CAJ | 학술논문

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.
목적 총결응용관관절외과탈위입로행절개복위수술치료청소년중、중도고골두골후활탈후지소12개월적수방효과.방법 2011년11월지2013년6월상해교통대학의학원부속신화의원인동골과수치6례(7관)중、중도고골두골후활탈환자,균유외상사,년령10 ～ 15세,평균13.6세.병정4～35 d,평균14.2d.활탈정도근거정위X선편고골두골후활탈부분점고골경직경적비례본조환자위25％～55％,평균45％.6례환자6측관관절(제1례우측동시행경피원위공심정고정)균채용경관관절외과탈위입로,Dunn절개복위내고정술.술후지구고정환지4주,상상견인4주배합관관절활동도적강복치료,8주후축점부괴행주훈련.결과 수방시간12 ～ 30개월,평균23.8개월.6례환자균이하지행주,무수주괴,무명현파행.복사X선편현시고골두골후대위대선회복량호,미출현고골두배사표현,관절간극정상.말차수방관관절Harris평분위85°～100°,평균94.7°.결론 응용관관절외과탈위입로행절개복위수술치료청소년중、중도고골두골후활탈시가공선택적유효방법,활탈적고골두골후획득해부복위,단기수방미출현고골두배사,소유병례관관절활동만의.
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.