Adolescent and Young Adult Hip Unit, Department of Orthopaedic Surgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115-5724, USA.
J Bone Joint Surg Am. 2011 May;93 Suppl 2:46-51. doi: 10.2106/JBJS.K.00040.
Slipped capital femoral epiphysis is usually treated with in situ fixation to prevent progression of deformity. However, slipped capital femoral epiphysis always is associated with structural risk factors for hip dysfunction in addition to the risk of slip progression. Femoro-acetabular impingement causes some mechanical abnormality in every hip affected by slipped capital femoral epiphysis, even when the slip is mild. The severity of femoro-acetabular impingement caused by slipped capital femoral epiphysis depends on several factors. Cumulative injury to the articular cartilage can result from impingement, and it is better to prevent this type of injury than to treat it later. In situ fixation alone rarely relieves femoro-acetabular impingement in slipped capital femoral epiphysis. Skillful and precise in situ fixation allows careful analysis of hip function in the stabilized slip by eliminating the major risk of acute instability. The more subtle risk of long-term articular damage caused by femoro-acetabular impingement must be considered. The treatment of femoro-acetabular impingement in patients who have slipped capital femoral epiphysis is a separate issue from instability of the proximal femoral physis. Femoro-acetabular impingement must be assessed in every hip that is affected by slipped capital femoral epiphysis, even when the deformity is mild. Several treatment options exist for treating femoro-acetabular impingement associated with slipped capital femoral epiphysis.
股骨头骨骺滑脱通常采用原位固定治疗，以防止畸形进展。然而，股骨头骨骺滑脱除了滑脱进展的风险外，还总是与髋关节功能障碍的结构性危险因素有关。股骨髋臼撞击症会导致每个受股骨头骨骺滑脱影响的髋关节出现一些机械异常，即使滑脱程度较轻。股骨头骨骺滑脱引起的股骨髋臼撞击症的严重程度取决于几个因素。撞击会导致关节软骨的累积损伤，最好是预防这种损伤，而不是以后再治疗。单纯的原位固定很少能缓解股骨头骨骺滑脱中的股骨髋臼撞击症。熟练而精确的原位固定通过消除急性不稳定的主要风险，允许对稳定滑脱中的髋关节功能进行仔细分析。必须考虑到由股骨髋臼撞击症引起的长期关节损伤的更微妙风险。对于患有股骨头骨骺滑脱的患者，股骨髋臼撞击症的治疗与股骨近端骨骺不稳定是分开的问题。即使畸形程度较轻，也应评估每个受股骨头骨骺滑脱影响的髋关节的股骨髋臼撞击症。治疗与股骨头骨骺滑脱相关的股骨髋臼撞击症有几种治疗选择。
