Post-Graduation Departament of the Federal University of Rio de Janeiro, (UFRJ) and Jesus Children's Hospital, Rio de Janeiro, Brazil.
J Orthop Surg Res. 2011 Feb 19;6:10. doi: 10.1186/1749-799X-6-10.
Treatment of the Slipped Capital Femoral Epiphysis remains a cause of concern due to the fact that the true knowledge of the etiopathogeny is unknown, as well as one of its major complications: chondrolysis. The conservative treatment remains controversial; it has been overlooked in the studies and subjected to intense criticism. The purpose of this study is to investigate the results of treatment on the hip of patients displaying slipped capital femoral epiphysis, using the plaster cast immobilization method and its link to chondrolysis.
The research was performed based on the study of the following variables: symptomatology, and the degree of slipping. A hip spica cast and bilateral short/long leg casts in abduction, internal rotation with anti-rotational bars were used for immobilizing the patient's hip for twelve weeks. Statistical analysis was accomplished by Wilcoxon's marked position test and by the Fisher accuracy test at a 5% level.
A satisfactory result was obtained in the acute group, 70.5%; 94%; in the chronic group (chronic + acute on chronic). Regarding the degree of the slipping, a satisfactory result was obtained in 90.5% of hips tested with a mild slip; in 76% with moderate slip and 73% in the severe slip. The statistical result revealed that a significant improvement was found for flexion (p = 0.0001), abduction (p = 0.0001), internal rotation (p = 0.0001) and external rotation (p = 0.02). Chondrolysis was present in 11.3% of the hips tested. One case of pseudoarthrosis with aseptic capital necrosis was presented. There was no significant variation between age and chondrolysis (p = 1.00).Significant variation between gender/non-white patients versus chondrolysis (p = 0.031) and (p = 0.037), respectively was verified. No causal association between plaster cast and chondrolysis was observed (p = 0.60). In regard to the symptomatology group and the slip degree versus chondrolysis, the p value was not statistically significant in both analyses, p = 0.61 and p = 0.085 respectively.
After analyzing the nonoperative treatment of slipped capital femoral epiphysis and chondrolysis, we conclude that employment of the treatment revealed that the method was functional, efficient, valid, and reproducible; it also can be used as an alternative therapeutic procedure regarding to this specific disease.
由于对滑脫性股骨頭骨骺炎的病因病理知之甚少，其主要併發症之一——骨软骨炎仍是一个值得关注的问题。保守治疗仍然存在争议；在研究中被忽视，并受到强烈批评。本研究旨在探讨使用石膏固定方法治疗滑脫性股骨頭骨骺炎患者的髋关节，并探讨其与骨软骨炎的关系。
本研究通过研究以下变量来进行：症状和滑脫程度。患者髋关节采用石膏固定，双侧短/长腿外展、内旋，并使用抗旋杆，固定 12 周。統計分析采用 Wilcoxon 标记位置检验和 Fisher 确切概率检验，检验水准为 5%。
急性组（70.5%）和慢性组（慢性+慢性急性）的结果均令人满意。对于滑脫程度，轻度滑脫的髋关节中有 90.5%的结果令人满意，中度滑脫的髋关节中有 76%的结果令人满意，重度滑脫的髋关节中有 73%的结果令人满意。統計结果显示，屈伸（p=0.0001）、外展（p=0.0001）、内旋（p=0.0001）和外旋（p=0.02）均有显著改善。测试的髋关节中有 11.3%存在骨软骨炎。1 例出现无菌性股骨頭壞死的假關節。年龄和骨软骨炎之间无显著差异（p=1.00）。性别/非白人患者与骨软骨炎之间存在显著差异（p=0.031）和（p=0.037）。未观察到石膏固定与骨软骨炎之间存在因果关系（p=0.60）。在分析症状组和滑脫程度与骨软骨炎之间的关系时，两种分析的 p 值均无统计学意义，分别为 p=0.61 和 p=0.085。
分析非手术治疗滑脫性股骨頭骨骺炎和骨软骨炎后，我们认为该方法有效、有效、有效且可重复，也可作为治疗这种特定疾病的替代治疗方法。
