螺钉螺纹构型对稳定型股骨颈骨骺滑脱内固定术的结局无影响。

Screw Thread Configuration Has No Effect on Outcomes of In Situ Fixation for Stable Slipped Capital Femoral Epiphysis.

机构信息

Department of Orthopaedic Surgery, Wright State University.

Department of Orthopaedic Surgery, Dayton Children's Hospital, Dayton, OH.

出版信息

J Pediatr Orthop. 2022 Aug 1;42(7):e767-e771. doi: 10.1097/BPO.0000000000002192. Epub 2022 Jun 8.

DOI:10.1097/BPO.0000000000002192

PMID:35671226

Abstract

BACKGROUND

No consensus exists regarding the optimal surgical management of slipped capital femoral epiphysis (SCFE). Treatment goals include avoiding slip progression and sequelae such as avascular necrosis (AVN). Factors associated with surgical implants merit further research. This study investigates the effect of screw thread configuration and the number of screws on surgical outcomes.

METHODS

A total of 152 patients undergoing cannulated, stainless steel, in situ screw fixation of SCFE between January 2005 and April 2018 were included. Procedure laterality, screw number and thread configuration (partially threaded/fully threaded), bilateral diagnosis, Loder classification, final follow-up, patient demographics, and endocrinopathy history were analyzed. Primary outcomes were return to the operating room (ROR), AVN, hardware failure/removal, and femoroacetabular impingement (FAI).

RESULTS

Most patients received a single (86.2%), partially threaded (81.6%) screw; most were unilateral (67.8%) and stable (79.6%). Mean follow-up was 2.0±2.7 years, with a 15.8% rate of ROR, 5.3% exhibiting AVN, 6.6% exhibiting FAI, and 9.2% experiencing hardware failure/removal. Number of screws was the sole predictor of ROR [odds ratio (OR)=3.35, 95% confidence interval (CI): 1.18-9.49]. Unstable SCFE increased the odds of AVN (OR=38.44; 95% CI: 4.35-339.50) as did older age (OR=1.43, 95% CI: 1.01-2.03). Female sex increased risk for FAI (OR=4.87, 95% CI: 1.20-19.70), and bilateral SCFE elevated risk for hardware failure/removal versus unilateral SCFE (OR=4.41, 95% CI: 1.39-14.00). Screw thread configuration had no significant effect on any outcome (for each, P ≥0.159).

CONCLUSIONS

Rates of ROR, AVN, FAI, and hardware failure/removal did not differ between patients treated with partially threaded or fully threaded screws. The use of 2 screws was associated with an increased likelihood of ROR. These findings suggest that screw thread configuration has no impact on complication rates, whereas screw number may be an important consideration in SCFE fixation.

LEVEL OF EVIDENCE

Level III-retrospective cohort study.

摘要

背景

对于股骨颈骨骺滑脱（SCFE），目前尚无最佳手术治疗方法的共识。治疗目标包括避免滑移动和避免出现诸如股骨头缺血性坏死（AVN）等后遗症。与手术植入物相关的因素值得进一步研究。本研究调查了螺钉螺纹构型和螺钉数量对手术结果的影响。

方法

本研究纳入了 2005 年 1 月至 2018 年 4 月期间采用经皮不锈钢原位螺钉固定治疗的 152 例 SCFE 患者。分析了手术侧别、螺钉数量和螺纹构型（部分螺纹/全螺纹）、双侧诊断、Loder 分类、最终随访、患者人口统计学和内分泌病史。主要结局为重返手术室（ROR）、AVN、内固定物失败/取出和股骨髋臼撞击症（FAI）。

结果

大多数患者接受了单枚（86.2%）、部分螺纹（81.6%）螺钉固定；大多数患者为单侧（67.8%）和稳定型（79.6%）。平均随访时间为 2.0±2.7 年，ROR 发生率为 15.8%，AVN 发生率为 5.3%，FAI 发生率为 6.6%，内固定物失败/取出率为 9.2%。螺钉数量是 ROR 的唯一预测因素[比值比（OR）=3.35，95%置信区间（CI）：1.18-9.49]。不稳定型 SCFE 增加了 AVN 的发生风险（OR=38.44；95% CI：4.35-339.50），年龄较大（OR=1.43，95% CI：1.01-2.03）也是如此。女性增加了 FAI 的风险（OR=4.87，95% CI：1.20-19.70），双侧 SCFE 与单侧 SCFE 相比，内固定物失败/取出的风险升高（OR=4.41，95% CI：1.39-14.00）。螺钉螺纹构型对任何结局均无显著影响（每项，P≥0.159）。