Department of Orthopaedics and Traumatology, University of Torino, Torino, Italy.
Department of Paediatric Orthopaedics, IRCCS Istituto 'Giannina Gaslini', Children's Hospital, Genova, Liguria, Italy.
Hip Int. 2022 Nov;32(6):813-819. doi: 10.1177/11207000211004862. Epub 2021 Apr 8.
The modified Dunn procedure (MDP) has risen enthusiasm in treating slipped capital femoral epiphyses (SCFE) due to the anatomic reduction and high patients' satisfaction rates at long-term follow-up. Main aim of this study is to compare clinical and radiographic outcomes of 2 cohorts with moderate to severe stable SCFE treated by MDP and fixation.
Medical records were analysed to collect demographic data, comorbidities and time from slip to surgery. The collected postoperative data were: avascular necrosis (AVN); complications; progression of osteoarthritis and subsequent procedures. Southwick angles (SA), alpha angles and Klein line were measured on the preoperative x-rays, on the immediate postoperative period and at the latest follow-up. Outcomes scores were recorded by the following questionnaires: the Harris Hip Score, the Hip disability and Osteoarthritis Outcome Score, the Merle d'Aubigné and Postel score and the Western Ontario and McMaster Universities Arthritis Index. Kaplan-Meier survivorship curve was calculated.
We compared 81 hips treated by MDP with 22 hips treated by pinning (PS) for moderate/severe stable SCFE. No significant differences were found between the 2 groups in terms of age, BMI, comorbidities and preoperative slip angles. At the latest follow-up, postoperative anteroposterior mean slip angles were respectively 6.2 and 19.9° in MDP and PS group ( = 0.3). Slip angles in frog lateral view were 11° in the MDP group and 39.7° in the PS group ( = 0.2). MDP group achieved better correction angles on frog leg view (11° vs. 39.7°; < 0.001). There was no statistically significant difference in the occurrence of AVN among both groups (19.7% MDP group vs. 31.8% PS group) ( = 0.2).
The MDP in treating severe stable SCFE showed the best deformities corrections in conjunction with the highest functional scores at long-term follow-up and similar rates of osteonecrosis compared to fixation.
改良 Dunn 手术（MDP）在治疗股骨颈骨骺滑脱（SCFE）方面引起了广泛关注，因为它能够实现解剖复位，并且患者在长期随访中满意度较高。本研究的主要目的是比较 MDP 与固定治疗中重度稳定型 SCFE 的两组患者的临床和影像学结果。
分析病历资料以收集患者的人口统计学数据、合并症以及从滑脱到手术的时间。收集的术后数据包括：股骨头缺血性坏死（AVN）；并发症；骨关节炎进展和后续手术。术前、术后即刻和末次随访时测量 Southwick 角（SA）、α角和 Klein 线。记录以下问卷的髋关节功能评分：Harris 髋关节评分、髋关节残疾和骨关节炎结果评分、Merle d'Aubigné 和 Postel 评分以及西部安大略省和麦克马斯特大学关节炎指数。计算 Kaplan-Meier 生存曲线。
我们比较了 81 例 MDP 治疗的中重度稳定型 SCFE 患者和 22 例钢针固定（PS）治疗的患者。两组患者在年龄、BMI、合并症和术前滑脱角度方面无显著差异。在末次随访时，MDP 组和 PS 组的术后前后位平均滑脱角度分别为 6.2°和 19.9°（ = 0.3）。蛙式侧位片上的滑脱角度分别为 11°和 39.7°（ = 0.2）。MDP 组在蛙式腿位片上获得了更好的矫正角度（11°对 39.7°； < 0.001）。两组患者的 AVN 发生率无统计学差异（19.7% MDP 组与 31.8% PS 组）（ = 0.2）。
与钢针固定相比，MDP 治疗严重稳定型 SCFE 可获得最佳畸形矫正效果，长期随访时功能评分最高，且股骨头缺血性坏死的发生率相似。
