儿童中重度股骨头骨骺滑脱的手术治疗  

Comparison of different surgical treatments in moderate and severe slipped capital femoral epiphysis

作　　者：李浩[1] 刘柱[1] 张志强[1] 李海[1] 范清[1] 杨璇[1] 沈品泉[1] 陈珽[1] 张自明[1] 

机构地区：[1]上海交通大学医学院附属新华医院儿骨科,上海200092

出　　处：《骨科临床与研究杂志》2018年第1期27-33,共7页Journal Of Clinical Orthopedics And Research

基　　金：上海市科学技术委员会西医引导类项目(17411965800)~~

摘　　要：目的探讨原位固定和改良Dunn截骨术对中重度股骨头骨骺滑脱(SCFE)患儿的治疗效果,并评估预防性固定的应用效果。方法回顾分析2006年2月至2015年1月上海交通大学医学院附属新华医院接受手术治疗的21例(23髋)SCFE患儿的临床资料,根据治疗方法的不同分为原位固定组(15髋)和改良Dunn截骨术组(8髋),对其中7例患儿进行了健侧髋关节的预防性固定。术前及末次随访时,测量X线片上的Southwick角,α角,股骨颈长度以及股骨偏心距,并采用Harris髋关节评分评估髋关节功能。结果平均随访19.6个月(12~58个月)。末次随访时,原位固定组Southwick角及α角较术前平均减小15.0°和12.1°(P均<0.05),Harris髋关节评分较术前平均增加26.3分,且均为良;改良Dunn截骨术组Southwick角及α角较术前平均减小54.7°和21.5°(P均<0.05),Harris髋关节评分较术前平均增加33.8分,除1髋外均为优。原位固定组患侧与健侧股骨颈长度差异无统计学意义(P=0.150),而股骨偏心距差异有统计学意义(P=0.006)。改良Dunn截骨术组患侧与健侧的股骨颈长度及股骨偏心距差异均有统计学意义(P=0.044,0.026),出现1例软骨溶解,未见其他并发症。所有预防性固定患儿均未再次发生SCFE。结论原位固定主要适用于中度SCFE患儿,改良Dunn截骨术主要适用于重度SCFE患儿。改良Dunn截骨术对于股骨近端形态的改善更加明显,但对手术技术要求较高,术后出现严重并发症的可能性更大。预防性固定可以有效阻止SCFE的发生与发展,尤其对于年龄较小的重度SCFE肥胖患儿效果更加明显。Objective To compare the outcomes of in situ fixation and modified Dunn procedure for moderate and severe slipped capital femoral epiphysis （SCFE） , find to evaluate the effect of prophylactic fixation. Methods Twenty-one patients （23 hips） with moderate and severe SCFE （15 hips in in situ fixation group and 8 hips in modified Dunn procedure group） from February 2006 to January 2015 were retrospectively stu-died. Additionally, prophylactic fixation for unaffected hip was performed in 7 patients. The Southwick angles, a angles, longitudinal lengths of femoral neck and femoral offsets were compared between two groups before the preoperation and at final follow- up. Hip function was evaluated using Harris hip scores. Results The mean follow-up time was 19. 6 months （ranged from 12 to 58 months）. At the final follow-up in in situ fixation group, the Southwick angle and a angle were decreased 15.0° and 12. l ° （ a l l P 〈0.05）. Harris hip score was increased 26. 3 points, and all were good. The Southwick angle and a angle in modified Dunn procedure group were decreased 54.7 °and 21.5° （￡dl P 〈0.05）. Harris hip score was increased 33. 8 points. All were excellent except for one hip. There was no significant difference in longitudinal length of the femoral neck between affect-ed side and healthy side in in situ fixation group （P = 0.150） , but the difference of femoral offset was statisti-cally significant （P = 0. 006） . However, there was a significant difference in longitudinal length of the femoral neck and femoral offset between affected side ￡ind healthy side in modified Dunn procedure group （ P =0.044, 0. 026） , and one case of chondrolysis was found. No other complications were found. No slip was found in 7 patients prophylactic fixation at the final follow- up. Conclusion In situ fixation is mainly suitable for children with moderate SCFE, while

关 键 词：股骨头 骨骺脱离 手术治疗 预后 

分 类 号：R726.8[医药卫生—儿科]