Davis Richard L, Samora Walter P, Persinger Freddie, Klingele Kevin E
Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH.
J Pediatr Orthop. 2019 Sep;39(8):411-415. doi: 10.1097/BPO.0000000000000975.
The modified Dunn procedure (open subcapital realignment via a surgical dislocation approach) has been shown to be a safe and effective way of treating acute, unstable slipped capital femoral epiphysis (SCFE). There is a paucity of literature comparing the modified Dunn procedure in stable SCFE. The purpose of this study was to compare acute, unstable versus chronic, stable SCFE managed with the modified Dunn procedure.
A retrospective chart review was performed on 44 skeletally immature patients who underwent the modified Dunn procedure for SCFE. Patients were divided into stable or unstable based on clinical presentation and intraoperative findings. Demographics, radiographic measurements, and complications were recorded and compared. χ and t tests were used to compare variables.
In total, 31 consecutive hips (29 patients) with acute, unstable slips, and 17 consecutive hips (15 patients) with chronic, stable slips were reviewed. Average age was 12.5 and 13.8 years for acute and chronic, respectively (P=0.05). Mean follow-up was 27.9 months (unstable) and 35.5 months (stable). Average postoperative Southwick angle was 14.2 degrees; (unstable) and 25.3 degrees (stable) (P=0.001). Greater trochanteric height averaged 6.2 mm below the center of the femoral head in the acute group and 6.2 mm above center in the chronic group (P<0.001). Average femoral neck length measured 34.1 mm (unstable) and 27.1 mm (stable) (P<0.001). Two patients (6%) developed avascular necrosis (AVN) in the unstable group, with 5 patients (29.4%) in the stable group (P=0.027). All patients with hip instability (N=3) developed AVN.
Although both acute, unstable and chronic, stable SCFE can be successfully treated with the modified Dunn procedure, the complication rate is statistically higher in patients with stable SCFE, specifically both AVN rate and postoperative instability. In addition, it is more difficult to establish normal anatomic indexes with regard to greater trochanteric height and femoral neck length. This procedure has great utility in the correction of the anatomic deformity associated with SCFE, but should be used with caution in patients with chronic, stable SCFE.
Level III-retrospective review.
改良邓恩手术（通过手术脱位方法进行开放性股骨头下复位）已被证明是治疗急性、不稳定型股骨头骨骺滑脱（SCFE）的一种安全有效的方法。关于改良邓恩手术治疗稳定型SCFE的文献较少。本研究的目的是比较采用改良邓恩手术治疗的急性、不稳定型与慢性、稳定型SCFE。
对44例接受改良邓恩手术治疗SCFE的骨骼未成熟患者进行回顾性病历审查。根据临床表现和术中发现将患者分为稳定型或不稳定型。记录并比较人口统计学、影像学测量结果和并发症。采用χ检验和t检验比较变量。
共回顾了31例连续的急性、不稳定型滑脱髋关节（29例患者）和17例连续的慢性、稳定型滑脱髋关节（15例患者）。急性组和慢性组的平均年龄分别为12.5岁和13.8岁（P=0.05）。平均随访时间为27.9个月（不稳定型）和35.5个月（稳定型）。术后平均Southwick角为14.2度（不稳定型）和25.3度（稳定型）（P=0.001）。急性组大转子高度平均低于股骨头中心6.2mm，慢性组高于中心6.2mm（P<0.001）。平均股骨颈长度测量值为34.1mm（不稳定型）和27.1mm（稳定型）（P<0.001）。不稳定组有2例患者（6%）发生股骨头缺血性坏死（AVN），稳定组有5例患者（29.4%）（P=0.027）。所有髋关节不稳定的患者（n=3）均发生了AVN。
虽然急性、不稳定型和慢性、稳定型SCFE均可通过改良邓恩手术成功治疗，但稳定型SCFE患者的并发症发生率在统计学上更高，特别是AVN发生率和术后不稳定发生率。此外，在大转子高度和股骨颈长度方面更难建立正常的解剖学指标。该手术在矫正与SCFE相关的解剖畸形方面有很大作用，但对于慢性、稳定型SCFE患者应谨慎使用。
III级——回顾性研究。
