在股骨头骨骺滑脱原位固定后，外侧插入是一个良好的预后因素。
Lateral insertion is a good prognostic factor after in situ fixation in slipped capital femoral epiphysis.
作者信息
Hagiwara Shigeo, Nakamura Junichi, Kamegaya Makoto, Saisu Takashi, Kakizaki Jun, Ohtori Seiji, Kishida Shunji, Takahashi Kazuhisa
机构信息
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8677, Japan.
出版信息
BMC Musculoskelet Disord. 2014 Sep 26;15:317. doi: 10.1186/1471-2474-15-317.
BACKGROUND
In situ fixation (ISF) is standard treatment for slipped capital femoral epiphysis (SCFE) to stabilize the epiphysis and to prevent further slip. The aim of this study was to clarify the incidence of slip progression after ISF and its prognostic factors.
METHODS
We retrospectively reviewed 53 hips in 49 consecutive SCFE patients who underwent single screw ISF and were followed until physeal closure. Clinical and radiographic findings were viewed to assess progression of the posterior tilting angle (PTA).
RESULTS
Mean PTA was 33.4 degrees (range, 18 to 75 degrees) at ISF and 35.9 degrees (range, 18 to 75 degrees) at physeal closure with progression of PTA of 2.5 degrees (range, -2 to 19 degrees). Slip progression occurred in 28 of 53 hips (53%), and more than five degrees of progression occurred in 14 hips (26%). Multiple regression analysis revealed that point of screw insertion (one point for lateral and two points for medial) was a significant prognostic factor for progression of the slip by the following formula: (progression of PTA) = -1.523 + 2.701 × (point of screw insertion), R(2) = 0.148, p = 0.005.
CONCLUSIONS
The current study showed that a screw inserted from the lateral side to the intertrochanteric line prevented postoperative slip progression.
背景
原位固定（ISF）是治疗股骨头骨骺滑脱（SCFE）的标准方法，用于稳定骨骺并防止进一步滑脱。本研究的目的是明确原位固定后滑脱进展的发生率及其预后因素。
方法
我们回顾性分析了49例连续接受单枚螺钉原位固定并随访至骨骺闭合的SCFE患者的53个髋关节。观察临床和影像学表现以评估后倾角（PTA）的进展情况。
结果
原位固定时平均PTA为33.4度（范围18至75度），骨骺闭合时为35.9度（范围18至75度），PTA进展2.5度（范围-2至19度）。53个髋关节中有28个（53%）发生了滑脱进展，14个髋关节（26%）进展超过5度。多元回归分析显示，螺钉置入点（外侧为1分，内侧为2分）是滑脱进展的一个重要预后因素，计算公式如下：（PTA进展）=-1.523 + 2.701×（螺钉置入点），R² = 0.148，p = 0.005。
结论
本研究表明，从外侧向转子间线置入螺钉可防止术后滑脱进展。
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