Leunig Michael, Slongo Theddy, Ganz Reinhold
Department of Orthopaedics, Schulthess Clinic, Zurich, Switzerland.
Instr Course Lect. 2008;57:499-507.
Based on the recognition that even minor slip displacement in patients with slipped capital femoral epiphysis can regularly produce acetabular cartilage damage and early clinical symptoms, subcapital realignment of the epiphysis should be considered, although a substantial risk of osteonecrosis has been reported. A modified surgical technique can be used in which the perfusion of the epiphysis via the medial femoral circumflex artery is actively protected during surgery by executing surgical dislocation of the joint and by developing a soft-tissue flap consisting of the retinaculum and the external rotator muscles. This flap allows mobilization of the epiphysis within the growth plate as well as complete callus resection of the neck without stretching the retinaculum. The dislocation of the head allows manual fixation of the epiphysis while curettage of the residual growth plate is performed, as well as manual reduction of the epiphysis onto the metaphysis under visual control of the retinaculum. With the head dislocated, any uncontrolled manipulation of the leg will result in less risk to the integrity of the retinaculum than would be the case if the head was reduced in the socket.
基于认识到即使是股骨头骨骺滑脱患者的轻微滑移移位也会经常导致髋臼软骨损伤和早期临床症状，尽管有报道称存在骨坏死的重大风险，但仍应考虑进行骨骺的股骨头下复位。可以采用一种改良的手术技术，在手术过程中通过进行关节的手术脱位并形成由支持带和外旋肌组成的软组织瓣，积极保护经由股内侧旋动脉的骨骺灌注。该瓣允许在生长板内移动骨骺以及完全切除颈部的骨痂而不拉伸支持带。头部脱位可在进行残余生长板刮除时手动固定骨骺，并在支持带的视觉控制下将骨骺手动复位到干骺端上。在头部脱位的情况下，与头部复位在髋臼内时相比，腿部的任何不受控制的操作对支持带完整性造成的风险更小。
