Matsushita Masaki, Mishima Kenichi, Iwata Kohji, Hattori Tadashi, Ishiguro Naoki, Kitoh Hiroshi
Department of Orthopaedics, Nagoya University Graduate School of Medicine, Nagoya Department of Orthopaedics, Aichi Children's Health and Medical Center, Aichi, Japan.
Medicine (Baltimore). 2017 May;96(19):e6662. doi: 10.1097/MD.0000000000006662.
Unstable slipped capital femoral epiphysis (SCFE) has a relatively high risk of avascular necrosis of the femoral head. Standard treatment for unstable SCFE is still controversial. We reviewed unstable SCFE case series treated with the standardized protocol, which consisted of percutaneous pinning after prolonged skeletal traction.
Our treatment regimen for unstable SCFE patients included 1 week or more of skeletal traction with the hip in a flexed position of 45 degrees, and subsequent percutaneous pinning after unintentional reduction. Eleven patients were treated in our institution and an affiliated hospital between 2003 and 2013. Sex, age at surgery, body mass index, the presence of hormonal abnormality, duration between onset and surgery, head shaft angle, posterior tilting angle, and modified Harris hip score were investigated from the medical records and radiographs.
There were 8 male and 3 female with an average age of 11.7 years and an average body mass index of 24.5 kg/mm. No patients had hormonal abnormalities. The duration between onset and surgery ranged from 8 to 16 days. The average preoperative and postoperative head shaft angles were 126 and 141 degrees, respectively. Postoperative posterior tilting angle was averaged of 30.7 degrees, which decreased to 21.5 degrees during follow-up period. One patient showed mild avascular necrosis only confirmed by magnetic resonance imaging, but he was uneventfully treated without additional procedures. As a result, all patients had a perfect modified Harris hip score of 91 points.
Prolonged traction with the hip in a flexed position may not only provide gradual reduction of posteriorly displaced epiphysis but also decrease intra-articular pressure before surgery. Although percutaneous pinning after unintentional reduction leaves mild displacement of the femoral epiphysis, remodeling could be expected during remaining growth period.
不稳定型股骨头骨骺滑脱（SCFE）发生股骨头缺血性坏死的风险相对较高。不稳定型SCFE的标准治疗方法仍存在争议。我们回顾了采用标准化方案治疗的不稳定型SCFE病例系列，该方案包括长时间骨骼牵引后经皮穿针固定。
我们对不稳定型SCFE患者的治疗方案包括：髋关节处于45度屈曲位进行1周或更长时间的骨骼牵引，以及在无意中复位后进行经皮穿针固定。2003年至2013年期间，我们机构及一家附属医院共治疗了11例患者。从病历和X光片中调查患者的性别、手术年龄、体重指数、激素异常情况、发病至手术的时间、头干角、后倾角以及改良Harris髋关节评分。
8例男性，3例女性，平均年龄11.7岁，平均体重指数为24.5kg/mm。无患者存在激素异常。发病至手术的时间为8至16天。术前和术后平均头干角分别为126度和141度。术后平均后倾角为30.7度，随访期间降至21.5度。仅1例患者经磁共振成像证实有轻度缺血性坏死，但未进行额外治疗，病情平稳。结果，所有患者的改良Harris髋关节评分为91分，效果理想。
髋关节屈曲位长时间牵引不仅可使后移位骨骺逐渐复位，还可在手术前降低关节内压力。尽管无意中复位后经皮穿针固定会使股骨骨骺留有轻度移位，但在剩余生长期间有望实现重塑。
