Souder Christopher D, Bomar James D, Wenger Dennis R
Department of Orthopedic Surgery, Rady Children's Hospital-San Diego, San Diego, CA.
J Pediatr Orthop. 2014 Dec;34(8):791-8. doi: 10.1097/BPO.0000000000000193.
Slipped capital femoral epiphysis (SCFE) can be treated by a variety of methods with the traditional method of in situ pin fixation being most commonly used. More recently, the Modified Dunn (Mod. Dunn) procedure consisting of capital realignment has been popularized as a treatment method for SCFE, particularly for more severe cases. Over the last 5 years, our institution has selectively used this method for more complex cases. The purpose of this article is to evaluate the differences between these 2 treatment methods in terms of avascular necrosis (AVN) rate, reoperation rate, and complication rate.
Eighty-eight hips that were surgically treated for SCFE between July 2004 and June 2012 met our inclusion criteria. The in situ fixation group included 71 hips, whereas 17 hips were anatomically reduced with the Mod. Dunn procedure. Loder classification, severity, acuity, complication rate, and reoperation rate were determined for the 2 cohorts. The χ analysis was performed to evaluate the relationship between the treatment method and outcome.
As expected, stable slips did well with in situ pinning with no cases of AVN, even in more severe slips. Ten stable slips were treated with the Mod. Dunn approach and 2 (20%) developed AVN. Unstable slips were more difficult to treat with 3 of the 7 hips stabilized in situ developing AVN (43%). Two of the 7 unstable slips treated by the Mod. Dunn procedure developed AVN (29%). The other outcomes studied (reoperation rate and complication rate) were not significantly related to the surgical treatment method (P = 0.732 and 0.261, respectively).
In situ pinning remains a safe and predictable method for treatment of stable SCFE with no AVN noted, even in severe slips. Attempts to anatomically reduce stable slips led to severe AVN in 20% of cases, thus this treatment approach should be considered with caution. Treatment of unstable slips remains problematic with high AVN rates noted whether treated by in situ fixation or capital realignment (Mod. Dunn).
Level III retrospective comparative study.
股骨头骨骺滑脱（SCFE）可用多种方法治疗，传统的原位针固定法最为常用。最近，包括股骨头复位的改良邓恩（Mod. Dunn）手术作为SCFE的一种治疗方法已得到推广，尤其是对于更严重的病例。在过去5年中，我们机构针对更复杂的病例选择性地使用了这种方法。本文的目的是评估这两种治疗方法在缺血性坏死（AVN）率、再次手术率和并发症发生率方面的差异。
2004年7月至2012年6月期间接受手术治疗的88例SCFE髋关节符合我们的纳入标准。原位固定组包括71例髋关节，而17例髋关节采用改良邓恩手术进行解剖复位。确定了两组的洛德分类、严重程度、急性程度、并发症发生率和再次手术率。进行χ分析以评估治疗方法与结果之间的关系。
正如预期的那样，稳定型滑脱采用原位穿针治疗效果良好，即使是更严重的滑脱也没有AVN病例。10例稳定型滑脱采用改良邓恩方法治疗，其中2例（20%）发生AVN。不稳定型滑脱治疗起来更困难，7例原位固定稳定的髋关节中有3例发生AVN（43%）。采用改良邓恩手术治疗的7例不稳定型滑脱中有2例发生AVN（29%）。研究的其他结果（再次手术率和并发症发生率）与手术治疗方法无显著相关性（P分别为0.732和0.261）。
原位穿针仍然是治疗稳定型SCFE的一种安全且可预测的方法，即使在严重滑脱的情况下也未发现AVN。试图对稳定型滑脱进行解剖复位导致20%的病例发生严重AVN，因此应谨慎考虑这种治疗方法。不稳定型滑脱的治疗仍然存在问题，无论是采用原位固定还是股骨头复位（改良邓恩），AVN发生率都很高。
III级回顾性比较研究。
