Falciglia Francesco, Aulisa Angelo G, Giordano Marco, Guzzanti Vincenzo
Department of Orthopaedics and Traumatology, Institute of Scientific Research, Children's Hospital Bambino Gesù, P.zza S. Onofrio 4, 00165, Rome, Italy.
University of Cassino, Strada Folcare, 4, 03043, Cassino, FR, Italy.
J Orthop Surg Res. 2017 Oct 30;12(1):163. doi: 10.1186/s13018-017-0663-3.
The appropriate treatment in mild slipped capital femoral epiphysis (SCFE) should not only prevent further slipping of the epiphysis but also address potential femoroacetabular impingement by restoring the anatomy of the proximal femur. The aim of this study was to quantify length of the remodeling phase mediated by growth of the femoral neck, after treatment of SCFE with a screw designed to prevent premature closure of the physis and provide stability.
Between 2001 and 2011, 38 patients with unilateral mild SCFE were treated by fixation in situ using a modified screw which does not cause premature physeal arrest. Twenty-four patients were investigated for clinical and radiological evidence of femoroacetabular impingement immediately after surgery, at 6- and 12-month follow-ups. Statistical analysis was performed comparing measurements of neck length and the α angle of the affected and contralateral side.
Mean α angle immediately after pinning was 56.2 ± 10.6° on the anteroposterior view and 91.4 ± 8.2° on the lateral view. These measurements significantly improved at 6 months post-op to 48.9 ± 5.4° on the anteroposterior view and 51.2 ± 6.5° on the lateral view (p < 0.0001). At 12 months from surgery, AP view α angle was 43.0 ± 2.8° (p < 0.0001) and lateral view was 44.2 ± 4.1° (p < 0.0001). We observed a similar growth rate and speed of the femoral neck of both the affected and unaffected sides during the first year of treatment. The clinical results in all patients were rated as excellent.
Our data supports the use of a surgical technique that allows residual growth of the femoral neck following mild SCFE and permits restoration of the anatomy of the proximal femur while avoiding development of femoroacetabular impingement following mild SCFE.
轻度股骨头骨骺滑脱（SCFE）的恰当治疗不仅应防止骨骺进一步滑脱，还应通过恢复股骨近端的解剖结构来解决潜在的股骨髋臼撞击问题。本研究的目的是量化在用旨在防止骨骺过早闭合并提供稳定性的螺钉治疗SCFE后，由股骨颈生长介导的重塑期的时长。
在2001年至2011年期间，38例单侧轻度SCFE患者采用改良螺钉原位固定治疗，该螺钉不会导致骨骺过早停滞。对24例患者在术后即刻、6个月和12个月随访时进行了股骨髋臼撞击的临床和影像学证据调查。进行了统计学分析，比较患侧和对侧的颈长测量值和α角。
穿针后即刻前后位平均α角为56.2±10.6°，侧位为91.4±8.2°。这些测量值在术后6个月时显著改善，前后位为48.9±5.4°，侧位为51.2±6.5°（p<0.0001）。术后12个月时，前后位α角为43.0±2.8°（p<0.0001），侧位为44.2±4.1°（p<0.0001）。在治疗的第一年，我们观察到患侧和未患侧股骨颈的生长速率和速度相似。所有患者的临床结果均评为优秀。
我们的数据支持使用一种手术技术，该技术允许轻度SCFE后股骨颈有残余生长，并能恢复股骨近端的解剖结构，同时避免轻度SCFE后发生股骨髋臼撞击。
