Cheok Tim, Smith Thomas, Berman Morgan, Jennings Matthew, Williams Kanishka, Poonnoose Pradeep Mathew, Rawat Jaideep, Foster Bruce
Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, NT, Australia.
College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
J Child Orthop. 2022 Feb;16(1):27-34. doi: 10.1177/18632521221078864. Epub 2022 Apr 5.
The management of moderate and severe slipped capital femoral epiphysis is controversial. While in situ fixation is commonly used, the modified Dunn's procedure is increasingly popular within high-volume centers. We compared the clinical and radiological outcomes, as well as the rates of femoral head avascular necrosis or chondrolysis in patients managed with either modified Dunn's procedure or in situ fixation.
A systematic search of the PubMed, Embase, The Cochrane Library, Science Direct, and Web of Science was performed in August 2021. Studies comparing outcomes and complications of modified Dunn's procedure versus in situ fixation in patients with moderate or severe slipped capital femoral epiphysis were included.
A total of four studies were included in the final analysis. Modified Dunn's procedure did not result in improved clinical outcomes. However, radiological outcomes as measured using Southwick angles and Alpha angles were significantly improved in the modified Dunn's procedure group, with a mean difference of -14.68 (p < 0.00001) and -34.26 degrees (p < 0.00001), respectively, compared to in situ fixation. There was no difference in the odds of femoral head avascular necrosis or chondrolysis, with odds ratio of 0.99 (p = 0.97).
Within the limits of our study, modified Dunn's procedure did not improve clinical outcomes. There were significantly improved radiological outcomes without higher odds of femoral head avascular necrosis or chondrolysis. Further long-term studies are required to better guide management of moderate and severe slipped capital femoral epiphysis, especially in unstable slips. In the meantime, we recommend that the modified Dunn's procedure, if done, be restricted to high-volume centers with low complication rates.
Level III-Systematic review of Level III studies.
CRD42021279503.
中度和重度股骨头骨骺滑脱的治疗存在争议。虽然原位固定是常用方法，但改良邓恩手术在大型医疗中心越来越受欢迎。我们比较了采用改良邓恩手术或原位固定治疗的患者的临床和放射学结果，以及股骨头缺血性坏死或关节溶解的发生率。
2021年8月对PubMed、Embase、Cochrane图书馆、Science Direct和Web of Science进行了系统检索。纳入比较改良邓恩手术与原位固定治疗中度或重度股骨头骨骺滑脱患者的结果和并发症的研究。
最终分析共纳入四项研究。改良邓恩手术并未改善临床结果。然而，与原位固定相比，改良邓恩手术组使用Southwick角和Alpha角测量的放射学结果有显著改善，平均差异分别为-14.68（p<0.00001）和-34.26度（p<0.00001）。股骨头缺血性坏死或关节溶解的几率没有差异，比值比为0.99（p=0.97）。
在我们的研究范围内，改良邓恩手术并未改善临床结果。放射学结果有显著改善，且股骨头缺血性坏死或关节溶解的几率没有增加。需要进一步的长期研究来更好地指导中度和重度股骨头骨骺滑脱的治疗，尤其是不稳定滑脱的治疗。同时，我们建议，如果进行改良邓恩手术，应限于并发症发生率低的大型医疗中心。
III级——III级研究的系统评价。
PROSPERO注册号：CRD42021279503。
