Jauregui Julio J, Shaw Nichole M, Weir Tristan B, Barvarz Sherwin A, McClure Philip K
Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD 21201, USA.
SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation, Brooklyn, NY 11203, USA.
Children (Basel). 2022 Oct 31;9(11):1680. doi: 10.3390/children9111680.
In situ stabilization is a widely accepted treatment for slipped capital femoral epiphysis (SCFE) despite risks of avascular necrosis (AVN) and femoroacetabular impingement (FAI). The modified Dunn procedure with surgical hip dislocation attempts to maintain epiphyseal perfusion and allows anatomic epiphyseal repositioning, theoretically reducing AVN and FAI risks. We systematically evaluated the literature, elucidating overall and stability-stratified rates of AVN following the modified Dunn procedure, and revision rates in non-AVN patients. Using Ovid and MEDLINE (PubMed), studies involving the modified Dunn procedure were evaluated for age, stability, preoperative slip (Southwick) angle, ROM at follow-up, outcome metrics, and revisions. Utilizing a random effect model of proportions, we determined overall and stability-stratified AVN rates, and revision rates in patients without AVN.673 patients (688 SCFEs) who underwent modified Dunn procedure were included. Overall AVN rate was 14.3% with a 95% Confidence Interval (CI) of 9.3 to 20.2%. AVN rate in stable slips was 10.9% (95% CI: 6.0 to 17.1%) and 19.9% (95% CI: 12.8% to 28.1%) in unstable slips. Revision rate in non-AVN patients was 13.3% (95% CI: 8.3% to 19.2%). Fixation failures occurred following K-wire or small-caliber (<6.5 mm) screw fixation. Overall mean Harris Hip Score (HHS) was excellent (>90 points). Mean HHS was 98.9 points (range of means: 86 to 99 points) in stable cases, and 90.5 points (range of means: 73 to 98 points) in unstable cases. Patients undergoing modified Dunn procedure had excellent clinical outcomes and low incidences of AVN. Further studies are needed to determine if modified Dunn osteotomy with surgical hip dislocation is a viable alternative to in situ pinning for treatment of severe SCFE.
尽管存在股骨头缺血性坏死（AVN）和股骨髋臼撞击症（FAI）的风险，但原位稳定术仍是治疗股骨头骨骺滑脱（SCFE）广泛接受的方法。改良邓恩手术结合手术性髋关节脱位试图维持骨骺灌注并实现解剖复位，理论上可降低AVN和FAI风险。我们系统评估了文献，阐明改良邓恩手术后AVN的总体发生率和按稳定性分层的发生率，以及非AVN患者的翻修率。通过Ovid和MEDLINE（PubMed），对涉及改良邓恩手术的研究进行了年龄、稳定性、术前滑脱（Southwick）角度、随访时的活动度、结果指标和翻修情况的评估。利用比例的随机效应模型，我们确定了总体和按稳定性分层的AVN发生率，以及无AVN患者的翻修率。纳入了673例接受改良邓恩手术的患者（688例SCFE）。总体AVN发生率为14.3%，95%置信区间（CI）为9.3%至20.2%。稳定滑脱的AVN发生率为10.9%（95%CI：6.0%至17.1%），不稳定滑脱的发生率为19.9%（95%CI：12.8%至28.1%）。非AVN患者的翻修率为13.3%（95%CI：8.3%至19.2%）。克氏针或小口径（<6.5mm）螺钉固定后出现固定失败。总体平均Harris髋关节评分（HHS）良好（>90分）。稳定病例的平均HHS为98.9分（平均范围：86至99分），不稳定病例为90.5分（平均范围：73至98分）。接受改良邓恩手术的患者临床结果良好，AVN发生率低。需要进一步研究以确定改良邓恩截骨术结合手术性髋关节脱位是否是原位固定治疗严重SCFE的可行替代方法。
