de Moura Vallim Frederico Coutinho, de Angeli Luiz Renato Agrizzi, Serafim Bárbara Lívia Corrêa, Manca Angelo
Hospital Estadual da Criança, Rio de Janeiro, Brazil.
Rio de Janeiro State University, Rio de Janeiro, Brazil.
Eur J Orthop Surg Traumatol. 2025 Mar 3;35(1):86. doi: 10.1007/s00590-025-04194-8.
Evaluate a modification of the original modified Dunn technique, for unstable slipped capital femoral epiphysis (SCFE), where the proximal femoral epiphysis is not dislocated from the acetabulum.
We compared two cohorts of patients with unstable SCFE: one operated with dislocation of the femoral epiphysis (DG) and the other without (NDG). Groups were compared demographically and radiographically. Femoral head bleeding was determined after reduction of the slip. Operative time, development of AVN and other complications were registered. The influence of surgical technique and covariates on the slip correction was modeled by a generalized linear mixed model. The risk of necrosis was modeled by logistic regression.
The groups (20 patients each) were similar regarding age (p = 0.8), time until operation (p = 0.8), gender (p = 1), laterality (p = 1) and race (p = 0.45). Operative time was longer in DG (p = 0.07). Not dislocating the head reduced Southwick angle correction by 3.74 degrees (p = 0.04). Femoral head bleeding was associated with an 85.14% reduction in AVN odds (p = 0.04). Shorter operative time (< 200 min) decreased AVN rate by 44% (p = 0.37). Both surgical techniques had similar complication rates, including 20% AVN (p > 0.05).
Not dislocating the femoral head in the modified Dunn technique presents similar AVN rates when compared to the original operation, shortens the operative time but provides a lower degree of Southwick angle correction. Femoral head bleeding following slip reduction is a good prognostic indicator for AVN occurrence.
Level III-Retrospective comparative study.
评估对原始改良邓恩技术的一种改进方法，用于治疗不稳定型股骨头骨骺滑脱（SCFE），即股骨近端骨骺未从髋臼脱位的情况。
我们比较了两组不稳定型SCFE患者：一组进行了股骨头脱位手术（DG），另一组未进行（NDG）。对两组患者进行了人口统计学和影像学比较。在滑脱复位后确定股骨头出血情况。记录手术时间、股骨头缺血性坏死（AVN）的发生情况及其他并发症。通过广义线性混合模型模拟手术技术和协变量对滑脱矫正的影响。通过逻辑回归模型模拟坏死风险。
两组（每组20例患者）在年龄（p = 0.8）、手术前时间（p = 0.8）、性别（p = 1）、侧别（p = 1）和种族（p = 0.45）方面相似。DG组的手术时间更长（p = 0.07）。不使股骨头脱位使Southwick角矫正减少3.74度（p = 0.04）。股骨头出血与AVN发生率降低85.14%相关（p = 0.04）。较短的手术时间（<200分钟）使AVN发生率降低44%（p = 0.37）。两种手术技术的并发症发生率相似，包括20%的AVN发生率（p>0.05）。
与原始手术相比，改良邓恩技术中不使股骨头脱位时AVN发生率相似，缩短了手术时间，但Southwick角矫正程度较低。滑脱复位后股骨头出血是AVN发生的良好预后指标。
III级——回顾性比较研究。
