Chen Ryan C, Schoenecker Perry L, Dobbs Matthew B, Luhmann Scott J, Szymanski Deborah A, Gordon J Eric
Department of Orthopaedic Surgery, Washington University School of Medicine, and St Louis Children's Hospital, St Louis, MO 63110, USA.
J Pediatr Orthop. 2009 Oct-Nov;29(7):687-94. doi: 10.1097/BPO.0b013e3181b7687a.
The management of unstable slipped capital femoral epiphysis (SCFE) is controversial. A high incidence of avascular necrosis (AVN) has been reported after unstable SCFE.
Twenty-eight consecutive patients with thirty unstable SCFE underwent urgent reduction and fixation with two 6.5-mm cannulated screws. Positional reduction was performed in 25 cases. Arthrotomy was performed percutaneously in 16 cases and as part of an open capsulotomy in 5 cases.
Slip severity was mild in 13 patients, moderate in 9, and severe in 8. At mean duration of follow-up of 5.5 years (range: 2.0 to 11.2), 4 patients reported groin pain, and 8 patients reported a limp. Four patients developed AVN. One patient experienced slip progression and no patient developed chondrolysis.
Treatment of unstable SCFE with urgent positional reduction with accompanying arthrotomy and fixation through 2 cannulated screws resulted in a low incidence of slip progression and AVN.
Therapeutic study, level 4 (case series, no or historical control group).
不稳定型股骨头骨骺滑脱（SCFE）的治疗存在争议。据报道，不稳定型SCFE后股骨头缺血性坏死（AVN）的发生率较高。
连续28例患者共30例不稳定型SCFE接受了紧急复位并用两枚6.5毫米空心螺钉固定。25例行闭合复位。16例经皮进行关节切开，5例作为开放关节囊切开术的一部分进行。
13例患者滑脱程度为轻度，9例为中度，8例为重度。平均随访时间为5.5年（范围：2.0至11.2年），4例患者报告腹股沟疼痛，8例患者报告跛行。4例发生AVN。1例出现滑脱进展，无患者发生关节溶解。
对不稳定型SCFE进行紧急闭合复位并伴有关节切开，通过2枚空心螺钉固定，导致滑脱进展和AVN的发生率较低。
治疗性研究，4级（病例系列，无或有历史对照组）。
