Örtegren Jakob, Björklund-Sand Lina, Engbom Malin, Siversson Carl, Tiderius Carl J
Departments of *Orthopaedics †Medical Radiation Physics, Lund University, Lund/Malmö, Sweden.
J Pediatr Orthop. 2016 Jul-Aug;36(5):494-8. doi: 10.1097/BPO.0000000000000684.
The optimal treatment for slipped capital femoral epiphysis (SCFE) remains controversial. In Sweden, the standard treatment is unthreaded fixation over the physis, with the purpose to permit continued growth of the femoral neck. The aim of the present study was to verify and quantify longitudinal growth of the femoral neck after in situ pinning with the Hansson hook-pin.
We performed a retrospective study of 54 patients treated with the Hansson hook-pin for SCFE between 2001 and 2009. The immediate postoperative radiograph and the radiograph after physeal closure (mean interval, 34 mo) were analyzed. Because the smooth Hansson hook-pin only has a grip fixation in the epiphysis, the femoral neck growth was determined as the difference in nail protrusion from the lateral cortex between the 2 radiographs. The femoral neck offset was also measured in all radiographs.
Significant longitudinal growth occurred both in the slipped and the prophylactically treated contralateral hip by mean 7.1 mm (P<0.001) and 10.0 mm (P<0.001), respectively. There was no difference in growth between genders and no correlation between the amount of longitudinal growth and slip severity (range, 4.0 to 71,6 degrees; mean 27.3 degrees). Young patients (less than 11 y) grew more than older patients (more than 14 y), 12.1 vs. 4.2 mm, P=0.002. The femoral offset increased by mean 16% from mean 30.0 to 35.2 mm (P<0.001). The longitudinal growth of the femoral neck correlated with the increase in femoral offset (R=0.51, P<0.001).
Unthreaded fixation of SCFE with the Hansson hook-pin allows continued growth of the femoral neck. The remaining growth enables the patient to achieve an almost anatomic offset of the hip. This is essential to optimize the abduction forces that stabilize the pelvis during gait. Future studies need to establish whether the longitudinal growth also results in improved remodelling of the proximal femur.
Level III-retrospective comparative study.
股骨头骨骺滑脱（SCFE）的最佳治疗方法仍存在争议。在瑞典，标准治疗方法是在骨骺上进行无螺纹固定，目的是使股骨颈继续生长。本研究的目的是验证并量化使用汉森钩钉原位固定后股骨颈的纵向生长情况。
我们对2001年至2009年间54例接受汉森钩钉治疗SCFE的患者进行了回顾性研究。分析了术后即刻的X线片和骨骺闭合后的X线片（平均间隔34个月）。由于光滑的汉森钩钉仅在骨骺处有握持固定，股骨颈生长量被确定为两张X线片上钉子从外侧皮质突出的差异。所有X线片还测量了股骨颈偏移。
滑脱侧和预防性治疗的对侧髋关节均出现显著的纵向生长，平均分别为７.１ｍｍ（Ｐ＜０.００１）和１０.０ｍｍ（Ｐ＜０.００１）。两性之间的生长无差异，纵向生长量与滑脱严重程度（范围4.0至71.6度；平均27.3度）之间无相关性。年轻患者（小于11岁）比老年患者（大于14岁）生长更多，分别为12.1ｍｍ和4.2ｍｍ，Ｐ＝０.００２。股骨偏移平均增加16％，从平均30.0ｍｍ增加到35.2ｍｍ（Ｐ＜０.００１）。股骨颈的纵向生长与股骨偏移的增加相关（Ｒ＝０.51，Ｐ＜０.００１）。
使用汉森钩钉对SCFE进行无螺纹固定可使股骨颈继续生长。剩余的生长使患者能够实现髋关节几乎解剖学上的偏移。这对于优化步态期间稳定骨盆的外展力至关重要。未来的研究需要确定纵向生长是否也会导致股骨近端更好的重塑。
Ⅲ级——回顾性比较研究。
