。 2-4 此外，股骨头骨骺严重畸形可能与步态和髋关节活动范围的功能限制有关。 Ziebarth 等人和 Slongo 等人将股骨头下重新排列描述为一种安全有效的治疗近端股骨骺开放患者急性和亚急性 SCFE 的方法。 5, 6 人们认为早期畸形矫正可以预防 SCFE 的一些长期后遗症。
Background:Slipped capital femoral epiphysis (SCFE), causing posterior and inferior displacement and retroversion of the femoral head, is a well-recognized etiology for femoroacetabular impingement and can lead to premature arthritis in the young adult. The treatment of malunited SCFE remains controversial. Surgical dislocation and subcapital correction osteotomy (SCO) has been described as a powerful method to correct the proximal femoral deformity.Methods:Between January 2003 and January 2010, 11 patients (12 hips) with closed femoral physes and symptomatic femoroacetabular impingement from malunited SCFE were treated with surgical dislocation and SCO. We performed a retrospective review of patient histories, physical examinations, operative findings, and preoperative and postoperative anteroposterior (AP) and groin-lateral (GLat) radiographs. Mean follow-up was 61 months.Results:There were 4 female and 7 male patients with an average age of 15 years at the time of SCO. On the AP radiograph, the mean inferior femoral head displacement (AP epiphyseal-neck angle) was significantly improved (− 26 to− 6 degrees, P< 0.001). On the GLat radiograph, the mean posterior femoral head displacement (lateral epiphyseal-neck angle) was significantly improved (− 45 to− 3 degrees, P< 0.001). The mean α-angle was also significantly improved on both views (AP: 85 to 56 degrees, P< 0.001; GLat: 85 to 46 degrees, P< 0.001). Operative findings included 1 femoral osteochondral defect, 8 Outerbridge grade 3 to 4 acetabular cartilage lesions, and 10 labral lesions. Significant improvement of the mean Harris Hip Score was seen at latest follow-up (54 to 77, P= 0.016). Complications occurred in 4 of the 12 cases with avascular necrosis in 2 patients, a worse postoperative Harris Hip Score in 1 patient, and failure of fixation treated successfully with revision open reduction internal fixation in 1 patient.Conclusions:SCO as an adjunct to surgical dislocation and osteochondroplasty can be used to correct the deformity of the proximal femur associated with malunited SCFE. Normalization of proximal femoral anatomy may postpone progression to severe osteoarthritis and thus delay the need for arthroplasty in this young patient population. However, surgeons and patients should be aware that the risks of this procedure in this population are significant.Level of Evidence:Level IV—therapeutic study.Slipped capital femoral epiphysis (SCFE), a condition of early adolescence wherein the femoral epiphysis “slips” off of the proximal femoral neck, often leads to posteroinferior displacement and retroversion of the femoral head relative the femoral neck. In the absence of significant remodeling, this resulting deformity causes reduced range of motion and severe femoroacetabular impingement (FAI). 1 The FAI associated with SCFE leads to cartilage injury and premature arthritis in the young adult. 2–4 In addition, severely malunited capital epiphyses can be associated with functional limitations during gait and hip range of motion. Subcapital realignment has been described by Ziebarth et al and Slongo et al as a safe and effective treatment for acute and subacute SCFE in patients with open proximal femoral physes. 5, 6 It is felt that early deformity correction may prevent some of the long-term sequelae of SCFE.