Tannast M, Jost L M, Lerch T D, Schmaranzer F, Ziebarth K, Siebenrock K A
Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
Department of Pediatric Orthopaedics, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
J Child Orthop. 2017 Apr;11(2):138-146. doi: 10.1302/1863-2548-11-170046.
Based on previous investigations on the vascular blood supply to the femoral head, a technique for anatomical reduction after slipped capital femoral epiphysis was developed. This technique is a modification of the original technique by Dunn using a retinacular soft-tissue flap. This allows the visual control of the epiphyseal vascular blood supply. We report the experience at the inventor's institution with a critical discussion of the available literature.
Using a trochanteric osteotomy for surgical dislocation of the hip, a retinacular soft tissue flap is created containing the deep branch of the medial femoral circumflex artery, the external rotators and the capsule. The femoral epiphysis can be mobilised safely and reduced on the femoral neck after resection of the almost constantly present reactive metaphyseal callus.
In our institution, the rate of avascular necrosis with 2% is comparably low to Dunn's original results. It is only present in cases where no bleeding was already evident before reduction of the epiphysis. The ten-year long-term results are favorable in these cases with a good functional result and only little progression of osteoarthritis. However, other authors have reported higher rates of avascular necrosis up to 24% in their initial experience.
In experienced hands using the correct meticulous surgical technique, the results are favorable regarding the rates of avascular necrosis, the functional outcome and the development of radiographic osteoarthritis - even in acute and severe cases. Avascular necrosis is rare but can be observed if there is no evidence of intra-operative femoral head perfusion before and after reduction of the epiphysis.
基于先前对股骨头血管血供的研究，开发了一种用于治疗股骨头骨骺滑脱后解剖复位的技术。该技术是对邓恩（Dunn）使用支持带软组织瓣的原始技术的改良。这使得能够可视化控制骨骺的血管血供。我们报告了发明者所在机构的经验，并对现有文献进行了批判性讨论。
通过转子截骨术使髋关节手术脱位，创建一个包含股内侧旋动脉深支、外旋肌和关节囊的支持带软组织瓣。在切除几乎总是存在的反应性干骺端骨痂后，可安全地移动股骨头骨骺并将其复位到股骨颈上。
在我们机构，2%的无血管坏死率与邓恩的原始结果相比相对较低。仅在骨骺复位前无明显出血的病例中出现。在这些病例中，十年长期结果良好，功能结果良好，骨关节炎进展轻微。然而，其他作者在其初始经验中报告的无血管坏死率高达24%。
在经验丰富的医生手中，使用正确细致的手术技术，即使在急性和严重病例中，无血管坏死率、功能结果和影像学骨关节炎的发展方面的结果也是良好的。无血管坏死很少见，但如果骨骺复位前后均无术中股骨头灌注的证据，则可观察到。
