股骨颈生长与重塑：游离滑动螺钉固定治疗股骨头骨骺滑脱。
Femoral Neck Growth and Remodeling With Free-Gliding Screw Fixation of Slipped Capital Femoral Epiphysis.
机构信息
Department of Orthopaedics, IWK Health Centre, Halifax, Canada.
出版信息
J Pediatr Orthop. 2021 Apr 1;41(4):e309-e315. doi: 10.1097/BPO.0000000000001770.
BACKGROUND
Treatment of stable slipped capital femoral epiphysis (SCFE) most commonly involves in situ fixation with a standard cannulated screw, leading to physeal arrest. Recently, Pega Medical (Laval, Canada) introduced the free-gliding (FG) SCFE screw, which employs a growth-friendly, telescopic design. This study examines femoral neck growth and remodeling over the first 2 postoperative years in stable SCFE treated with FG versus standard screws.
METHODS
We retrospectively reviewed 32 hips (19 SCFE, 13 prophylactic) in 16 patients treated with FG screws for stable SCFE. We also reviewed 102 hips (63 SCFE, 19 prophylactic, 20 controls) in 55 patients treated with standard screws. Immediate postoperative radiographs were compared with 1- and 2-year follow-up images.
RESULTS
For the overall study cohort, mean age at surgery was 12.2±1.9 years, with a mean slip angle of 26.9±18.0 degrees. In FG SCFE hips, the alpha angle remodeled 12.9±19.2 degrees in the first postoperative year (P=0.018) and articulotrochanteric distance decreased by 4.2±4.6 mm at 2 years (P=0.018). In standard SCFE hips, the alpha angle remodeled 4.3±11.3 degrees at 1 year (P=0.014), while articulotrochanteric distance decreased by 4.5±3.2 mm at 2 years (P<0.001). By 2 years, FG screws lengthened more in prophylactic (4.8±3.4 mm) than SCFE hips (1.7±1.8 mm, P=0.027).
CONCLUSIONS
Greater remodeling of femoral neck cam deformity occurs when treating SCFE using an FG screw. Further research is required to measure the impact of this finding on femoroacetabular impingement and degenerative arthritis. In addition, FG screws allow ongoing growth of prophylactically treated hips, while standard screws promote coxa breva.
LEVEL OF EVIDENCE
Level III-retrospective comparative, therapeutic study.
背景
稳定型股骨颈骨骺滑脱（SCFE）的治疗方法通常包括使用标准空心螺钉进行原位固定，导致骨骺停止生长。最近，Pega Medical（加拿大拉瓦尔）推出了自由滑动（FG）SCFE 螺钉，该螺钉采用了一种有利于生长的伸缩设计。本研究旨在比较 FG 螺钉与标准螺钉治疗稳定型 SCFE 后，在前 2 年的股骨颈生长和重塑情况。
方法
我们回顾性分析了 16 例患者的 32 髋（19 例 SCFE，13 例预防性）采用 FG 螺钉治疗稳定型 SCFE，同时回顾性分析了 55 例患者的 102 髋（63 例 SCFE，19 例预防性，20 例对照组）采用标准螺钉治疗。比较术后即刻与 1 年和 2 年随访时的影像学资料。
结果
对于整个研究队列，手术时的平均年龄为 12.2±1.9 岁，平均滑脱角度为 26.9±18.0 度。在 FG SCFE 髋关节中，第 1 年时 alpha 角重塑了 12.9±19.2 度（P=0.018），关节突-转子距离在 2 年时减少了 4.2±4.6mm（P=0.018）。在标准 SCFE 髋关节中，第 1 年 alpha 角重塑了 4.3±11.3 度（P=0.014），关节突-转子距离在 2 年时减少了 4.5±3.2mm（P<0.001）。到 2 年时，FG 螺钉在预防性治疗中（4.8±3.4mm）比 SCFE 髋关节（1.7±1.8mm）延长更多（P=0.027）。
结论
使用 FG 螺钉治疗 SCFE 时，股骨颈凸轮畸形的重塑更大。需要进一步研究来测量这一发现对股骨髋臼撞击和退行性关节炎的影响。此外，FG 螺钉允许预防性治疗的髋关节持续生长，而标准螺钉则促进了短颈畸形。
证据等级
III 级-回顾性比较治疗研究。
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