闭合性骨移植骺板切除术治疗股骨头骨骺缺血性坏死。
Closed bone graft epiphysiodesis for avascular necrosis of the capital femoral epiphysis.
机构信息
Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Medical Center, Case Western Reserve University, Cleveland, OH 44106-5043, USA.
出版信息
Clin Orthop Relat Res. 2013 Jul;471(7):2199-205. doi: 10.1007/s11999-013-2819-8.
BACKGROUND
Avascular necrosis (AVN) of the capital femoral epiphysis (CFE) after an unstable slipped capital femoral epiphysis (SCFE), femoral neck fracture or traumatic hip dislocation can result in severe morbidity. Treatment options for immature patients with AVN are limited, including a closed bone graft epiphysiodesis (CBGE). However, it is unclear whether this procedure prevents AVN progression.
QUESTIONS/PURPOSES: We investigated whether early MRI screening and CBGE prevented the development of advanced AVN changes in the CFE and the rates of complications with this approach.
METHODS
We prospectively followed all 13 patients (seven boys, six girls) with unstable SCFEs (six patients), femoral neck fractures (five patients), and traumatic hip dislocations (two patients) and evidence of early AVN treated between 1984 and 2012. Mean age at initial injury was 12 years (range, 10-16 years). Nine of the 13 patients had followup of at least 2 years or until conversion to THA (mean, 4.5 years; range, 0.8-8.5 years), including two with unstable SCFEs, the five with femoral neck fractures, and the two with traumatic hip dislocations. All patients had technetium scans and/or MRI within 1 to 2 months of their initial injury (before CBGE) and all had evidence of early (Ficat 0) AVN. Patients were followed clinically and radiographically for AVN progression.
RESULTS
Six of the nine hips did not develop typical clinical or radiographic evidence of AVN. These six patients have been followed 6.3 years (range, 4.3-9.1 years) from initial injury and 5.9 years (range, 3.8-8.5 years) from CBGE. The remaining three patients were diagnosed with AVN at periods ranging from 3 to 6 months after CBGE.
CONCLUSIONS
Early recognition and treatment of AVN with a CBGE may alter the natural history of this complication.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
背景
不稳定型股骨头骨骺滑脱（SCFE）、股骨颈骨折或创伤性髋关节脱位后发生的股骨头骨骺缺血性坏死（AVN）可导致严重的发病率。对于患有 AVN 的未成年患者，治疗选择有限，包括闭合性骨移植骺板融合术（CBGE）。然而，目前尚不清楚该手术是否能阻止 AVN 的进展。
问题/目的：我们研究了早期 MRI 筛查和 CBGE 是否能预防 CFE 中晚期 AVN 改变的发生，并探讨了这种方法的并发症发生率。
方法
我们前瞻性随访了 1984 年至 2012 年期间接受治疗的 13 例（7 名男孩，6 名女孩）不稳定型 SCFE（6 例）、股骨颈骨折（5 例）和创伤性髋关节脱位（2 例）且有早期 AVN 证据的患者。初次损伤时的平均年龄为 12 岁（范围 10-16 岁）。13 例患者中有 9 例（2 例不稳定型 SCFE、5 例股骨颈骨折和 2 例创伤性髋关节脱位）的随访时间至少为 2 年或直至转为全髋关节置换术（平均随访时间 4.5 年；范围 0.8-8.5 年）。所有患者在初次损伤后 1 至 2 个月内均接受锝扫描和/或 MRI 检查（在 CBGE 之前），且均有早期（Ficat 0）AVN 的证据。对患者进行临床和影像学随访，以评估 AVN 的进展情况。
结果
9 例中有 6 例髋关节未出现典型的临床或影像学 AVN 证据。这 6 例患者从初次损伤开始已经随访了 6.3 年（范围 4.3-9.1 年），从 CBGE 开始已经随访了 5.9 年（范围 3.8-8.5 年）。其余 3 例患者在 CBGE 后 3 至 6 个月时被诊断为 AVN。
结论
早期识别和 CBGE 治疗 AVN 可能会改变这种并发症的自然病程。
证据等级
IV 级，治疗性研究。有关证据等级的完整描述，请参见作者须知。
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