持续股骨髁上骨牵引结合经皮空心钉内固定治疗不稳定股骨头骺滑脱临床疗效分析

Analysis of progressive Russell traction reduction with percutaneous screw fixation for teatment of unstable slipped capital femoral epiphysis

目的评价持续股骨髁上骨牵引结合经皮空心钉内固定治疗不稳定股骨头骺滑脱的临床疗效。方法回顾性分析自2007-03—2011-02诊治的18例不稳定股骨头骺滑脱,采用Russell牵引结合闭合复位经皮空心钉内固定治疗。其中急性发作16例,慢性急性发作2例;中度移位11例,重度移位7例。摄髋关节X线片评估骺板闭合时间,观察是否存在股骨头坏死、软骨溶解及髋内翻等并发症,末次随访时髋关节功能根据Harris评分标准进行评估。结果本组平均随访2.6（1.5~3.0）年,18例骺板闭合后均取出内固定材料。所有患儿均未行对侧预防性原位固定,3例术后对侧发作,行手术治疗。末次随访时髋关节X线片显示2例术后股骨头坏死,均为重度滑脱患儿,均未发生软骨溶解;其余16例髋关节功能大致正常,日常生活无明显影响;髋关节功能根据Harris评分标准评定：优5例,良10例,可1例,差2例,优良率83.3%。结论不稳定股骨头骺滑脱行早期Russell牵引结合闭合复位经皮空心钉内固定可减少股骨头坏死等相关并发症的发生,疗效肯定,且手术操作简单易行。

Objective To evaluate the outcome of the progressive longitudinal traction reduction with screw fixation for treatment of unstable slipped capital femoral epiphysis（SCFE）. Methods From March of 2007 to February of 2011, 18 children with unstable slipped capital femoral epiphysis were operated in our hospital. The progressive longitudinal traction reduction with screw fixation was performed for all patients. The group involved 16 acute and 2 acute-on-chronic unstable SCFE according to the duration of symptoms. There were 11 moderate and 7 severe according to the degree of slip. Hip radiographs was utilized to determine the closure time of the epiphyseal plate, and also to verify occurrence of the complications, e.g. femoral head necrosis, chondrolysis and coxa vara. The hip function was evaluated based on Harris hip score. Results All patients were followed up for 1.5 to 3.0 years, 2.6 years on average. Upon closure of the epiphyseal plate,the internal fixation material was removed. In all the 18 patients, no prophylactic in-place fixation of the contralateral limb was applied, among whom 3 patients underwent surgical treatment due to onset of the disease in the contralateral limb. At the end of the follow-ups, it was indicated in hip radiographs that 2 patients with severe SCFE had postoperative femoral head necrosis and but no chondrolysis was found in all the patients. Except for the 2 patients with femoral head necrosis, the other16 patients showed basically normal hip function, with their daily lives not significantly affected. According to Harris score system, there were excellent in 5 patients, good in 10, fair in 1 and poor in 2. The excellent and good rate was 83.3%.Conclusion The progressive longitudinal traction reduction with screw fixation has the good effect for unstable slipped capital femoral epiphysis. It can minimize the complication of avascular necrosis.