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股骨头骨骺滑脱固定术后的髋关节镜检查:软骨损伤和盂唇撕裂的发现

Hip arthroscopy following slipped capital femoral epiphysis fixation: chondral damage and labral tears findings.

作者信息

Besomi Javier, Escobar Valeria, Alvarez Santiago, Valderrama Juanjose, Lopez Jaime, Mella Claudio, Lara Joaquin, Meneses Claudio

机构信息

Pediatric Orthopaedic Surgery Unit, Orthopaedic Surgery Department and Urgencia Escolar Clinica Alemana de Santiago/Facultad de Medicina Clinica Alemana - Universidad del Desarrollo, Santiago, Chile.

Pediatric Orthopaedic Surgery Service Hospital Clinico San Borja Arriaran, Santiago, Chile.

出版信息

J Child Orthop. 2021 Feb 1;15(1):24-34. doi: 10.1302/1863-2548.15.200178.

Abstract

PURPOSE

This study investigated the association between chondrolabral damage and time to arthroscopic surgery for slipped capital femoral epiphysis (SCFE).

METHODS

This was a descriptive retrospective study that enrolled patients with SCFE who underwent hip arthroscopy for femoral osteochondroplasty after SCFE fixation. SCFE type, time from SCFE symptom onset or slip fixation surgery to hip arthroscopy and intraarticular arthroscopic findings were recorded. Acetabular chondrolabral damage was evaluated according to the Konan and Outerbridge classification systems. Nested analysis of variance and the chi-squared test were used for statistical analyses.

RESULTS

We analyzed 22 cases of SCFE in 17 patients (five bilateral). The mean age at the time of hip arthroscopy was 13.6 years-old (8-20), and mean time from SCFE fixation to arthroscopy was 25.1 months (3 weeks to 8 years). Labral frying was present in 20 cases, labral tears in 16 and acetabular chondral damage in 17. The most frequent lesion was type 3 (41%) (Konan classification). Two cases had a grade III and 1 had a grade II acetabular chondral lesion (Outerbridge classification). Positive associations were observed between time from SCFE to hip arthroscopy and hip intraarticular lesions evaluated using Konan (p = 0.004) and Outerbridge (p = 0.000) classification systems. There was no association between SCFE severity (chi-squared = 0.315), stability (chi-squared = 0.558) or temporality (chi-squared = 0.145) type and hip intraarticular lesions.

CONCLUSION

A longer time from SCFE symptom onset and fixation to hip arthroscopy is associated with greater acetabular chondrolabral damage.

LEVEL OF EVIDENCE

IV.

摘要

目的

本研究调查了股骨头骨骺滑脱(SCFE)患者软骨盂唇损伤与关节镜手术时间之间的关联。

方法

这是一项描述性回顾性研究,纳入了因SCFE固定后行髋关节镜下股骨骨软骨成形术的SCFE患者。记录SCFE类型、从SCFE症状出现或滑脱固定手术至髋关节镜检查的时间以及关节内关节镜检查结果。根据Konan和Outerbridge分类系统评估髋臼软骨盂唇损伤情况。采用方差嵌套分析和卡方检验进行统计分析。

结果

我们分析了17例患者(5例双侧)的22例SCFE病例。髋关节镜检查时的平均年龄为13.6岁(8 - 20岁),从SCFE固定至关节镜检查的平均时间为25.1个月(3周 - 8年)。20例存在盂唇磨损,16例有盂唇撕裂,17例有髋臼软骨损伤。最常见的病变为3型(41%)(Konan分类)。2例有III级髋臼软骨病变,1例有II级髋臼软骨病变(Outerbridge分类)。使用Konan(p = 0.004)和Outerbridge(p = 0.000)分类系统评估发现,从SCFE至髋关节镜检查的时间与髋关节内病变之间存在正相关。SCFE严重程度(卡方 = 0.315)、稳定性(卡方 = 0.558)或时间性(卡方 = 0.145)类型与髋关节内病变之间无关联。

结论

从SCFE症状出现及固定至髋关节镜检查的时间越长,髋臼软骨盂唇损伤越严重。

证据级别

IV级。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/861a/7907763/a36473193623/jco-15-24-g0001.jpg

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