青少年股骨头骨骺滑脱的临床特点及手术治疗效果分析
|
摘要
目的分析青少年股骨头骨骺滑脱的临床特点及其手术治疗效果。方法回顾性分析自2010-01—2016-12诊治的13例(14髋)股骨头骨骺滑脱,9髋稳定股骨头骨骺滑脱,5髋为不稳定股骨头骨骺滑脱。6髋行闭合复位原位空心钉或克氏针内固定术,8髋经髋前外侧Smith-Petersen入路切开复位空心钉或克氏针内固定术,其中1例因严重股骨头骨骺滑脱行切开复位内固定附加髂骨骨移植与股骨颈重建术。结果 13例均获得随访,随访时间平均5(1～8)年。术后早期1髋出现股骨头缺血性坏死,1髋发生软骨溶解。末次随访时2髋发展为髋关节骨性关节炎。所有患者术后髋部疼痛及功能均明显改善,末次随访时均未出现双下肢不等长,髋关节功能Harris评分由术前(30.0±5.6)分提升至(86.0±7.3)分。结论对存在明显滑脱风险及稳定股骨头骨骺滑脱患者应提前采取干预性措施,避免其发展成为不稳定股骨头骨骺滑脱。只要选择正确的手术适应证、手术方式、手术时机,术后进行正确的康复锻炼,青少年股骨头骨骺滑脱患者可以通过手术治疗获得良好的近、中期效果。
Objective To analyze the clinical characteristics and surgical effect of adolescent slipped capital femoral epiphysis. Methods A retrospective analysis was performed on 13 patients(14 hips) with slipped capital femoral epiphysis,diagnosed and treated from January 2010 to December 2016, including 9 hips with stable slipped capital femoral epiphysis and 5 hips with unstable slipped capital femoral epiphysis. Six hips were treated with closed reduction in situ cannulated screw or Kirschner wire internal fixation, 8 hips were treated with open reduction cannulated screw or Kirschner wire internal fixation through anterolateral hip smith-petersen approach, and 1 case was treated with open reduction internal fixation plus iliac bone graft and femoral neck reconstruction for severe slipped capital femoral epiphysis. Results All the 13 patients were followed up for an average of 5(1-8) years. Early postoperative ischemic necrosis of the femoral head occurred in one hip, and chondrolysis occurred in one hip. At the last follow-up, 2 hips developed into hip arthritis. Postoperative hip pain and function were significantly improved in all patients, and at the last follow-up, all patients did not have unequal length of lower limbs. At the last follow-up, Harris score of hip joint function increased from(30.0 ±5.6) before surgery to(86.0±7.3).Conclusion Intervention measures should be taken in advance for patients with obvious risk of slip and stable slipped capital femoral epiphysis to prevent them from developing into unstable slipped capital femoral epiphysis. As long as the correct surgical indications, surgical methods and surgical timing are selected, and correct postoperative rehabilitation exercises are carried out, adolescent patients with slipped capital femoral epiphysis can obtain good near-and medium-term results through surgical treatment.
Objective To analyze the clinical characteristics and surgical effect of adolescent slipped capital femoral epiphysis. Methods A retrospective analysis was performed on 13 patients(14 hips) with slipped capital femoral epiphysis,diagnosed and treated from January 2010 to December 2016, including 9 hips with stable slipped capital femoral epiphysis and 5 hips with unstable slipped capital femoral epiphysis. Six hips were treated with closed reduction in situ cannulated screw or Kirschner wire internal fixation, 8 hips were treated with open reduction cannulated screw or Kirschner wire internal fixation through anterolateral hip smith-petersen approach, and 1 case was treated with open reduction internal fixation plus iliac bone graft and femoral neck reconstruction for severe slipped capital femoral epiphysis. Results All the 13 patients were followed up for an average of 5(1-8) years. Early postoperative ischemic necrosis of the femoral head occurred in one hip, and chondrolysis occurred in one hip. At the last follow-up, 2 hips developed into hip arthritis. Postoperative hip pain and function were significantly improved in all patients, and at the last follow-up, all patients did not have unequal length of lower limbs. At the last follow-up, Harris score of hip joint function increased from(30.0 ±5.6) before surgery to(86.0±7.3).Conclusion Intervention measures should be taken in advance for patients with obvious risk of slip and stable slipped capital femoral epiphysis to prevent them from developing into unstable slipped capital femoral epiphysis. As long as the correct surgical indications, surgical methods and surgical timing are selected, and correct postoperative rehabilitation exercises are carried out, adolescent patients with slipped capital femoral epiphysis can obtain good near-and medium-term results through surgical treatment.
引文
[1] Loder RT,Richards BS,Shapiro PS,et al. Acute slipped capitalfemoral epiphysis:the importance of physeal stability[J]. J BoneJoint Surg Am,1993,75(8):1134-1140.
[2] Sankar WN,McPartland TG,Millis MB,et al. The unstable slippedcapital femoral epiphysis:risk factors for osteonecrosis[J]. J PediatrOrthop,2010,30(6):544-548.
[3] Peterson MD,Weiner DS,Green NE,et al. Acute slipped capitalfemoral epiphysis:the value and safety of urgent manipulative re-duction[J]. J Pediatr Orthop,1997,17(5):648-654.
[4] Fahey JJ,O'Brien ET. Acute slipped capital femoral epiphysis:re-view of the literature and report of ten cases[J]. J Bone Joint SurgAm,1965,47:1105-1127.
[5] Almonte-Becerril M,Navarro-Garcia F,Gonzalez-Robles A,et al.Cell death of chondrocytes is a combination between apoptosis andautophagy during the pathogenesis of osteoarthritis within an experi-mental model[J]. Apoptosis,2010,15(5):631-638.
[6] Yngve DA,Moulton DL,Burke Evans E. Valgus slipped capitalfemoral epiphysis[J]. J Pediatr Orthop B,2005,14(3):172-176.
[7] Shank CF,Thiel EJ,Klingele KE. Valgus slipped capital femoralepiphysis:prevalence,presentation,and treatment options[J]. J Pe-diatr Orthop,2010,30(2):140-146.
[8] Leunig M,Manner HM,Turchetto L,et al. Femoral and acetabularre-alignment in slipped capital femoral epiphysis[J]. J Child Or-thop,2017,11(2):131-137.
[9] Sink EL,Zaltz I,Heare T,et al. Acetabular cartilage and labraldamage observed during surgical hip dislocation for stable slippedcapital femoral epiphysis[J]. J Pediatr Orthop,2010,30(1):26-30.
[10] Larson AN,Sierra RJ,Yu EM,et al. Outcomes of slipped capitalfemoral epiphysis treated with in situ pinning[J]. J Pediatr Orthop,2012,32(2):125-130.
[11] Early SD,Hedman TP,Reynolds RA. Biomechanical analysis ofcompression screw fixation versus standard in situ pinning inslipped capital femoral epiphysis[J]. J Pediatr Orthop,2001,21(2):183-188.
[12] Kohno Y,Nakashima Y,Kitano T,et al. Is the timing of surgery as-sociated with avascular necrosis after unstable slipped capitalfemoral epiphysis? A multicenter study[J]. J Orthop Sci,2017,22(1):112-115.
[13] Rached E,Akkari M,Braga SR,et al. Slipped capital femoral epi-physis:reduction as a risk factor for avascular necrosis[J]. J Pedi-atr Orthop B,2012,21(4):331-334.
[14] Herrera-Soto JA,Duffy MF,Birnbaum MA,et al. Increased intra-capsular pressures after unstable slipped capital femoral epiphysis[J]. J Pediatr Orthop,2008,28(7):723-728.
[15] Soto-Hall R,Johnson LH,Johnson RA. Variations in the intra-ar-ticular ppressure of the hip joint in injury and disease. A probablefactor in avascular necrosis[J]. J Bone Joint Surg Am,1964,46:509-516.
[16] Loder RT,Dietz FR. What is the best evidence for the treatment ofslipped capital femoral epiphysis?[J]. J Pediatr Orthop,2012,32Suppl 2:S158-S165.
[17] Chen RC,Schoenecker PL,Dobbs MB,et al. Urgent reduction,fixa-tion,and arthrotomy for unstable slipped capital femoral epiphysis[J]. J Pediatr Orthop,2009,29(7):687-694.
[18] Parsch K,Weller S,Parsch D. Open reduction and smooth Kirschn-er wire fixation for unstable slipped capital femoral epiphysis[J]. JPediatr Orthop,2009,29(1):1-8.
[19] Kalogrianitis S,Tan CK,Kemp GJ,et al. Does unstable slippedcapital femoral epiphysis require urgent stabilization?[J]. J PediatrOrthop B,2007,16(1):6-9.
[20] Rhoad RC,Davidson RS,Heyman S,et al. Pretreatment bone scanin SCFE:a predictor of ischemia and avascular necrosis[J]. J Pe-diatr Orthop,1999,19(2):164-168.
[21] Kohno Y,Nakashima Y,Kitano T,et al. Is the timing of surgery as-sociated with avascular necrosis after unstable slipped capitalfemoral epiphysis? A multicenter study[J]. J Orthop Sci,2017,22(1):112-115.
[22] Wall PD,Brown JS,Freshney S,et al. Hip shape and long-term hipfunction:a study of patients with in-situ fixation for slipped capi-tal femoral epiphysis[J]. Hip Int,2013,23(6):560-564.
[23] Hagglund G,Hansson LI,Ordeberg G,et al. Bilaterality in slippedupper femoral epiphysis[J]. J Bone Joint Surg Br,1988,70(2):179-181.
[24] Kocher MS,Bishop JA,Hresko MT,et al. Prophylactic pinning ofthe contralateral hip after unilateral slipped capital femoral epiph-ysis[J]. J Bone Joint Surg Am,2004,86(12):2658-2665.
[25] Schultz WR,Weinstein JN,Weinstein SL,et al. Prophylactic pin-ning of the contralateral hip in slipped capital femoral epiphysis:evaluation of long-term outcome for the contralateral hip with useof decision analysis[J]. J Bone Joint Surg Am,2002,84(8):1305-1314.
[2] Sankar WN,McPartland TG,Millis MB,et al. The unstable slippedcapital femoral epiphysis:risk factors for osteonecrosis[J]. J PediatrOrthop,2010,30(6):544-548.
[3] Peterson MD,Weiner DS,Green NE,et al. Acute slipped capitalfemoral epiphysis:the value and safety of urgent manipulative re-duction[J]. J Pediatr Orthop,1997,17(5):648-654.
[4] Fahey JJ,O'Brien ET. Acute slipped capital femoral epiphysis:re-view of the literature and report of ten cases[J]. J Bone Joint SurgAm,1965,47:1105-1127.
[5] Almonte-Becerril M,Navarro-Garcia F,Gonzalez-Robles A,et al.Cell death of chondrocytes is a combination between apoptosis andautophagy during the pathogenesis of osteoarthritis within an experi-mental model[J]. Apoptosis,2010,15(5):631-638.
[6] Yngve DA,Moulton DL,Burke Evans E. Valgus slipped capitalfemoral epiphysis[J]. J Pediatr Orthop B,2005,14(3):172-176.
[7] Shank CF,Thiel EJ,Klingele KE. Valgus slipped capital femoralepiphysis:prevalence,presentation,and treatment options[J]. J Pe-diatr Orthop,2010,30(2):140-146.
[8] Leunig M,Manner HM,Turchetto L,et al. Femoral and acetabularre-alignment in slipped capital femoral epiphysis[J]. J Child Or-thop,2017,11(2):131-137.
[9] Sink EL,Zaltz I,Heare T,et al. Acetabular cartilage and labraldamage observed during surgical hip dislocation for stable slippedcapital femoral epiphysis[J]. J Pediatr Orthop,2010,30(1):26-30.
[10] Larson AN,Sierra RJ,Yu EM,et al. Outcomes of slipped capitalfemoral epiphysis treated with in situ pinning[J]. J Pediatr Orthop,2012,32(2):125-130.
[11] Early SD,Hedman TP,Reynolds RA. Biomechanical analysis ofcompression screw fixation versus standard in situ pinning inslipped capital femoral epiphysis[J]. J Pediatr Orthop,2001,21(2):183-188.
[12] Kohno Y,Nakashima Y,Kitano T,et al. Is the timing of surgery as-sociated with avascular necrosis after unstable slipped capitalfemoral epiphysis? A multicenter study[J]. J Orthop Sci,2017,22(1):112-115.
[13] Rached E,Akkari M,Braga SR,et al. Slipped capital femoral epi-physis:reduction as a risk factor for avascular necrosis[J]. J Pedi-atr Orthop B,2012,21(4):331-334.
[14] Herrera-Soto JA,Duffy MF,Birnbaum MA,et al. Increased intra-capsular pressures after unstable slipped capital femoral epiphysis[J]. J Pediatr Orthop,2008,28(7):723-728.
[15] Soto-Hall R,Johnson LH,Johnson RA. Variations in the intra-ar-ticular ppressure of the hip joint in injury and disease. A probablefactor in avascular necrosis[J]. J Bone Joint Surg Am,1964,46:509-516.
[16] Loder RT,Dietz FR. What is the best evidence for the treatment ofslipped capital femoral epiphysis?[J]. J Pediatr Orthop,2012,32Suppl 2:S158-S165.
[17] Chen RC,Schoenecker PL,Dobbs MB,et al. Urgent reduction,fixa-tion,and arthrotomy for unstable slipped capital femoral epiphysis[J]. J Pediatr Orthop,2009,29(7):687-694.
[18] Parsch K,Weller S,Parsch D. Open reduction and smooth Kirschn-er wire fixation for unstable slipped capital femoral epiphysis[J]. JPediatr Orthop,2009,29(1):1-8.
[19] Kalogrianitis S,Tan CK,Kemp GJ,et al. Does unstable slippedcapital femoral epiphysis require urgent stabilization?[J]. J PediatrOrthop B,2007,16(1):6-9.
[20] Rhoad RC,Davidson RS,Heyman S,et al. Pretreatment bone scanin SCFE:a predictor of ischemia and avascular necrosis[J]. J Pe-diatr Orthop,1999,19(2):164-168.
[21] Kohno Y,Nakashima Y,Kitano T,et al. Is the timing of surgery as-sociated with avascular necrosis after unstable slipped capitalfemoral epiphysis? A multicenter study[J]. J Orthop Sci,2017,22(1):112-115.
[22] Wall PD,Brown JS,Freshney S,et al. Hip shape and long-term hipfunction:a study of patients with in-situ fixation for slipped capi-tal femoral epiphysis[J]. Hip Int,2013,23(6):560-564.
[23] Hagglund G,Hansson LI,Ordeberg G,et al. Bilaterality in slippedupper femoral epiphysis[J]. J Bone Joint Surg Br,1988,70(2):179-181.
[24] Kocher MS,Bishop JA,Hresko MT,et al. Prophylactic pinning ofthe contralateral hip after unilateral slipped capital femoral epiph-ysis[J]. J Bone Joint Surg Am,2004,86(12):2658-2665.
[25] Schultz WR,Weinstein JN,Weinstein SL,et al. Prophylactic pin-ning of the contralateral hip in slipped capital femoral epiphysis:evaluation of long-term outcome for the contralateral hip with useof decision analysis[J]. J Bone Joint Surg Am,2002,84(8):1305-1314.