Thomsen Laurent, Vialle Raphaël, Maillet Marie, Mary Pierre, Damsin Jean-Paul, Filipe Georges
Armand Trousseau Hospital, Department of Paediatric Orthopaedics, Université Pierre et Marie Curie-Paris 6, 26, Avenue du Docteur Arnold Netter, Paris Cedex 12, 75571, France.
J Child Orthop. 2007 Jul;1(2):121-5. doi: 10.1007/s11832-007-0030-8. Epub 2007 Jun 21.
Unstable slipped capital femoral epiphysis is rare, but is frequently associated with avascular necrosis. The rapid and complete reduction of the epiphysis displacement was shown to be responsible for this complication. We present the preliminary results of a progressive reduction technique of epiphysis displacement.
A total of 11 patients treated using progressive traction and internal fixation were reviewed retrospectively. Only children who underwent clinical and radiological follow-up for at least 18 months were included in this study to detect avascular necrosis.
The mean posterior displacement of the femoral head was 67 degrees and mean traction duration was 13 days. Of the patients, 2 had cutaneous problems requiring traction interruption, one on day 5 and the other on day 9. The mean residual slip was 16 degrees and 3 patients had complete or partial avascular necrosis well tolerated at the final follow-up.
Our experience showed that if traction is supported for more than 2 weeks, a good correction of the epiphysis displacement can be obtained. Our short series does not allow affirmation of the superiority of our therapeutic strategy, especially with regards to avascular necrosis of the femoral head.
不稳定型股骨头骨骺滑脱较为罕见，但常与缺血性坏死相关。已表明骨骺移位的快速完全复位是导致该并发症的原因。我们展示了一种骨骺移位渐进性复位技术的初步结果。
回顾性分析了11例采用渐进性牵引和内固定治疗的患者。本研究仅纳入了接受临床和影像学随访至少18个月以检测缺血性坏死的儿童。
股骨头平均后移67度，平均牵引持续时间为13天。其中2例患者出现皮肤问题需要中断牵引，1例在第5天，另1例在第9天。平均残余滑脱为16度，3例患者在最终随访时出现完全或部分缺血性坏死，但耐受性良好。
我们的经验表明，如果牵引持续超过2周，可以获得骨骺移位的良好矫正。我们的短系列病例不允许肯定我们治疗策略的优越性，尤其是在股骨头缺血性坏死方面。
