Jerre R, Billing L, Hansson G, Wallin J
Department of Orthopaedics, East Hospital, Göteborg, Sweden.
J Bone Joint Surg Br. 1994 Jul;76(4):563-7.
We reviewed, at an average age of 46 years, a series of 61 patients treated for unilateral slipped upper femoral epiphysis. At maturity there had been slipping of the contralateral hip in 11 patients (18%) and another 14 (23%) had originally had evidence of bilateral slipping when the primary radiographs were reviewed. In only two of these 25 patients (8%) was the slipping of the contralateral hip symptomatic. The incidence of early osteoarthritis of the contralateral hip was 7 of 36 with no slip, 5 of 16 with an untreated slip and 1 of 9 with a slip pinned in situ. If all 61 contralateral hips had been prophylactically pinned at the primary admission, 36 of the operations (59%) would have been unnecessary. We recommend that prophylactic pinning of the contralateral hip should not be standard, but that lateral radiography by the Billing technique be repeated every third to fourth month until closure of the growth plate begins. Hips in which a slip occurs should be pinned in situ.
我们回顾了一组平均年龄为46岁、因单侧股骨头骨骺滑脱接受治疗的61例患者。在骨骼成熟时，11例患者（18%）对侧髋关节发生了滑脱，另有14例（23%）在复查初次X线片时最初就有双侧滑脱的证据。在这25例患者中，仅2例（8%）对侧髋关节的滑脱有症状。对侧髋关节早期骨关节炎的发生率为：无滑脱的36例中有7例，未治疗滑脱的16例中有5例，原位固定滑脱的9例中有1例。如果在初次入院时对所有61例对侧髋关节都进行预防性固定，其中36例手术（59%）将是不必要的。我们建议，对侧髋关节的预防性固定不应作为标准操作，而应每隔三到四个月采用比林技术重复进行侧位X线检查，直至生长板开始闭合。发生滑脱的髋关节应原位固定。
