Kitano Toshio, Nakagawa Keisuke, Wada Mayuko, Moriyama Michiko
Department of Pediatric Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan.
J Pediatr Orthop B. 2015 Jul;24(4):281-5. doi: 10.1097/BPB.0000000000000170.
How should we treat acute/unstable slipped capital femoral epiphysis (SCFE) without the development of avascular necrosis (AVN)? To answer this question, we investigated the risk factors of AVN development after SCFE. Seventy-six hips of 64 patients were classified using two kinds of classification systems, Loder's classification based on instability and the conventional classification based on the duration of symptom, because both classifications are related to AVN development. Of 21 unstable SCFEs, seven hips developed AVN. Of 35 hips defined as acute or acute on chronic, nine hips developed AVN. Two stable SCFEs of Loder's classification developed AVN, one was acute and the other was acute on chronic. No hips of chronic SCFE developed AVN. The factor that had influenced AVN development was only closed reduction, whether purposefully or inadvertently, in an acute or unstable SCFE. On the basis of the findings of this study, one should not embark on any modality of closed reduction for an unstable or acute form of SCFE, as there is a high risk for occurrence of AVN. For the same reason, a traction table should not be used for SCFE fixation, so as to avoid an inadvertent reduction or force that can lead to AVN.
对于未发生缺血性坏死（AVN）的急性/不稳定型股骨头骨骺滑脱（SCFE），我们应如何治疗？为回答这个问题，我们研究了SCFE后发生AVN的危险因素。64例患者的76髋采用两种分类系统进行分类，一种是基于不稳定程度的Loder分类，另一种是基于症状持续时间的传统分类，因为这两种分类都与AVN的发生有关。在21例不稳定型SCFE中，7髋发生了AVN。在被定义为急性或慢性起病急性加重的35髋中，9髋发生了AVN。Loder分类中的2例稳定型SCFE发生了AVN，1例为急性，另1例为慢性起病急性加重。慢性SCFE无一例发生AVN。影响AVN发生的因素仅为在急性或不稳定型SCFE中进行了闭合复位，无论这种复位是有意还是无意的。基于本研究的结果，对于不稳定型或急性型SCFE，不应采用任何形式的闭合复位，因为发生AVN的风险很高。出于同样的原因，不应使用牵引床进行SCFE固定，以避免导致AVN的意外复位或外力。
