- 期刊
Closed Reduction and Pinning for Unstable Slipped Capital Femoral Epiphysis
以徒手性復位及鋼釘固定術治療不穩定性股骨頭滑脫
摘要
背景及目的：股骨頭滑脫常發生於青春期或前期；慢性患者以鋼釘原位固定以使生長板融合，防止進行性滑脫，但是不穩定性者治療則有爭議，尤其在是否復位或如何復位方面；本文章主要研究復位的安全性及併發症。 方法：我們自1987年到2000年收集六病例，皆為不穩定性者，以徒手性復位及鋼釘固定治療，並以X光片股骨頭移位程度決定滑脫嚴重度及以Heyman and Herndon建議的標準來評估臨床結果。 結果：術前有一例是輕度，四例中度，一例重度滑脫，全都復位到急性前狀態並以鋼釘固定；術後平均追蹤5.1年，四例結果屬優良，一例差，一例失敗；失敗乃因麻醉後姿勢性急速、非手動復位而造成股骨頭缺血壞死；其他例乃用溫柔性手動牽引復位，一例因屬少年性滑脫、故產生股骨頸短小；一例產生鋼釘穿透；平均生長板關閉時間為2.1年。 結論：故本文報告以溫柔手動牽引且在透視機監督下復位，不僅安全且可減少滑脫的嚴重性，尤其針對重度及中度患者可降低日後關節病變的機會。
並列摘要
Background and purpose: Slipped capital femoral epiphysis (SCFE) is a common disorder of the hip in pre-adolescence and adolescence. Pinning in situ is the standard procedure for chronic SCFE. However, treatment of unstable SCFE remains controversial, especially regarding reduction. We investigated the safety of reduction and complications resulting from the operation. Methods: Between January 1987 and December 2000, five patients (six hips) with a diagnosis of unstable SCFE were evaluated at Changhua Christian Hospital and Chang Gung Memorial Hospital. Closed reduction and percutaneous pinning were performed for acute SCFE. The severity of the slip was measured by epiphyseal displacement relative to the metaphysis on antero-posterior or lateral views. Clinical results were classified according to the criteria of Heyman and Herndon. Results: One slip was classified as mild, four as moderate, and one as severe. The femoral head was reduced to the preacute position in all patients. Gentle manipulative reduction was performed on five hips, while inadvertent reduction was performed on one hip. No hip was over-reduced. None of the slip continued to progress after pinning. The mean time to physeal closure was 2.1 years. Four hips were graded as excellent, one hip as poor, and one hip as failure at the latest clinical evaluation. One hip developed avascular necrosis (AVN). Pin penetration was found in one hip. Leg-length discrepancy of about 2.5cm was noted in a juvenile SCFE (nine years old) after skeletal maturity. The mean duration of follow up was 5.1 years. Conclusions: Closed manipulation and pinning is a safe procedure for management of unstable SCFE if performed carefully and under fluoroscopic guidance. Adequate reduction decreases the severity of malunion and prevents development of osteoarthrosis, particularly in moderate or severe slips.