髋关节固定治疗股骨颈骨骺滑脱后的退行性改变：至少 18 年的随访研究。
Degenerative changes of the hip following fixation for slipped capital femoral epiphysis: a minimum 18-year follow-up study.
机构信息
Orthopaedic Department, University Hospitals Leuven - Pellenberg, Belgium.
Orthopaedic Department, ZOL Genk, Belgium.
出版信息
Hip Int. 2021 Mar;31(2):264-271. doi: 10.1177/1120700019867248. Epub 2019 Aug 4.
INTRODUCTION
fixation (ISF) is currently still the 'gold standard' treatment for slipped capital femoral epiphysis (SCFE) and has shown acceptable results at mid-term follow-up. This study aims to evaluate functional, clinical and radiographic long-term outcomes after this procedure.
METHODS
We reviewed 64 SCFE patients (76 SCFE hips) treated with ISF between 1983 and 1998. 82.9% were stable hips and 17.1% unstable according to Loder's definition. Initial radiographs demonstrated a mild slip in 50%, moderate in 41.3% and severe in 8.7% based on the Southwick angle. Long-term outcomes were assessed using the modified Harris Hip Score (mHHS), University of California at Los Angeles (UCLA) and Tegner activity scores, visual analogue scale (VAS) pain, VAS function, flexion-adduction-internal rotation (FADIR) test, extent of internal-rotation at 90° of hip flexion and Tönnis classification for hip osteoarthritis (OA).
RESULTS
10 (15.6%) SCFE hips were converted to a total hip replacement (THR) after a mean of 16 years. 38 (59.4%) patients underwent a clinical and radiographic examination after a mean follow-up of 23 (range 18-33) years. 12 (18.8%) patients were lost to follow-up. 74% of SCFE hips demonstrated degenerative change on radiography or were converted to THR (Tönnis 1: 33.3%, 2: 18.5%, 3 or THR: 22.2%). There were 3 cases of avascular necrosis (AVN) all in unstable hips. Mean mHHS was 86.8/100, UCLA activity score 7.5/10, Tegner activity score 3.8/10, VAS pain 1.7/10 and VAS function 1.5/10. 20% of SCFE hips were found to have a positive FADIR-test and a limited internal-rotation of 19.7° versus 36.1° ( < 0.001) in contralateral normal hips.
DISCUSSION
This long-term follow-up study of ISF for SCFE shows that although complication rates in terms of AVN are low, a high number of patients become symptomatic and have a limited function. Degenerative changes are common with 22.2% of hips developing end-stage hip OA (Tönnis 3 or THR). It is important that patients and parents are informed about these risks.
简介
目前，对于股骨颈骨骺滑脱（SCFE），复位内固定（ISF）仍然是“金标准”治疗方法，中期随访结果可接受。本研究旨在评估该手术的长期功能、临床和影像学结果。
方法
我们回顾了 1983 年至 1998 年间采用 ISF 治疗的 64 例（76 髋）SCFE 患者。根据 Loder 的定义，82.9%为稳定髋，17.1%为不稳定髋。根据 Southwick 角，初始 X 线片显示轻度滑脱 50%，中度滑脱 41.3%，重度滑脱 8.7%。采用改良 Harris 髋关节评分（mHHS）、加利福尼亚大学洛杉矶分校（UCLA）和 Tegner 活动评分、视觉模拟评分（VAS）疼痛、VAS 功能、屈伸内收内旋（FADIR）试验、髋关节屈曲 90°时内旋程度和 Tönnis 髋关节骨关节炎（OA）分类评估长期结果。
结果
10 例（15.6%）SCFE 髋因平均 16 年后发生骨关节炎而改行全髋关节置换术（THR）。38 例（59.4%）患者在平均 23 年（18-33 年）的随访后进行了临床和影像学检查。12 例（18.8%）患者失访。74%的 SCFE 髋在 X 线片上显示退行性改变或改行 THR（Tönnis 1：33.3%，2：18.5%，3 或 THR：22.2%）。有 3 例发生股骨头坏死（AVN），均发生在不稳定髋。平均 mHHS 为 86.8/100，UCLA 活动评分为 7.5/10，Tegner 活动评分为 3.8/10，VAS 疼痛评分为 1.7/10，VAS 功能评分为 1.5/10。20%的 SCFE 髋出现 FADIR 试验阳性，与对侧正常髋相比，内旋受限 19.7°（<0.001）。
讨论
本研究对 ISF 治疗 SCFE 的长期随访显示，尽管 AVN 的并发症发生率较低，但仍有大量患者出现症状，功能受限。退行性改变很常见，22.2%的髋出现终末期髋关节骨关节炎（Tönnis 3 或 THR）。重要的是，应告知患者及其家属这些风险。
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