{"title":"原位固定还是改良邓恩手术？在股骨头骺滑脱手术中哪种方法更胜一筹？一项仅包括稳定/中度病例的病例对照研究。","authors":"Ali Sisman, Caner Poyraz, Bilal Akbas, Mutlu Cobanoglu, Sevki Oner Savk, Emre Cullu","doi":"10.1177/18632521241295869","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The study aimed to compare the clinical and radiologic results of <i>in situ</i> pinning and modified Dunn procedure methods in stable-moderate slipped capital femoral epiphyses surgery.</p><p><strong>Methods: </strong>Slipped capital femoral epiphyses cases between January 2000 and December 2022 were retrospectively analyzed. Stable and moderate cases treated with <i>in situ</i> pinning or modified Dunn procedure and those with a follow-up period longer than 1 year were included. Two groups were formed: the <i>in situ</i> pinning group and the modified Dunn procedure group. Radiologically, postoperative alpha angle, Southwick angle, avascular necrosis, and osteoarthritis rates were compared. Clinically, Harris Hip Score and Merle d'Aubigné score were compared. Total complications were evaluated.</p><p><strong>Results: </strong>The <i>in situ</i> pinning group consisted of 28 patients and the modified Dunn procedure group consisted of 17 patients. The groups were similar in terms of age, gender, affected side, body mass index, Fahey/O'Brien Classification, preoperative slip angles, and follow-up time. Operation time was shorter in the <i>in situ</i> pinning group (<i>p</i> < 0.001). Postoperative Southwick and alpha angle were lower in the modified Dunn procedure group (<i>p</i> < 0.001). In clinical outcomes, Merle d'Aubigné and Harris Hip Score were higher in the <i>in situ</i> pinning group (<i>p</i> = 0.013, <i>p</i> = 0.005, respectively). The rate of avascular necrosis was higher in the modified Dunn procedure group (<i>p</i> = 0.048). There was no difference between the groups in terms of total complications and osteoarthritis.</p><p><strong>Conclusions: </strong><i>In situ</i> pinning has an advantage over the modified Dunn procedure in the treatment of stable-moderate slipped capital femoral epiphyses due to shorter operative time, better clinical outcomes, and fewer avascular necrosis rates. Although Southwick and alpha angle measurements were found to be higher after <i>in situ</i> pinning compared to the modified Dunn procedure, this does not constitute a significant disadvantage in terms of osteoarthritis development in the mid-term.</p><p><strong>Level of evidence: </strong>Level III, case-control study.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521241295869"},"PeriodicalIF":1.3000,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556608/pdf/","citationCount":"0","resultStr":"{\"title\":\"<i>In situ</i> pinning or modified Dunn procedure? Which one is superior in slipped capital femoral epiphysis surgery? A case-control study including only stable/moderate cases.\",\"authors\":\"Ali Sisman, Caner Poyraz, Bilal Akbas, Mutlu Cobanoglu, Sevki Oner Savk, Emre Cullu\",\"doi\":\"10.1177/18632521241295869\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>The study aimed to compare the clinical and radiologic results of <i>in situ</i> pinning and modified Dunn procedure methods in stable-moderate slipped capital femoral epiphyses surgery.</p><p><strong>Methods: </strong>Slipped capital femoral epiphyses cases between January 2000 and December 2022 were retrospectively analyzed. Stable and moderate cases treated with <i>in situ</i> pinning or modified Dunn procedure and those with a follow-up period longer than 1 year were included. Two groups were formed: the <i>in situ</i> pinning group and the modified Dunn procedure group. Radiologically, postoperative alpha angle, Southwick angle, avascular necrosis, and osteoarthritis rates were compared. Clinically, Harris Hip Score and Merle d'Aubigné score were compared. Total complications were evaluated.</p><p><strong>Results: </strong>The <i>in situ</i> pinning group consisted of 28 patients and the modified Dunn procedure group consisted of 17 patients. The groups were similar in terms of age, gender, affected side, body mass index, Fahey/O'Brien Classification, preoperative slip angles, and follow-up time. Operation time was shorter in the <i>in situ</i> pinning group (<i>p</i> < 0.001). Postoperative Southwick and alpha angle were lower in the modified Dunn procedure group (<i>p</i> < 0.001). In clinical outcomes, Merle d'Aubigné and Harris Hip Score were higher in the <i>in situ</i> pinning group (<i>p</i> = 0.013, <i>p</i> = 0.005, respectively). The rate of avascular necrosis was higher in the modified Dunn procedure group (<i>p</i> = 0.048). There was no difference between the groups in terms of total complications and osteoarthritis.</p><p><strong>Conclusions: </strong><i>In situ</i> pinning has an advantage over the modified Dunn procedure in the treatment of stable-moderate slipped capital femoral epiphyses due to shorter operative time, better clinical outcomes, and fewer avascular necrosis rates. Although Southwick and alpha angle measurements were found to be higher after <i>in situ</i> pinning compared to the modified Dunn procedure, this does not constitute a significant disadvantage in terms of osteoarthritis development in the mid-term.</p><p><strong>Level of evidence: </strong>Level III, case-control study.</p>\",\"PeriodicalId\":56060,\"journal\":{\"name\":\"Journal of Childrens Orthopaedics\",\"volume\":\" \",\"pages\":\"18632521241295869\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2024-10-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556608/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Childrens Orthopaedics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/18632521241295869\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Childrens Orthopaedics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/18632521241295869","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的：该研究旨在比较在稳定-中度股骨骺滑脱手术中，原位固定法和改良Dunn手术法的临床和放射学效果：对2000年1月至2022年12月期间的股骨头骺滑脱病例进行回顾性分析。方法：对 2000 年 1 月至 2022 年 12 月期间的股骨骺滑脱病例进行回顾性分析，纳入采用原位固定或改良 Dunn 术治疗的稳定和中度病例，以及随访时间超过 1 年的病例。分为两组：原位钉入术组和改良邓恩术组。在放射学方面，比较了术后阿尔法角、南威克角、血管坏死和骨关节炎的发生率。在临床上，比较了 Harris 髋关节评分和 Merle d'Aubigné 评分。对总并发症进行了评估：结果：原位固定组有 28 名患者，改良 Dunn 手术组有 17 名患者。两组患者在年龄、性别、患侧、体重指数、Fahey/O'Brien分类、术前滑脱角度和随访时间方面相似。原位固定组的手术时间更短（分别为 p = 0.013 和 p = 0.005）。改良邓恩手术组的血管坏死率更高（p = 0.048）。两组在总并发症和骨关节炎方面没有差异：结论：在治疗稳定-中度股骨头骺滑脱方面，原位固定比改良Dunn术更有优势，因为手术时间更短、临床疗效更好、血管坏死率更低。虽然与改良Dunn术相比，原位钉入术后的Southwick角和α角测量值更高，但就中期骨关节炎的发展而言，这并不构成明显的劣势：证据等级：III级，病例对照研究。
In situ pinning or modified Dunn procedure? Which one is superior in slipped capital femoral epiphysis surgery? A case-control study including only stable/moderate cases.
Purpose: The study aimed to compare the clinical and radiologic results of in situ pinning and modified Dunn procedure methods in stable-moderate slipped capital femoral epiphyses surgery.
Methods: Slipped capital femoral epiphyses cases between January 2000 and December 2022 were retrospectively analyzed. Stable and moderate cases treated with in situ pinning or modified Dunn procedure and those with a follow-up period longer than 1 year were included. Two groups were formed: the in situ pinning group and the modified Dunn procedure group. Radiologically, postoperative alpha angle, Southwick angle, avascular necrosis, and osteoarthritis rates were compared. Clinically, Harris Hip Score and Merle d'Aubigné score were compared. Total complications were evaluated.
Results: The in situ pinning group consisted of 28 patients and the modified Dunn procedure group consisted of 17 patients. The groups were similar in terms of age, gender, affected side, body mass index, Fahey/O'Brien Classification, preoperative slip angles, and follow-up time. Operation time was shorter in the in situ pinning group (p < 0.001). Postoperative Southwick and alpha angle were lower in the modified Dunn procedure group (p < 0.001). In clinical outcomes, Merle d'Aubigné and Harris Hip Score were higher in the in situ pinning group (p = 0.013, p = 0.005, respectively). The rate of avascular necrosis was higher in the modified Dunn procedure group (p = 0.048). There was no difference between the groups in terms of total complications and osteoarthritis.
Conclusions: In situ pinning has an advantage over the modified Dunn procedure in the treatment of stable-moderate slipped capital femoral epiphyses due to shorter operative time, better clinical outcomes, and fewer avascular necrosis rates. Although Southwick and alpha angle measurements were found to be higher after in situ pinning compared to the modified Dunn procedure, this does not constitute a significant disadvantage in terms of osteoarthritis development in the mid-term.
期刊介绍：
Aims & Scope
The Journal of Children’s Orthopaedics is the official journal of the European Paediatric Orthopaedic Society (EPOS) and is published by The British Editorial Society of Bone & Joint Surgery.
It provides a forum for the advancement of the knowledge and education in paediatric orthopaedics and traumatology across geographical borders. It advocates an increased worldwide involvement in preventing and treating musculoskeletal diseases in children and adolescents.
The journal publishes high quality, peer-reviewed articles that focus on clinical practice, diagnosis and treatment of disorders unique to paediatric orthopaedics, as well as on basic and applied research. It aims to help physicians stay abreast of the latest and ever-changing developments in the field of paediatric orthopaedics and traumatology.
The journal welcomes original contributions submitted exclusively for review to the journal. This continuously published online journal is fully open access and will publish one print issue each year to coincide with the EPOS Annual Congress, featuring the meeting’s abstracts.
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