WANG En-bo,WANG Kang,ZHANG Li-jun,et al.Bone traction in the treatment of slipped capttal femoral epiphysis in adolescent.[J].Journal of Clinical Pediatric Surgery,2010,9(04):0.
骨牵引在青少年股骨头骨骺滑脱治疗中的应用价值
- Title:
- Bone traction in the treatment of slipped capttal femoral epiphysis in adolescent.
- Keywords:
- Adolescent; Skeletal Tractingreposition; Femur Head; Epiphyses; Therapy
- 摘要:
- 目的 探讨骨牵引在青少年股骨头骨骺滑脱治疗中的作用与意义。方法 2002年9月至2007年8月作者治疗青少年股骨头骨骺滑脱12例，其中男8例，女4例。发病年龄11～14岁，平均年龄13.1岁；稳定型滑脱7例，不稳定型5例。轻度稳定型滑脱采用经皮1枚空心螺钉原位固定（3例）。中、重度稳定型滑脱（4例）及不稳定型滑脱（4例）先行股骨远端外展内旋位骨牵引2周，后在全麻下行经皮1～2枚空心螺钉固定。采用X线摄片测量股骨近端正侧位头干角，自身比较股骨头骨骺复位情况。采用Iowa 髋关节评分评价最后随访时髋关节功能。结果 12例均获随访，随访时间1.5～5年，平均2.6年。稳定滑脱组牵引前-牵引后-术后的正位头干角与侧位头干角均无显著差异；不稳定型滑脱组正位头干角牵引前与牵引后和术后均有显著差异（P < 0.05）。除1例治疗经过复杂的不稳定型滑脱发生股骨头缺血性坏死外，其余未见严重并发症。该例Iowa 髋关节评分86分，其余均在90分以上。 结论 空心钉固定前骨牵引对于不稳定型滑脱复位效果良好，值得推广；对于中、重度稳定型滑脱，骨牵引无效。
- Abstract:
- Objective To evaluate the function of bone traction in the treatment of slipped capital femoral epiphysis(SCFE) in adolescent. Methods 12 cases of SCFE were retrospectively reviewed from September 2002 to August 2007 with average age 13.1 years (ranged from 11 to 14 years old). There were 8 cases in male, 4 in female, 7 stable cases and 5 unstable ones. Mild slippages(3 cases) were fixed in situ with single cannulated screw. Moderate to severe stable slippages(4 cases) and unstable slippages(4 cases) were treated with distal femoral bone traction in abduction and internalrotation for about 2 weeks followed with fixation by 1or 2 cannulated screws percutaneously under general anesthesia. The femoral reductions were estimated by head-shaft angle preo?鄄peratively and post?鄄operatively. The Iowa Hip Score system was used evaluate the functional results at last followup. Results All cases were followed up with the average period of 2.6 years(1.5～5 years). There were no difference in head-shaft angle between pretraction, posttraction and postoperation in stable cases（P > 0.05）. There were statistic difference between pretraction and posttraction , postoperation respectively in unstable cases（P < 0.05）.Except for one patient with complex treatment turned out to be avascular necrosis of femoral head with Iowa Hip Score 86 scores, there were no main complications in the other cases with Iowa Hip Score above 90 points. Conclusions Good reduction could be expected in unstable SCFE by bone traction before fixation with less complication. Bone traction would be invalid in stable SCFE.
参考文献/References:
1 Noguchi Y,Sakamaki T.Epidemiology and demographics of slipped capital femoral epiphysis in Japan: a multicenter study by the Japanese Paediatric Orthopaedic Association[J].J Orthop Sci，2002,7(6):610-617.
2 马瑞雪,李祁伟,王恩波,等.原位空心钉固定治疗股骨头骨骺滑脱的临床观察[J].临床小儿外科杂志,2004,3(4):241-244.
3 Southwick WO.Osteotomy through the lesser trochanter for slipped capital femoral epiphysis[J].J Bone Joint Surg Am, 1967,49(5):807-835.
4 Parsch K,Zehender H,Bühl T,et al.Intertrochanteric corrective osteotomy for moderate and severe chronic slipped capital femoral epiphysis[J].J Pediatr Orthop B,1999,8(3):223-230.
5 Kay RM.Slipped Capital Femoral Epiphysis In: Morrissy RT, ed. Lovell and Winter's pediatric orthopaedics.6th ed, Philadelphia: Lippincott,2003,1086-1124.
6 Nisar A,Salama A,Freeman JV,et al.Avascular necrosis in acute and acute-on-chronic slipped capital femoral epiphysis[J]. J Pediatr Orthop B,2007,16 (6):393-398.
7 Yildirim Y,Bautista S,Davidson RS.Chondrolysis, osteonecrosis, and slip severity in patients with subsequent contralateral slipped capital femoral epiphysis[J].J Bone Joint Surg Am,2008,90(3):485-492.
8 Mamisch TC,Kim YJ,Richolt JA,et al.Femoral morphology due to impingement influences the range of motion in slipped capital femoral epiphysis[J].Clin Orthop Relat Res,2009,467(3):692-698.
9 王承武,徐易京. 股骨头骨髓滑脱8例治疗体会[J].中华小儿外科杂志,1996,27(2):85-87.
10 Dietz FR.Traction reduction of acute and acute-on-chronic slipped capital femoral epiphysis[J].Clin Orthop Relat Res, 1994,302:101-110.
11 Goodwin RC,Mahar AT,Oswald TS,et al.Screw head impingement after in situ fixation in moderate and severe slipped capital femoral epiphysis[J].J Pediatr Orthop,2007,27(3):319-325.
12 Kishan S,Upasani V,Mahar A,et al.Biomechanical stability of single-screw versus two-screw fixation of an unstable slipped capital femoral epiphysis model: effect of screw position in the femoral neck[J].J Pediatr Orthop，2006, 26(5):601-605.
13 Kalogrianitis S,Tan CK,Kemp GJ,et al.Does unstable slipped capital femoral epiphysis require urgent stabilization?[J].J Pediatr Orthop B，2007,16(1):6-9.
14 Diab M,Hresko MT,Millis MB.Intertrochanteric versus subcapital osteotomy in slipped capital femoral epiphysis[J].Clin Orthop Relat Res，2004,(427): 204-12.
相似文献/References:
[1]杜智军 吕洪海 王彭. 弹性髓内针固定治疗青少年锁骨中段骨折[J].临床小儿外科杂志,2012,11(01):4.
[2]李云龙,文建国..三种手术方式治疗青少年精索静脉曲张242例[J].临床小儿外科杂志,2016,15(05):453.
[3]张彦,陈博昌,鲍琨..后路交叉置钉技术在青少年脊柱侧凸治疗中的应用[J].临床小儿外科杂志,2017,16(04):364.
[4]郑杰文,唐耘熳.青少年精索静脉曲张的手术指征探讨[J].临床小儿外科杂志,2019,18(04):341.[doi:10.3969/j.issn.1671-6353.2019.04.019]
Zheng Jiewen,Tang Yunman.Surgical indications for varicocele in youth and adolescence[J].Journal of Clinical Pediatric Surgery,2019,18(04):341.[doi:10.3969/j.issn.1671-6353.2019.04.019]
[5]孙燕,郭兴奇,陈志峰,等.“十”字缝合固定法治疗青少年急性髌骨脱位伴软骨面骨折的临床疗效[J].临床小儿外科杂志,2019,18(12):1031.[doi:10.3969/j.issn.1671-6353.2019.12.009]
Sun Yan,Guo Xingqi,Chen Zhifeng,et al.Clinical efficacy of “+” suturing fixation for acute patella dislocation with cartilage fracture in adolescents[J].Journal of Clinical Pediatric Surgery,2019,18(04):1031.[doi:10.3969/j.issn.1671-6353.2019.12.009]
[6]张百慧,叶文松,朱伟玮,等.青少年特发性脊柱侧凸矫形术后adding-on现象的研究进展[J].临床小儿外科杂志,2020,19(02):140.[doi:10.3969/j.issn.1671-6353.2020.02.010]
Zhang Baihui,Ye Wensong,Zhu Weiwei,et al.Research advances of adding-on phenomenon after operations for adolescent idiopathic scoliosis[J].Journal of Clinical Pediatric Surgery,2020,19(04):140.[doi:10.3969/j.issn.1671-6353.2020.02.010]
[7]卢育南,林然,潘源城,等.闭合复位克氏针空心钉内固定治疗青少年肱骨髁间T型骨折的疗效分析[J].临床小儿外科杂志,2020,19(06):508.[doi:10.3969/j.issn.1671-6353.2020.06.009]
Lu Yunan,Lin Ran,Pan Yuancheng,et al.Treatment of T-type intercondylar humeral fractures with closed reduction K-wire and cannulated screw internal fixation[J].Journal of Clinical Pediatric Surgery,2020,19(04):508.[doi:10.3969/j.issn.1671-6353.2020.06.009]
[8]张悦振,孙凌云,吴雄伟,等.亚甲蓝在单孔腹腔镜保留淋巴管治疗小儿精索静脉曲张中的应用[J].临床小儿外科杂志,2021,20(04):365.[doi:10.12260/lcxewkzz.2021.04.012]
Zhang Yuezhen,Sun Lingyun,Wu Xiongwei,et al.Application of methylene blue in the treatment of varicocele in children with single-port laparoscopic lymphatic vessel preservation[J].Journal of Clinical Pediatric Surgery,2021,20(04):365.[doi:10.12260/lcxewkzz.2021.04.012]
[9]陈嵩,陈福明,潘源城,等.75例青少年胫骨远端三平面骨折的三维CT特征研究[J].临床小儿外科杂志,2021,20(07):641.[doi:10.12260/lcxewkzz.2021.07.009]
Chen Song,Chen Fuming,Pang Yuanchen,et al.Title Study on the fracture line of 75 adolescents with triplanar fracture of tibia[J].Journal of Clinical Pediatric Surgery,2021,20(04):641.[doi:10.12260/lcxewkzz.2021.07.009]
[10]白云松,张学军,高荣轩,等.后路多节段Ponte截骨矫形固定术治疗青少年休门氏脊柱后凸畸形疗效分析[J].临床小儿外科杂志,2021,20(08):737.[doi:10.12260/lcxewkzz.2021.08.007]
Bai Yunsong,Zhang Xuejun,Gao Rongxuan,et al.Posterior-only multi-segment Ponte osteotomies with internal fixation and fusion in adolescent Scheuermann’s kyphosis[J].Journal of Clinical Pediatric Surgery,2021,20(04):737.[doi:10.12260/lcxewkzz.2021.08.007]
备注/Memo
中国医科大学附属盛京医院小儿骨科（辽宁省沈阳市，110004），E-mail：websyy@tom.com