Vallim Frederico Coutinho de Moura, Cruz Henrique Abreu da, Silva Carlos Francisco Bittencourt, Abreu Caroline Sandra Gomes de, Rodrigues Ricardo Carneiro, Cunha Marcio Garcia
Médico Ortopedista, Especialista em Cirurgião Ortopédico Pediátrico, Hospital Estadual da Criança, Rio de Janeiro, RJ, Brasil.
Médico Ortopedista, Chefe da Ortopedia Pediátrica, Hospital Estadual da Criança, Rio de Janeiro, RJ, Brasil.
Rev Bras Ortop (Sao Paulo). 2023 Jul 21;58(4):e632-e638. doi: 10.1055/s-0042-1758362. eCollection 2023 Aug.
To evaluate the safety and reproducibility of the surgery for unstable slipped capital femoral epiphysis (SCFE) through the modified Dunn technique in a single center cohort from Brazil. We retrospectively analyzed a cohort of patients submitted to this procedure by a single surgeon who was a hip preservation specialist. Demographic data and radiographic angles were evaluated for the relative risk (RR) of avascular necrosis (AVN) using a log-binomial regression model with simple and random effects. Among the 30 patients (30 hips) with a mean age of 11.79 years at the time of the operation, there were 17 boys and 18 left hips, which were operated on in a mean of 11.5 days after the slip. The mean follow-up was of 38 months. The preoperative Southwick angle averaged 60.69° against 4.52° postoperatively ( < 0.001). A larger preoperative slip angle was associated with the development of AVN (RR: 1.05; 95% confidence interval [95%CI]: 1.02-1.07; < 0.01). The overall AVN rate was of 26.7%. Function was good or excellent in 86% of uncomplicated hips, and poor in 87.5% of the partients who developed AVN, as graded by the Harris Hip Score. There was no statistical relationship between epiphyseal bleeding and AVN development ( = 0.82). The modified Dunn technique is associated with restoration of the femoral alignment and function after unstable SCFE, when uncomplicated. Moreover, it was shown to be reproducible in our population, with a rate of 26% of femoral head necrosis.
为评估在巴西一个单中心队列中，采用改良邓恩技术治疗不稳定型股骨头骨骺滑脱（SCFE）手术的安全性和可重复性。我们回顾性分析了由一位髋关节保留专家对一组患者实施该手术的情况。使用具有简单和随机效应的对数二项回归模型，评估人口统计学数据和影像学角度，以确定无血管性坏死（AVN）的相对风险（RR）。在30例患者（30髋）中，手术时平均年龄为11.79岁，其中17例为男孩，18例为左髋，平均在滑脱后11.5天进行手术。平均随访38个月。术前Southwick角平均为60.69°，术后为4.52°（P < 0.001）。术前滑脱角度越大，与AVN的发生相关（RR：1.05；95%置信区间[95%CI]：1.02 - 1.07；P < 0.01）。总体AVN发生率为26.7%。根据Harris髋关节评分，86%无并发症的髋关节功能良好或优秀，而发生AVN的患者中87.5%功能较差。骨骺出血与AVN发生之间无统计学关系（P = 0.82）。改良邓恩技术在不稳定型SCFE术后未出现并发症时，与股骨对线和功能的恢复相关。此外，在我们的人群中显示该技术具有可重复性，股骨头坏死率为26%。
