Grubor Predrag, Mitkovic Milorad, Grubor Milan
Orthopaedics and Traumatology Clinic Banja Luka, Banja Luka, Bosnia and Herzegovina.
Clinic of Orthopedics and Traumatology, Clinical Center Nis, Nis, Serbia.
Med Arch. 2014 Oct;68(5):353-5. doi: 10.5455/medarh.2014.68.353-355. Epub 2014 Oct 15.
Epiphysiolysis of the femoral head is the most common accident occurring towards the end of pre-puberty and puberty growth.
The author describes the experience in the treatment of chronic epiphysiolysis in two patients treated by Southwick osteotomy. The site is accessed by way of a 15-cm long lateral skin incision and the trochanteric region is reached through the layers. The osteotomy angles prepared beforehand on a thin aluminium model are used to mark the Southwick osteotomy site on the anterior and lateral sides at the level of the lesser trochanter. Before performing the trochanteric osteotomy, two Mitković convergent pins type M20 are applied distally and proximally, above the planned osteotomy site. A tenotomy of the iliopsas muscle is performed, and then the previously marked bone triangle is redissected up to three quarters of the width of the femur. The distal part of the femur is rotated inwards, so that the patella is turned towards the ceiling. The osteotomised fragments of the femur are adapted, repositioned and fixated by installing an external fixator on the previously placed pins. Two more pins are placed, one proximally and one distally, with a view to adequately stabilising the femur. The patient was mobile from day two after the surgery. If, after the surgery, the lead surgeon realises that there is a requirement to make a correction of 5, 10 and 15 degrees of the valgus, varus, anteversion or retroversion deformity, the correction shall be performed without surgically opening the patient, using the fixator pins.
After performing a Southwick osteotomy it is easier to adapt, reposition and fixate the osteotomised fragments of the femur using a fixator type M20. Adequate stability allows regaining mobility quickly, which in turn is the best prevention of chondrolysis of the hip. It is possible to make post-operative valgus, varus, anteversion and retroversion corrections of 5, 10 and 15 degrees without performing a surgery. Once the osteotomy is healed, the fixator type M20 is removed without any additional surgery.
股骨头骨骺滑脱是青春期前和青春期生长末期最常见的意外情况。
作者描述了两例采用索思威克截骨术治疗慢性骨骺滑脱的经验。通过一个15厘米长的外侧皮肤切口进入手术部位，经各层组织到达转子区。预先在薄铝模型上准备好的截骨角度用于在小转子水平的前侧和外侧标记索思威克截骨部位。在进行转子截骨术前，在计划截骨部位上方的远端和近端应用两根M20型米特科维奇汇聚针。进行髂腰肌肌腱切断术，然后重新切开先前标记的骨三角形，直至股骨宽度的四分之三。股骨远端向内旋转，使髌骨朝向天花板。通过在先前放置的针上安装外固定器来调整、重新定位并固定股骨截骨碎片。再放置两根针，一根在近端，一根在远端，以充分稳定股骨。患者术后第二天即可活动。如果术后主刀医生意识到需要对5度、10度和15度的外翻、内翻、前倾或后倾畸形进行矫正，可使用固定针在不手术切开患者的情况下进行矫正。
采用索思威克截骨术后，使用M20型固定器更容易调整、重新定位并固定股骨截骨碎片。足够的稳定性可使患者迅速恢复活动能力，这反过来又是预防髋关节软骨溶解的最佳方法。无需再次手术即可在术后对外翻、内翻、前倾和后倾进行5度、10度和15度的矫正。一旦截骨愈合，无需进行任何额外手术即可取出M20型固定器。
