Veramuthu Vijayanagan, Munajat Ismail, Islam Md Asiful, Mohd Emil Fazliq, Sulaiman Abdul Razak
Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.
Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.
Children (Basel). 2022 Sep 11;9(9):1374. doi: 10.3390/children9091374.
The choice of treatment for unstable and severely displaced slipped capital femoral epiphysis (SCFE) is controversial. This meta-analysis was conducted to determine the prevalence of femoral head avascular necrosis (AVN) following various treatments for unstable SCFE. Various databases were searched to identify articles published until 4 February 2022. A random-effects model was used to examine prevalence as well as risk ratios with confidence intervals (CIs) of 95%. Thirty-three articles were analyzed in this study. The pooled prevalences of AVN in pinning in situ, pinning following intentional closed reduction, pinning following unintentional closed reduction, and open reduction via the Parsch method, subcapital osteotomy and the modified Dunn procedure were 18.5%, 23.0%, 27.6%, 9.9%, 18.6% and 19.9%, respectively. The risk of developing AVN in pinning following intentional closed reduction was found to be 1.62 times higher than pinning in situ; however, this result was not significant. The prevalence of AVN in open reduction was lowest when performed via the Parsch method; however, this finding should be interpreted with caution, since the majority of slips so-treated are of mild and moderate types as compared with the subcapital osteotomy and modified Dunn procedures, which are predominantly used to treat severely displaced slips. As the risk ratio between intentional closed reduction and the modified Dunn method showed no significant difference, we believe that the modified Dunn method has the advantage of meticulously preserving periosteal blood flow to the epiphysis, thus minimizing AVN risk. In comparison with intentional closed reduction, the modified Dunn method is used predominantly in cases of severe slips.
不稳定且严重移位的股骨头骨骺滑脱（SCFE）的治疗选择存在争议。本荟萃分析旨在确定不稳定SCFE的各种治疗方法后股骨头缺血性坏死（AVN）的发生率。检索了各种数据库，以识别截至2022年2月4日发表的文章。采用随机效应模型来检验发生率以及95%置信区间（CI）的风险比。本研究分析了33篇文章。原位固定、有意闭合复位后固定、无意闭合复位后固定、经帕尔施方法切开复位、头颈下截骨术和改良邓恩手术中AVN的合并发生率分别为18.5%、23.0%、27.6%、9.9%、18.6%和19.9%。发现有意闭合复位后固定发生AVN的风险比原位固定高1.62倍；然而，这一结果并不显著。经帕尔施方法切开复位时AVN的发生率最低；然而，这一发现应谨慎解读，因为与主要用于治疗严重移位滑脱的头颈下截骨术和改良邓恩手术相比，接受此类治疗的大多数滑脱为轻度和中度类型。由于有意闭合复位与改良邓恩方法之间的风险比无显著差异，我们认为改良邓恩方法的优势在于精心保留骨骺的骨膜血流，从而将AVN风险降至最低。与有意闭合复位相比，改良邓恩方法主要用于严重滑脱病例。
