Wölfle-Roos Julia V, Urlaub Stefanie, Reichel Heiko, Taurman Rita
Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany.
J Pediatr Orthop B. 2016 May;25(3):197-201. doi: 10.1097/BPB.0000000000000285.
There is an ongoing debate on which fixation technique should be preferred for the prophylactic fixation of the asymptomatic contralateral hip in slipped capital femoral epiphysis (SCFE). In the case of Kirschner-wire (K-wire) fixation, there is a possibility of secondary loss of fixation because of longitudinal growth of the physis, whereas in screw fixation, physeal growth of the femoral neck might be impaired. The aim of this matched-pair study was to compare the longitudinal growth of the femoral neck in screw fixation versus K-wire fixation of the asymptomatic contralateral hip in SCFE. All 18 patients (female:male=3:15), who had undergone screw fixation of the asymptomatic contralateral hip between 9/2001 and 9/2011, were matched according to age, bone age, sex, and time to follow-up to another 18 patients with K-wire fixation. The length of the femoral neck of the contralateral hip was measured in parallel to either screw or K-wire from the apex of the femoral head to the opposite cortical bone. The ratio of the femoral neck length measured directly after surgery and on follow-up was defined as femoral neck growth. There was no significant difference between groups with respect to age, modified Oxford Bone age score, and time to follow-up. We found a significant difference in femoral neck growth between patients with screw fixation (5.5 ± 4.3%) compared with K-wire fixation (8.9 ± 5.7%, P = 0.048 matched Wilcoxon test). The difference in femoral neck growth of patients with K-wire or screw fixation of the contralateral asymptomatic hip in SCFE was small, but statistically significant. Thus, despite high rates of secondary loss of fixation, K-wire fixation should still be considered, especially in very young patients.
对于无症状对侧髋关节预防性固定在股骨头骨骺滑脱（SCFE）中应首选哪种固定技术，目前仍存在争议。对于克氏针（K针）固定，由于骨骺的纵向生长，存在继发固定丢失的可能性，而在螺钉固定中，股骨颈的骨骺生长可能会受到影响。这项配对研究的目的是比较SCFE中无症状对侧髋关节螺钉固定与K针固定时股骨颈的纵向生长情况。2001年9月至2011年9月期间对无症状对侧髋关节进行螺钉固定的所有18例患者（女性:男性 = 3:15），根据年龄、骨龄、性别和随访时间，与另外18例接受K针固定的患者进行配对。从股骨头顶点到对侧皮质骨，平行于螺钉或K针测量对侧髋关节股骨颈的长度。将术后直接测量的股骨颈长度与随访时测量的股骨颈长度之比定义为股骨颈生长。两组在年龄、改良牛津骨龄评分和随访时间方面无显著差异。我们发现，与K针固定（8.9 ± 5.7%，配对Wilcoxon检验P = 0.0４8）相比，螺钉固定患者的股骨颈生长有显著差异（5.5 ± 4.3%）。SCFE中对侧无症状髋关节K针或螺钉固定患者的股骨颈生长差异较小，但具有统计学意义。因此，尽管继发固定丢失率较高，但仍应考虑K针固定，尤其是在非常年轻的患者中。
