青少年股骨头骺脱离伴严重股骨头骨骺滑脱手术方法的选择

封面


如何引用文章

全文:

开放存取 开放存取
受限制的访问 ##reader.subscriptionAccessGranted##
受限制的访问 订阅或者付费存取

详细

论证：采用各种类型的股骨关节外矫形截骨术和经典的Dunn手术，恢复了世界临床实践中严重的青少年股骨头骺脱离慢性移位的骨骺与髋臼的空间形态。股骨关节组件的明显残余变形、股骨髋臼撞击症现象以及大量严重的缺血性并发症促使外科医生改进这些手术干预技术。同时，提出了一种改良的Dunn手术，使用低创伤性手术髋关节脱位。与此同时，这些患者的手术治疗选择仍然是一个争论的话题。

目的：提高儿童青少年股骨头骺脱离的治疗效果，其特点是严重程度的慢性骨骺移位。

材料与方法。对40例（24个男孩和16个女孩）12至15岁儿童患有青少年股骨头骺脱离伴慢性严重股骨头骨骺滑脱的术前、术后临床及X线检查资料进行了分析。在所有病例中，病变一侧均有典型方向的移位（向后向下或仅向后），在对侧关节，观察到疾病的初始阶段（滑移前）。对第一组20例儿童，根据我们2011年提出的方法，行股骨关节外矫形（前外侧或外翻旋转）截骨术[22]，而对第二组20例患儿接受改良Dunn手术，严格遵循作者的方法。两组术后随访时间均为1个月至2.5年。

结果。术后2.5年，第一组8例患者中只有1例（12.5%）获得了良好的解剖和功能结果，而第二组8例患者中有7例（87.5%）获得了良好的解剖和功能结果。第一组5名（62.5%）儿童出现不满意结果的原因是骨骺残留移位（从22°到28°）和/或股骨颈前表面向头部的阶梯状转移，而第二组1例（12.5%）患儿术后6个月出现股骨头无菌性坏死。

结果。本研究使我们初步得出改良Dunn手术治疗青少年股骨头骺脱离合并严重股骨头骨骺滑脱的疗效高、关节外股骨矫形截骨术疗效低的结论。改良Dunn手术在上述解剖情况下可以消除受影响股骨关节组件明显的畸形和股骨髋臼撞击症。

全文:

受限制的访问

作者简介

Dmitry Barsukov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

编辑信件的主要联系方式.
Email: dbbarsukov@gmail.com
ORCID iD: 0000-0002-9084-5634

MD, PhD, Senior Research Associate of the Department of Hip Pathology

俄罗斯联邦, Saint Petersburg

Alexei Baindurashvili

The Turner Scientific Research Institute for Children’s Orthopedics

Email: turner01@mail.ru
ORCID iD: 0000-0001-8123-6944

MD, PhD, D.Sc., Professor, Member of RAS, Director

俄罗斯联邦, Saint-Petersburg

Pavel Bortulev

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: pavel.bortulev@yandex.ru
ORCID iD: 0000-0003-4931-2817

MD, Research Associate of the Department of Hip Pathology

俄罗斯联邦, Saint-Petersburg

Vladimir Baskov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: dr.baskov@mail.ru

MD, PhD, Head of Department for Cooperation with Regions

俄罗斯联邦, Saint Petersburg

Ivan Pozdnikin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: pozdnikin@gmail.com
ORCID iD: 0000-0002-7026-1586
SPIN 代码: 3744-8613

MD, PhD, Research Associate of the Department of Hip Pathology

俄罗斯联邦, Saint Petersburg

Andrey Krasnov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: turner02@mail.ru
ORCID iD: 0000-0001-9067-3732

MD, PhD, Orthopedic and Trauma Surgeon of the Consultative and Diagnostic Department

俄罗斯联邦, Saint-Petersburg

参考

  1. Кречмар А.Н. Юношеский эпифизеолиз головки бедра (клинико-экспериментальное исследование): автореф. дис. … д-ра мед. наук. – Л., 1982. [Krechmar AN. Yunosheskiy epifizeoliz golovki bedra (kliniko-eksperimental’noe issledovanie). [dissertation] Leningrad; 1982. (In Russ.)]
  2. Шкатула Ю.В. Этиология, патогенез, диагностика и принципы лечения юношеского эпифизеолиза головки бедренной кости (аналитический обзор литературы) // Журнал клинических и экспериментальных медицинских исследований. – 2007. – № 2. – С. 122–135. [Shkatula YV. Etiologiya, patogenez, diagnostika i printsipy lecheniya yunosheskogo epifizeoliza golovki bedrennoy kosti (analiticheskiy obzor literatury). Journal of clinical and experimental medical researches. 2007;(2):122-135. (In Russ.)]
  3. Bellemore JM, Carpenter EC, Yu NY, et al. Biomechanics of slipped capital femoral epiphysis: Evaluation of the posterior sloping angle. J Pediatr Orthop. 2016;36(6):651-655. https://doi.org/10.1097/BPO.0000000000000512.
  4. Abraham E, Gonzalez MH, Pratap S, et al. Clinical implications of anatomical wear characteristics in slipped capital femoral epiphysis and primary osteoarthritis. J Pediatr Orthop. 2007;27(7):788-795. https://doi.org/10.1097/BPO.0b013e3181558c94.
  5. Thawrani DP, Feldman DS, Sala DA. Current practice in the management of slipped capital femoral epiphysis. J Pediatr Orthop. 2016;36(3):e27-37. https://doi.org/10.1097/BPO.0000000000000496.
  6. Salvati EA, Robinson JH Jr, O’Down TJ. Southwick osteotomy for severe chronic slipped capital femoral epiphysis: Results and complications. J Bone Joint Surg Am. 1980;62(4):561-570.
  7. Kartenbender K, Cordier W, Katthagen BD. Long-term follow-up study after corrective Imhauser osteotomy for severe slipped capital femoral epiphysis. J Pediatr Orthop. 2000;20(6):749-756. https://doi.org/10.1097/00004694-200011000-00010.
  8. Diab M, Daluvoy S, Snyder BD, Kasser JR. Osteotomy does not improve early outcome after slipped capital femoral epiphysis. J Pediatr Orthop B. 2006;15(2):87-92. https://doi.org/10.1097/01.bpb.0000186646.84321.2f.
  9. Leunig M, Horowitz K, Manner H, Ganz R. In situ pinning with arthroscopic osteoplasty for mild SCFE: A preliminary technical report. Clin Orthop Relat Res. 2010;468(12):3160-3167. https://doi.org/10.1007/s11999-010-1408-3.
  10. Минеев В.В. Хирургическое лечение тяжелых нестабильных форм юношеского эпифизеолиза головки бедренной кости: автореф. дис. … канд. мед. наук. – Курган, 2012. – 24 с. [Mineev VV. Khirurgicheskoe lechenie tyazhelykh nestabil’nykh form yunosheskogo epifizeoliza golovki bedrennoy kosti. Kurgan; 2012. 24 p. (In Russ.)]
  11. Fabricant PD, Fields KG, Taylor SA, et al. The effect of femoral and acetabular version on clinical outcomes after arthroscopic femoroacetabular impingement surgery. J Bone Joint Surg Am. 2015;97(7):537-543. https://doi.org/10.2106/JBJS.N.00266.
  12. Schrader T, Jones CR, Kaufman AM, Herzog MM. Intraoperative monitoring of epiphyseal perfusion in slipped capital femoral epiphysis. J Bone Joint Surg Am. 2016;98(12):1030-1040. https://doi.org/10.2106/jbjs. 15.01002.
  13. Ilizaliturri VM, Jr., Nossa-Barrera JM, Acosta-Rodriguez E, Camacho-Galindo J. Arthroscopic treatment of femoroacetabular impingement secondary to paediatric hip disorders. J Bone Joint Surg Br. 2007;89(8):1025-1030. https://doi.org/10.1302/0301-620X.89B8.19152.
  14. Soni JF, Valenza WR, Uliana CS. Surgical treatment of femoroacetabular impingement after slipped capital femoral epiphysis. Curr Opin Pediatr. 2018;30(1):93-99. https://doi.org/10.1097/MOP.0000000000000565.
  15. Mamisch TC, Kim YJ, Richolt JA, et al. Femoral morphology due to impingement influences the range of motion in slipped capital femoral epiphysis. Clin Orthop Relat Res. 2009;467(3):692-698. https://doi.org/10.1007/s11999-008-0477-z.
  16. Ziebarth K, Leunig M, Slongo T, et al. Slipped capital femoral epiphysis: Relevant pathophysiological findings with open surgery. Clin Orthop Relat Res. 2013;471(7):2156-2162. https://doi.org/10.1007/s11999-013-2818-9.
  17. Madan SS, Cooper AP, Davies AG, Fernandes JA. The treatment of severe slipped capital femoral epiphysis via the Ganz surgical dislocation and anatomical reduction: A prospective study. Bone Joint J. 2013;95-B(3):424-429. https://doi.org/10.1302/0301-620X.95B3.30113.
  18. Leunig M, Ganz R. The evolution and concepts of joint-preserving surgery of the hip. Bone Joint J. 2014;96-B(1):5-18. https://doi.org/10.1302/0301-620X. 96B1.32823.
  19. Ziebarth K, Steppacher SD, Siebenrock KA. The modified Dunn procedure to treat severe slipped capital femoral epiphysis. Orthopade. 2019;48(8):668-676. https://doi.org/10.1007/s00132-019-03774-x.
  20. Otani T, Kawaguchi Y. Trochantericosteotomy for slipped capital femoral epiphysis; Three dimensional osteotomybased onflexion osteotomy planned with new technologies. In: Frontline of Hip Osteotomy. Ed. by I. Moritoshi. Tokyo: Medical View Co., Ltd; 2013. p. 263-275.
  21. Wensaas A, Svenningsen S, Terjesen T. Long-term outcome of slipped capital femoral epiphysis: A 38-year follow-up of 66 patients. J Child Orthop. 2011;5(2):75-82. https://doi.org/10.1007/s11832-010-0308-0.
  22. Патент РФ на изобретение № 2604039/10.12.2016. Бюл. № 31. Поздникин И.Ю., Барсуков Д.Б. Способ корригирующей остетомии бедра при юношеском эпифизеолизе головки бедренной кости. [Patent RUS No. 2604039/ 10.12.2016. Byul. No. 31. Pozdnikin IY, Barsukov DB. Sposob korrigiruyushchey ostetomii bedra pri yunosheskom epifizeolize golovki bedrennoy kosti. (In Russ.)]
  23. Барсуков Д.Б., Баиндурашвили А.Г., Поздникин И.Ю., и др. Новый метод корригирующей остеотомии бедра у детей с юношеским эпифизеолизом головки бедренной кости // Гений ортопедии. – 2018. – Т. 24. – № 4. – С. 450–459. [Barsukov DB, Baindurashvili AG, Pozdnikin IY, et al. New method of corrective femoral osteotomy in children with slipped capital femoral epiphysis. Genij ortopedii. 2018;24(4):450-459. (In Russ.)]. https://doi.org/10.18019/1028-4427-2018-24-4-450-459.
  24. Ziebarth K, Zilkens C, Spencer S, et al. Capital realignment for moderate and severe SCFE using a modified Dunn procedure. Clin Orthop Relat Res. 2009;467(3):704-716. https://doi.org/10.1007/s11999-008-0687-4.
  25. Барсуков Д.Б., Баиндурашвили А.Г., Бортулёв П.И., и др. Наш опыт применения модифицированной операции Dunn у детей с юношеским эпифизеолизом головки бедренной кости (предварительные результаты) // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2019. – Т. 7. – № 4. – С. 27–36. [Barsukov DB, Baindurashvili AG, Bortulev PI, et al. Our experience of the modified Dunn procedure in children with slipped capital femoral epiphysis (preliminary results). Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2020;7(4):27-36. (In Russ.)]. https://doi.org/10.17816/ptors7427-36.
  26. Masquijo JJ, Allende V, D’Elia M, et al. Treatment of slipped capital femoral epiphysis with the modified dunn procedure: A multicenter study. J Pediatr Orthop. 2019;39(2):71-75. https://doi.org/10.1097/BPO.0000000000000936.
  27. Lerch TD, Vuilleumier S, Schmaranzer F, et al. Patients with severe slipped capital femoral epiphysis treated by the modified Dunn procedure have low rates of avascular necrosis, good outcomes, and little osteoarthritis at long-term follow-up. Bone Joint J. 2019;101-B(4): 403-414. https://doi.org/10.1302/0301-620x.101b4.bjj-2018-1303.r1.
  28. Slongo T, Kakaty D, Krause F, Ziebarth K. Treatment of slipped capital femoral epiphysis with a modified Dunn procedure. J Bone Joint Surg Am. 2010;92(18):2898-2908. https://doi.org/10.2106/JBJS.I.01385.
  29. Ziebarth K, Milosevic M, Lerch TD, et al. High survivorship and little osteoarthritis at 10-year followup in SCFE patients treated with a modified Dunn procedure. Clin Orthop Relat Res. 2017;475(4):1212-1228. https://doi.org/10.1007/s11999-017-5252-6.
  30. Введенский П.С., Тенилин Н.А., Власов М.В., и др. Техника хирургического вывиха бедра при лечении больных с юношеским эпифизеолизом головки бедренной кости // Травматология и ортопедия России. – 2018. – Т. 24. – № 47. – С. 64–71. [Vvedenskiy PS, Tenilin NA, Vlasov MV, et al. Surgical hip dislocation technique in treatment of patients with slipped capital femoral epiphysis. Traumatology and Orthopedics of Russia. 2018;24(4):64-71. (In Russ.)]. https://doi.org/10.21823/2311-2905-2018-24-4-64-71.
  31. Соколовский А.М., Соколовский О.А., Гольдман Р.К., Деменцов А.Б. Планирование операций на проксимальном отделе бедренной кости // Медицинские новости. – 2005. – № 10. – С. 26–29. [Sokolovskiy AM, Sokolovskiy OA, Goldman RK, Dementsov AB. Planirovanie operatsii na proksimalnom otdele bedrennoi kosti. Meditsinskie novosti. 2005;(10):26-29. (In Russ.)]
  32. Al-Nammari SS, Tibrewal S, Britton EM, Farrar NG. Management outcome and the role of manipulation in slipped capital femoral epiphysis. J Orthop Surg (Hong Kong). 2008;16(1):131. https://doi.org/ 10.1177/230949900801600134.
  33. Sonnega RJ, van der Sluijs JA, Wainwright AM, et al. Management of slipped capital femoral epiphysis: Results of a survey of the members of the European Paediatric Orthopaedic Society. J Child Orthop. 2011;5(6):433-438. https://doi.org/10.1007/s11832-011-0375-x.
  34. Wylie JD, Novais EN. Evolving understanding of and treatment approaches to slipped capital femoral epiphysis. Curr Rev Musculoskelet Med. 2019;12(2):213-219. https://doi.org/10.1007/s12178-019-09547-5.

补充文件

附件文件
动作
1. JATS XML
下载

版权所有 © Barsukov D., Baindurashvili A., Bortulev P., Baskov V., Pozdnikin I., Krasnov A., 2021

Creative Commons License
此作品已接受知识共享署名 4.0国际许可协议的许可
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС77-54261 от 24 мая 2013 г.


##common.cookie##