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髋关节滑囊炎后股骨髋臼撞击征的手术治疗。

Surgical treatment of femoroacetabular impingement after slipped capital femoral epiphysis.

机构信息

Pediatric Orthopedics Department, Hospital do Trabalhador.

Hospital Universitário Cajuru - PUCPR.

出版信息

Curr Opin Pediatr. 2018 Feb;30(1):93-99. doi: 10.1097/MOP.0000000000000565.

Abstract

PURPOSE OF REVIEW

Femoroacetabular impingement (FAI) post slipped capital femoral epiphysis (SCFE) may lead to degenerative changes on the hip. We have reviewed the current procedures in the literature, aiming to correct the SCFE to prevent FAI and the ones that treat FAI post SCFE.

RECENT FINDINGS

The trends of managing moderated or severe SCFE is to correct the displacement by reduction and fixation with articular hematoma decompression in unstable hips and Dunn modified procedure even for unstable and stable situations. However, after FAI is settled, the options are osteochondroplasty by arthroscopy or surgical hip dislocation, associated or not to subtrocanteric osteotomy.

SUMMARY

Femoroacetabular impingement may occur in mild slips and certainly occur in cases of moderate and severe slips. The initial management depends on the severity and the stability of the slip.The modified Dunn procedure is a good option for the treatment of unstable SCFEs. Gentle closed reduction with capsulotomy (Parsch) may be considered whenever the surgeon is not comfortable with the modified Dunn procedure.Hips with open physis and stable moderate or severe SCFE, the modified Dunn procedure can be indicated. Cases with closed physis are managed with intertrochanteric osteotomy combined with osteoplasty.In the presence of symptomatic FAI secondary to SCFE, one should consider arthroscopic osteoplasty or surgical hip dislocation (with or without osteotomies) as treatment options.

摘要

目的综述

股骨髋臼撞击症(FAI)继发于髋关节前滑脱性股骨颈骨骺骨折(SCFE)可导致髋关节退变。我们回顾了文献中的现有治疗方法,旨在通过纠正 SCFE 来预防 FAI,以及治疗 SCFE 后 FAI 的方法。

最新发现

对于中度或重度 SCFE,治疗趋势是通过关节内血肿减压使不稳定髋关节复位和固定,对于不稳定和稳定的情况,采用 Dunn 改良术来纠正移位。然而,FAI 解决后,可选择关节镜下骨软骨成形术或手术髋关节脱位,联合或不联合转子下截骨术。

总结

轻度 SCFE 可能会发生 FAI,而中重度 SCFE 肯定会发生 FAI。初始治疗取决于 SCFE 的严重程度和稳定性。改良 Dunn 术是不稳定 SCFE 的一种较好的治疗选择。只要术者对改良 Dunn 术不熟悉,就可以考虑行轻柔的闭合复位和囊切开术(Parsch)。对于开放性骨骺且稳定的中重度 SCFE,可采用改良 Dunn 术。对于闭合性骨骺的病例,可采用转子间截骨术联合骨成形术治疗。对于继发于 SCFE 的有症状的 FAI,应考虑采用关节镜下骨成形术或手术髋关节脱位(联合或不联合截骨术)作为治疗选择。

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