摘要:

Fifty-one patients with unilateral severe (gliding angles 30°-60°) slipped capital femoral epiphysis (SCFE) treated by intertrochanteric corrective osteotomy were reexamined after 20–29 years (average 24 years) of follow-up; 55% of the patients showed neither radiographic signs of degenerative hip disease nor clinical symptoms, whereas 28% had moderate and 17% had severe osteoarthritis. These results are definitely superior to those reported in other series of patients with comparable slips treated by bed rest or in situ fixation only. Analysis of individual gliding angles and directions of the slips shows that results can probably be further improved by correct assessment of the gliding process to allow for best use of the potentials of intertrochanteric corrective osteotomies. Correction should also be performed as early as possible to allow for maximum remodeling.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The range of hip motion in 128 hips of 108 patients was measured at an average of 32.7 years after slipping of the capital femoral epiphysis (SCFE). Only hips without signs of osteoarthrosis were selected for the study. The hips were divided into three groups depending on treatment (i.e., fixation in situ, no treatment, osteotomy) and compared with those of a group with no slipping (normal hip). The slipping angle (SA) between the basis of the epiphysis and the perpendicular to the anteversion plane on lateral radiographs and the slope (S) between the basis of the epiphysis and the perpendicular to the axis of the femur on anteroposterior (AP) radiographs were measured. The only significant loss of hip motion evident in comparison of normal hips and hips with previous SCFE, was loss of external rotation in hips treated with osteotomy. Hips with no treatment and hips treated with fixation in situ showed no significant loss of hip motion as compared with normal hips. The greatest loss of hip motion in hips treated with fixation in situ was loss of internal rotation (LIR), which can be calculated using the radiographs as sin LIR = sin SA*sin S. The average difference between clinically established and calculated LIR was 1.15o. We conclude that the loss of hip motion after SCFE is slight and in most patients not clinically relevant. Therefore, early surgical intervention, e.g., femoral osteotomy, due to expected loss of hip motion cannot be justified.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We reviewed 59 hips in 44 children with slipped capital femoral epiphysis (SCFE), all treated by in situ pinning. The average clinical and radiographic follow-up was 11.4 years. Fifty-three hips (90%) were rated as either excellent or good. Osteonecrosis or chondroly-sis developed in five patients. Postoperative remodeling was noted, not only by a process of local resorption and apposition of bone, but also by correction of the disturbed anatomic axes, in proportion to the severity of the slip, together with global thickening of the femoral neck. We believe that the good long-term results after in situ pinning are the consequence of this important remodeling process.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The risk of contralateral slipping in slipped capital femoral epiphysis (SCFE) has been estimated to be 40–80% in follow-up examinations. Before age 50 years, 25% of the contralateral hips with untreated slipping showed arthrosis, some severe. In the same long-term follow-up, no hip with mild or moderate slipping treated with pinning in situ had developed severe arthrosis at that age, indicating the risk of arthrosis in the contralateral hip in SCFE can be reduced by prophylactic pinning. Prophylactic pinning also diminishes the need for repeated radiographical examination during the remaining growth period. Provided that a technique with a low complication rate is used, prophylactic pinning of the contralateral hip is recommended in all cases of SCFE.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Chondrolysis and avascular necrosis (AVN) are serious complications after slipped capital femoral epiphysis (SCFE). Chondrolysis, or acute cartilage necrosis of the capital femoral epiphysis, can occur in treated and untreated SCFE. Its exact etiology has not been conclusively determined, and there may be some connection with hardware penetration into the joint and its development. Because chondrolysis can occur in both treated and untreated hips, an immune mechanism has been postulated. Although some evidence of immune reaction has been confirmed in the joint, no screening test has yet been developed to determine susceptible individuals. AVN is clearly related to impeded blood supply to the femoral head and to severely slipped unstable acute slips. Forceful reduction of the femoral head must be avoided. However, some slips are so unstable that reductions occur merely with positioning of the patient for operation. Improperly placed fixation devices may also play a role in the development of AVN. Chondrolysis and AVN may not be completely avoidable in the treatment of SCFE.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Chondrolysis, or acute cartilage necrosis, is a controversial and perplexing complication of slipped capital femoral epiphysis (SCFE) in adolescents. It usually leads to deformity, pain, limping, and limitation of motion in the affected extremity. Although several theories have been proposed, no agreement has been reached as to the etiology or the pathogenesis of chondrolysis. Furthermore, no treatment program has been completely successful, and the general prognosis and natural history of this condition are not clear. An overview of the latest knowledge of the matter is presented.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The efficacy of orthopaedic treatment and its influence on clubfoot surgery has never been truly demonstrated. In the unsorted mass of clubfeet treated, it is difficult to determine exactly how effective orthopaedic treatment is for severely affected feet. If properly performed, perfectly synchronized, and supported by a Kinetec machine, such treatment can noticeably reduce the rate of operation and, when operation is still required, reduce its extent. In grade II soft > stiff feet with scores of 5–10, Kinetec-supported orthopaedic treatment is extremely effective. Operation is required in 32% of cases only, and posterior surgery is often sufficient. Lateral release, in this category, is never required. In grade III stiff > soft feet, with scores of 10–15, the efficacy of orthopaedic treatment associated with the Kinetec machine is far from negligible and operation most often includes posterior and medial release (PMR), variably associated with plantar release. Lateral release is exceptional (15%), and operation is necessary in 75% of cases. In grade IV stiff = stiff feet, with scores of 15–20, orthopaedic treatment with the Kinetec machine has a true, though limited, effect. In this category, operation is necessary in 90% of cases. Lateral release is performed in 50%. In the postoperative period, orthopaedic treatment combined with use of the Kinetic machine must be continued. Orthopaedic treatment coordinated with use of the machine has considerably shortened the duration of plaster cast immobilization: 2 months when operation included posterolateral-medial (PLMR) release or PMR, and only 1 month when operation was posterior release (PR). The machine has noticeably changed the results and has indisputably influenced operation on the whole.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Growth in 110 children with Legg-Calvé-Perthes' disease (LCPD) was longitudinally followed throughout the growth period. The infancy childhood puberty (ICP) growth model, which has the advantage that reference values can be adjusted for the individual age at pubertal maturation, was used. On the average, the children were slightly shorter at birth and they remained short throughout the entire growth period to maturity. At maturity, the boys were 4.4 cm and the girls were 2.5 cm below the reference mean. The growth velocity was normal at the time of diagnosis, prepubertally, and during puberty. Boys and girls differed only in that the boys were more overweight.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Eleven articles reporting 39 patients with the combination of progressive scoliosis and familial congenital gaze palsy have now been published. This disorder appears to be caused by a malfunction of the normal equilibrial control mechanism related to the brainstem or the central nervous system. The scoliosis progresses when the children begin to walk. Even when they are treated with physiotherapy or brace, they often require early operation. We consider that progressive juvenile or infant scoliosis associated with familiar congenital horizontal gaze palsy constitutes a clinical entity. We report two sisters with congenital gaze palsy, in one of whom scoliosis of at least 70° (Cobb) developed, and review and analyze all cases published until now.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The radiological and clinical results in 27 patients operated on for severe isthmic spondylolisthesis at age < 20 years with uninstrumented anterior interbody fusion alone in 11 or combined anterior and posterolateral (circumferential) fusion in 16 are reported. The mean follow-up time was 5.9 ± 2.4 years. The two groups were comparable with regard to age at operation, sex, preoperative symptoms, mean preoperative slip and sagittal rotation angle. The follow-up assessment, made by an independent observer, included interview, Oswestry disability index, physical examination, functional tests, and plain radiographs. At follow-up, there were no statistical differences between the groups in subjective, clinical, and functional outcomes. Follow-up radiographs showed no progression of slip in either group. The sagittal rotation angle worsened slightly in the anterior fusion group but improved by 5.8° (p < 0.001) on the average in the combined fusion group. There were no instances of pseudarthrosis. Two patients, one in each group, were reoperated on early for postoperative peroneal weakness; both recovered. The clinical and functional results were satisfactory in most cases. The radiological results concerning the sagittal rotation angle were superior in the combined fusion group, but whether this will affect the long-term clinical result is not known.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID