髋关节外科脱位入路切开复位手术治疗中重度股骨头骨骺滑脱的临床疗效

Results of surgical treatment for moderate or severe slipped capital femoral epiphysis through the approach of surgical hip dislocation

目的 总结应用髋关节外科脱位入路行切开复位手术治疗青少年中、重度股骨头骨骺滑脱后至少12个月的随访效果.方法 2011年11月至2013年6月上海交通大学医学院附属新华医院儿童骨科收治6例（7髋）中、重度股骨头骨骺滑脱患者,均有外伤史,年龄10 ～ 15岁,平均13.6岁.病程4～35 d,平均14.2d.滑脱程度根据正位X线片股骨头骨骺滑脱部分占股骨颈直径的比例本组患者为25％～55％,平均45％.6例患者6侧髋关节（除1例右侧同时行经皮原位空心钉固定）均采用经髋关节外科脱位入路,Dunn切开复位内固定术.术后支具固定患肢4周,床上牵引4周配合髋关节活动度的康复治疗,8周后逐渐扶拐行走训练.结果 随访时间12 ～ 30个月,平均23.8个月.6例患者均已下地行走,无须拄拐,无明显跛行.复查X线片显示股骨头骨骺对位对线恢复良好,未出现股骨头坏死表现,关节间隙正常.末次随访髋关节Harris评分为85°～100°,平均94.7°.结论 应用髋关节外科脱位入路行切开复位手术治疗青少年中、重度股骨头骨骺滑脱是可供选择的有效方法,滑脱的股骨头骨骺获得解剖复位,短期随访未出现股骨头坏死,所有病例髋关节活动满意.

Objective To evaluate the results of surgical treatment for moderate or severe slipped capital femoral epiphysis （SCFE） using modified Dunn procedure through the approach of surgical hip dislocation at the interval of minimum 12 months follow-up.Methods From November 2011 to June 2013,6 patients （7 hips） with SCFE were treated in department of pediatric orthopedics,Hospital Affiliated to Shanghai Jiaotong University School of Medicine,they all had trauma history.The patients were aged from 10-15 years,mean 13.6 years.The duration of symptoms ranged from 4 to 35 days,average 14.2 days.The degree of slip was averagely 45％ （25％-55％）.In 6 patients （except right side of 1 case was treated in situ with cannulated screws） were surgically treated using modified Dunn procedure through the approach of surgical hip dislocation.Postoperatively the brace was used for immobilizing the hip for 4 weeks,then 4 weeks of bed traction combined with rehabilitation program of hip joint activity.Eight weeks later,the gradual touchdown weight bearing was being allowed.Results The follow-up time ranged from 12 to 30 months,average 23.8 months.Six patients have been able to walk without crutches,no obvious limp.X-ray film showed femoral epiphysis line on the bit of good recovery,no appearance of avascular necrosis of the femoral head,joint space was normal.The Harris score of hip evaluation was 94.7 averagely,ranging 85 -100,at the time of last follow-up.Conclusions Application of surgical treatment for moderate or severe SCFE with open reduction through the approach of surgical hip dislocation is a valid alternative method.The femoral head epiphysis can be capable of restoring anatomy,at present no case occurred avascular necrosis,and patients are satisfied with the function of the hip joint.