关节造影辅助下股骨近端骨骺滑脱的固定：一项CT和影像学研究

Wright Patrick B, Ruder John, Herrera-Soto Jose A, Phillips Jonathan H

Department of Orthopedic Surgery and Rehabilitation, University of Mississipi Medical Center, Jackson, MS 39216, USA.

J Pediatr Orthop. 2012 Oct-Nov;32(7):693-6. doi: 10.1097/BPO.0b013e31826bb1d0.

BACKGROUND

Intraoperative fluoroscopy does not always provide the operating surgeon with optimal visualization of a slipped capital femoral epiphysis (SCFE). Arthrography can be used to enhance fluoroscopic images of these patients. This study retrospectively compared the screw placement between patients who received conventional versus arthrographic-assisted in situ screw fixation for SCFE.

METHODS

We reviewed the charts and radiographs of all patients diagnosed with a SCFE at our institution from 2005 to 2010. We isolated those who received postoperative computed tomography (CT) scans to confirm screw placement, and subdivided the patients into 2 groups: those who received arthrograms to facilitate screw placement and those who did not. The screw-tip-to-articular-surface distance was then measured on intraoperative fluoroscopic images and postoperative CT scans.

RESULTS

Seventy-eight patients met inclusion criteria and 24 received an intraoperative arthrogram. Screw placement determined by intraoperative fluoroscopic images did not differ between the 2 groups. When measured on postoperative CT scans the screw-tip-to-articular-surface distance was significantly smaller in the arthrogram-assisted cohort (2.8 vs. 5.2 mm), and the difference between intraoperative and postoperative measurements was significantly greater in the arthrogram-assisted cohort (4.9 vs. 1.6 mm). No cases of intra-articular screw placement were found in either cohort, nor were there any cases demonstrating loss of fixation.

CONCLUSIONS

Arthrogram-assisted fixation of SCFE is a safe and effective tool in patients whose body habitus makes diagnostic fluoroscopic images difficult to obtain. It is, however, not without technical challenges. After the dye is injected it becomes more difficult to visualize the subchondral bone on fluoroscopic images. Our screws were, on average, 4.9 mm closer to the joint space on CT scans than seen intraoperatively. The operating surgeon must be aware of this fact to avoid joint penetration.

LEVEL OF EVIDENCE

Level III.

背景

术中透视并不总能为手术医生提供股骨颈滑脱（SCFE）的最佳可视化图像。关节造影可用于增强这些患者的透视图像。本研究回顾性比较了接受传统原位螺钉固定与关节造影辅助原位螺钉固定治疗SCFE患者的螺钉置入情况。

方法

我们回顾了2005年至2010年在本机构诊断为SCFE患者的病历和X线片。我们挑选出那些接受术后计算机断层扫描（CT）以确认螺钉置入情况的患者，并将其分为两组：接受关节造影以辅助螺钉置入的患者和未接受关节造影的患者。然后在术中透视图像和术后CT扫描上测量螺钉尖端至关节面的距离。

结果

78例患者符合纳入标准，24例接受了术中关节造影。两组患者术中透视图像确定的螺钉置入情况无差异。术后CT扫描测量时，关节造影辅助组的螺钉尖端至关节面距离明显更小（2.8对5.2毫米），且关节造影辅助组术中与术后测量的差异明显更大（4.9对1.6毫米）。两组均未发现关节内螺钉置入情况，也没有出现固定失败的病例。