Deslizamientos epifisarios femorales proximales >30º. Procedimiento de Dunn modificado. Evaluación anatómica y funcional en una cohorte retrospectiva. [Slipped capital femoral epiphysis >30º. Modified Dunn procedure. Anatomical and functional evaluation in a retrospective cohort]
Barra lateral del artículo
Publicado:
dic 28, 2013
Palabras clave:
deslizamiento espifisario femoral proximal, luxación controlada de cadera, procedimiento de Dunn modificado, slipped capital femoral epiphysis, surgical dislocation of the hip, Modified Dunn procedure
Contenido principal del artículo
Resumen
IntroducciónLa deformidad residual resultante de un deslizamiento epifisario femoral proximal moderado o grave conduce a osteoartritis prematura debida al choque femoroacetabular. Los objetivos del trabajo fueron evaluar la mejoría de la anatomía del fémur proximal y evaluar la función de la cadera en pacientes con deslizamiento epifisario femoral proximal >30 grados tratados con el procedimiento de Dunn modificado, a corto plazo. Material y MétodosCohorte retrospectiva de pacientes con deslizamiento epifisario femoral proximal >30 grados, tratados con luxación controlada de cadera y el procedimiento de Dunn modificado. Se evaluaron mediciones clínicas y radiológicas preoperatorias y posoperatorias, hallazgos intraoperatorios y funcionalidad con los puntajes de Harris y de D’aubigne-Postel.ResultadosTrece casos, mediana de edad 12 años y mediana de seguimiento 14 meses. El ángulo de deslizamiento de Southwick preoperatorio (75 grados, ri 67-85) y posoperatorio (10 grados, ri 5-17) mostró una disminución estadísticamente significativa (p <0,001). El offset radio cabeza-cuello preoperatorio (-0,13) versus el posoperatorio (0,12) obtuvo una mejoría significativa (p 0,002). El 69,2% de los pacientes presentó daño de alguna estructura intraarticular. Los puntajes promedio de funcionalidad fueron 14,6 (muy buena mejoría) y 83,4 (bueno). Complicaciones: necrosis avascular 15,3% y condrólisis 15,3%. ConclusionEsta técnica restaura la anatomía del fémur proximal y la funcionalidad de la cadera a corto plazo. aunque no disponemos de resultados a largo plazo, al menos en teoría, serían buenos. Sin embargo, la luxación controlada con Dunn modificado no está exenta de complicaciones y el riesgo de necrosis avascular y condrólisis persiste.
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Praglia, F., Visona Dallapozza, D., Sueiro, J., & Stefano, E. (2013). Deslizamientos epifisarios femorales proximales >30º. Procedimiento de Dunn modificado. Evaluación anatómica y funcional en una cohorte retrospectiva. [Slipped capital femoral epiphysis >30º. Modified Dunn procedure. Anatomical and functional evaluation in a retrospective cohort]. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 78(4), 199-209. https://doi.org/10.15417/239
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Investigación Clínica
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Citas
1. Carney BT, Weinstein SL, Noble J. Long-term follow-up of slipped capital femoral epiphysis. J Bone Joint Surg Am 1991;73:667-74.
2. Engelhardt P. Juvenile Huftkopflosung und Koxarthrose, Stuttgart: EnkeVerlag; 1984.
3. Bellemans J, Fabry G, Molenaers G, Lammens J, Moens P. Slipped capital femoral epiphysis: a long-term follow-up, with special emphasis on the capacities for remodeling. J Pediatr Orthop Br 1996;5:151-7.
4. Jones JR, Paterson DC, Hillier TM, Foster BK. Remodeling after pinning for slipped capital femoral epiphysis. J Bone Joint Surg Br 1990;72:568-73.
5. Sucato DJ, Podeszwa DA. Surgical dislocation with open reduction and internal fixation for unstable slipped capital femoral epiphysis: early promising results. Annual Meeting of the Pediatric Orthopaedic Society of North America; Hollywood, FL. 2007.
6. Siegel DB, Kasser JR, Sponseller P, Gelberman RH. Slipped capital femoral epiphysis. A quantitative analysis of motion, gait, and femoral remodeling after in situ fixation. J Bone Joint Surg Am 1991;73:659-66.
7. Spencer S, Millis MB, Kim YJ. Early results of treatment of hip impingement syndrome in slipped capital femoral epiphysis and pistol grip deformity of the femoral head-neck junction using the surgical dislocation technique. J Pediatr Orthop 2006;26:281-5.
8. Sink EL, Zaltz I, Heare T, Dayton M. Acetabular cartilage and labral damage observed during surgical hip dislocation for stable slipped capital femoral epiphysis. J Pediatr Orthop 2010;30:26-30.
9. Leunig M, Huff TW, Ganz R. Femoroacetabular impingement: treatment of the acetabular side. Instr Course Lect 2009;58:223-9.
10. Leunig M, Casillas MM, Hamlet M, Hersche O, Notzli H, SlongoT, et al. Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand 2000;71:370-5.
11. Fish JB. Cuneiform osteotomy of the femoral neck in the treatment of slipped capital femoral epiphysis. J Bone Joint Surg Am 1984;66:1153-68.
12. Martin P. Slipped capital femoral epiphysis in the adolescent hip: a reconsideration of open reduction. J Bone Joint Surg Am 1948;30:9-19.
13. Gautier E, Ganz K, Krugel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br 2000;82:679-83.
14. Pearl AJ, Woodward B, Kellyr P. Cuneiform osteotomy in the treatment of slipped capital femoral epiphysis. J Bone Joint Surg Am 1961;43:947-54.
15. Barmada R, Bruch RF, Gimbel JS, Ray RD. Base of the neck extracapsular osteotomy for correction of deformity in slipped capital femoral epiphysis. Clin Orthop Relat Res 1978;132:98-101.
16. Kramer WG, Craig WA, Noel S. Compensating osteotomy at the base of the femoral neck for slipped capital femoral epiphysis. J Bone Joint Surg Am 1976;58:796-800.
17. Sugioka Y. Transtrochanteric Rotational Osteotomy of the Femoral Head, St Louis, MO: CV Mosby; 1980.
18. Müller M. Die huftnahen Osteotomien, Stuttgart, Germany: ThiemeVerlag; 1971.
19. Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am 1967;49:807-35.
20. Dunn DM. The treatment of adolescent slipping of the upper femoral epiphysis. J Bone Joint Surg Br 1964;46:621-9.
21. Ballmer PM, Gilg M, Aebi B, Ganz R. Results following subcapital and Imhauser-Weber osteotomy in femur head epiphyseolysis [in German]. Z Orthop Ihre Grenzgeb 1990;128:63-6.
22. Gage JR, Sundberg AB, Nolan DR, Sletten RG, Winter RB. Complications after cuneiform osteotomy for moderately or severely slipped capital femoral epiphysis. J Bone Joint Surg Am 1978;60:157-65.
23. Lefort G, Cottalorda J, Bouche-Pillon MA, Lefebvre F, Daoud S. Open reduction by the Dunn technique in upper femoral epiphysiolysis. Report of 14 cases [in French]. Chir Pediatr 1990;31:229-34.
24. Martin T, Fayad F. Severe upper femoral epiphysiolysis. Invasive reduction by Dunn’s technique: 11 cases [in French]. Rev Chir Orthop Reparatrice Appar Mot 1986;72:587-98.
25. Merle d’Aubigne R, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 1954;36:451-75.
26. Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD. Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am 1993;75:1134-40.
27. Mullins MM, Sood M, Hashemi-Nejad A, Catterall A. The management of avascular necrosis after slipped capital femoral epiphysis. J Bone Joint Surg Br 2005;87:1669-74.
28. Rab GT. The geometry of slipped capital femoral epiphysis: Implications for movement, impingement, and corrective osteotomy. J Pediatr Orthop 1999;19:419-24.
29. Goodman DA, Feighan JE, Smith AD, Latimer B, Buly RL, Cooperman DR. Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip. J Bone Joint Surg Am 1997;79:1489-97.
30. Aronsson DD, Loder RT, Breur GJ, Weinstein SL. Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg 2006;14:666-79.
31. O’Brien ET, Fahey JJ. Remodeling of the femoral neck after in situ pinning for slipped capital femoral epiphysis. J Bone Joint Surg Am 1977;59:62-8.
32. Szypryt EP, Clement DA, Colton CL. Open reduction or epiphysiodesis for slipped upper femoral epiphysis. A comparison of Dunn’s operation and the Heyman-Herndon procedure. J Bone Joint Surg Br 1987;69:737-42.
33. Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 2001;83:1119-24.
34. Leunig M, Slongo T, Kleinschmidt M, Ganz R. Subcapital correction osteotomy in slipped capital femoral epiphysis by means of surgical hip dislocation. Oper Orthop Traumatol 2007;19:389-410.
35. Loder RT. Unstable slipped capital femoral epiphysis. J Pediatr Orthop 2001;21:694-9. 36. Diab M, Hresko MT, Millis MB. Intertrochanteric versus subcapital osteotomy in slipped capital femoral epiphysis. Clin Orthop Relat Res 2004;427:204-12.
37. Waldenström H. On necrosis of the joint cartilage by epiphyseolysis capitis femoris. Acta Chir Scand 1930;67:936-46.
38. Allena LA, Sucato DJ. Unstable slipped capital femoral epiphysis. Current Orthopaedic Practice 2009;20(2):175-79.
39. 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;92:2898-908.
40. Sung Jin Shin, Hong-SeokKwak, Tae-Joon Cho, Moon Seok Park, Won Joon Yoo, Chin Youb Chung, et al. Application of Ganz surgical hip dislocation approach in pediatric hip diseases. Clin Orthop Surg 2009;1:132-137.
41. Ganz R, Huff T, Leunig M. Extended retinacular soft tissue flap for intraarticular surgery of the hip. Operative technique, indications and results of its application. Instr Course Lect 2009;58:241-55.
42. Ministerio de Salud. Guía Clínica Endoprótesis Total de Cadera en personas de 65 años y más con Artrosis de Cadera con Limitación
Funcional Severa, Santiago: Minsal, 2005.
43. Navarro Collado MJ, Peiró Moreno S, Ruiz Jareño L, Payá Rubio A, Hervás Juan MT, López Matéu P. Validity of the Harris hip score in rehabilitation after hip arthroplasty. Rehabilitación (Madr) 2005;39(4):147-54.
44. Clohisy JC, Carlisle JC, Beaulé PE, Kim YJ, Trousdale RT, Sierra RJ, et al. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am 2008;90(Suppl 4):47-66.
45. Gautier E, Ganz K, Krügel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br 2000;82(5):679-83.
46. Herrera-Soto JA, Duffy MF, Birnbaum MA, Vander Have KL. Increased intracapsular pressures after unstable slipped capital femoral epiphysis. J Pediatr Orthop 2008;28:723-8.
47. Ziebarth K, Zilkens C, Spencer S, Leunig M, Ganz R, Kim YJ. Capital realignment for moderate and severe SCFE using a modified Dunn procedure. Clin Orthop Relat Res 2009;467:704-16.
48. Parsch K, Weller S, Parsch D. Open reduction and smooth Kirschner wire fixation for unstable slipped capital femoral epiphysis. J Pediatr Orthop 2009;29:1-8.
2. Engelhardt P. Juvenile Huftkopflosung und Koxarthrose, Stuttgart: EnkeVerlag; 1984.
3. Bellemans J, Fabry G, Molenaers G, Lammens J, Moens P. Slipped capital femoral epiphysis: a long-term follow-up, with special emphasis on the capacities for remodeling. J Pediatr Orthop Br 1996;5:151-7.
4. Jones JR, Paterson DC, Hillier TM, Foster BK. Remodeling after pinning for slipped capital femoral epiphysis. J Bone Joint Surg Br 1990;72:568-73.
5. Sucato DJ, Podeszwa DA. Surgical dislocation with open reduction and internal fixation for unstable slipped capital femoral epiphysis: early promising results. Annual Meeting of the Pediatric Orthopaedic Society of North America; Hollywood, FL. 2007.
6. Siegel DB, Kasser JR, Sponseller P, Gelberman RH. Slipped capital femoral epiphysis. A quantitative analysis of motion, gait, and femoral remodeling after in situ fixation. J Bone Joint Surg Am 1991;73:659-66.
7. Spencer S, Millis MB, Kim YJ. Early results of treatment of hip impingement syndrome in slipped capital femoral epiphysis and pistol grip deformity of the femoral head-neck junction using the surgical dislocation technique. J Pediatr Orthop 2006;26:281-5.
8. Sink EL, Zaltz I, Heare T, Dayton M. Acetabular cartilage and labral damage observed during surgical hip dislocation for stable slipped capital femoral epiphysis. J Pediatr Orthop 2010;30:26-30.
9. Leunig M, Huff TW, Ganz R. Femoroacetabular impingement: treatment of the acetabular side. Instr Course Lect 2009;58:223-9.
10. Leunig M, Casillas MM, Hamlet M, Hersche O, Notzli H, SlongoT, et al. Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand 2000;71:370-5.
11. Fish JB. Cuneiform osteotomy of the femoral neck in the treatment of slipped capital femoral epiphysis. J Bone Joint Surg Am 1984;66:1153-68.
12. Martin P. Slipped capital femoral epiphysis in the adolescent hip: a reconsideration of open reduction. J Bone Joint Surg Am 1948;30:9-19.
13. Gautier E, Ganz K, Krugel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br 2000;82:679-83.
14. Pearl AJ, Woodward B, Kellyr P. Cuneiform osteotomy in the treatment of slipped capital femoral epiphysis. J Bone Joint Surg Am 1961;43:947-54.
15. Barmada R, Bruch RF, Gimbel JS, Ray RD. Base of the neck extracapsular osteotomy for correction of deformity in slipped capital femoral epiphysis. Clin Orthop Relat Res 1978;132:98-101.
16. Kramer WG, Craig WA, Noel S. Compensating osteotomy at the base of the femoral neck for slipped capital femoral epiphysis. J Bone Joint Surg Am 1976;58:796-800.
17. Sugioka Y. Transtrochanteric Rotational Osteotomy of the Femoral Head, St Louis, MO: CV Mosby; 1980.
18. Müller M. Die huftnahen Osteotomien, Stuttgart, Germany: ThiemeVerlag; 1971.
19. Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am 1967;49:807-35.
20. Dunn DM. The treatment of adolescent slipping of the upper femoral epiphysis. J Bone Joint Surg Br 1964;46:621-9.
21. Ballmer PM, Gilg M, Aebi B, Ganz R. Results following subcapital and Imhauser-Weber osteotomy in femur head epiphyseolysis [in German]. Z Orthop Ihre Grenzgeb 1990;128:63-6.
22. Gage JR, Sundberg AB, Nolan DR, Sletten RG, Winter RB. Complications after cuneiform osteotomy for moderately or severely slipped capital femoral epiphysis. J Bone Joint Surg Am 1978;60:157-65.
23. Lefort G, Cottalorda J, Bouche-Pillon MA, Lefebvre F, Daoud S. Open reduction by the Dunn technique in upper femoral epiphysiolysis. Report of 14 cases [in French]. Chir Pediatr 1990;31:229-34.
24. Martin T, Fayad F. Severe upper femoral epiphysiolysis. Invasive reduction by Dunn’s technique: 11 cases [in French]. Rev Chir Orthop Reparatrice Appar Mot 1986;72:587-98.
25. Merle d’Aubigne R, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 1954;36:451-75.
26. Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD. Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am 1993;75:1134-40.
27. Mullins MM, Sood M, Hashemi-Nejad A, Catterall A. The management of avascular necrosis after slipped capital femoral epiphysis. J Bone Joint Surg Br 2005;87:1669-74.
28. Rab GT. The geometry of slipped capital femoral epiphysis: Implications for movement, impingement, and corrective osteotomy. J Pediatr Orthop 1999;19:419-24.
29. Goodman DA, Feighan JE, Smith AD, Latimer B, Buly RL, Cooperman DR. Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip. J Bone Joint Surg Am 1997;79:1489-97.
30. Aronsson DD, Loder RT, Breur GJ, Weinstein SL. Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg 2006;14:666-79.
31. O’Brien ET, Fahey JJ. Remodeling of the femoral neck after in situ pinning for slipped capital femoral epiphysis. J Bone Joint Surg Am 1977;59:62-8.
32. Szypryt EP, Clement DA, Colton CL. Open reduction or epiphysiodesis for slipped upper femoral epiphysis. A comparison of Dunn’s operation and the Heyman-Herndon procedure. J Bone Joint Surg Br 1987;69:737-42.
33. Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 2001;83:1119-24.
34. Leunig M, Slongo T, Kleinschmidt M, Ganz R. Subcapital correction osteotomy in slipped capital femoral epiphysis by means of surgical hip dislocation. Oper Orthop Traumatol 2007;19:389-410.
35. Loder RT. Unstable slipped capital femoral epiphysis. J Pediatr Orthop 2001;21:694-9. 36. Diab M, Hresko MT, Millis MB. Intertrochanteric versus subcapital osteotomy in slipped capital femoral epiphysis. Clin Orthop Relat Res 2004;427:204-12.
37. Waldenström H. On necrosis of the joint cartilage by epiphyseolysis capitis femoris. Acta Chir Scand 1930;67:936-46.
38. Allena LA, Sucato DJ. Unstable slipped capital femoral epiphysis. Current Orthopaedic Practice 2009;20(2):175-79.
39. 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;92:2898-908.
40. Sung Jin Shin, Hong-SeokKwak, Tae-Joon Cho, Moon Seok Park, Won Joon Yoo, Chin Youb Chung, et al. Application of Ganz surgical hip dislocation approach in pediatric hip diseases. Clin Orthop Surg 2009;1:132-137.
41. Ganz R, Huff T, Leunig M. Extended retinacular soft tissue flap for intraarticular surgery of the hip. Operative technique, indications and results of its application. Instr Course Lect 2009;58:241-55.
42. Ministerio de Salud. Guía Clínica Endoprótesis Total de Cadera en personas de 65 años y más con Artrosis de Cadera con Limitación
Funcional Severa, Santiago: Minsal, 2005.
43. Navarro Collado MJ, Peiró Moreno S, Ruiz Jareño L, Payá Rubio A, Hervás Juan MT, López Matéu P. Validity of the Harris hip score in rehabilitation after hip arthroplasty. Rehabilitación (Madr) 2005;39(4):147-54.
44. Clohisy JC, Carlisle JC, Beaulé PE, Kim YJ, Trousdale RT, Sierra RJ, et al. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am 2008;90(Suppl 4):47-66.
45. Gautier E, Ganz K, Krügel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br 2000;82(5):679-83.
46. Herrera-Soto JA, Duffy MF, Birnbaum MA, Vander Have KL. Increased intracapsular pressures after unstable slipped capital femoral epiphysis. J Pediatr Orthop 2008;28:723-8.
47. Ziebarth K, Zilkens C, Spencer S, Leunig M, Ganz R, Kim YJ. Capital realignment for moderate and severe SCFE using a modified Dunn procedure. Clin Orthop Relat Res 2009;467:704-16.
48. Parsch K, Weller S, Parsch D. Open reduction and smooth Kirschner wire fixation for unstable slipped capital femoral epiphysis. J Pediatr Orthop 2009;29:1-8.