Cristiano COPPOLA, Francesco SADİLE, Francesco M. LOTITO, Fabrizio CIGALA, Chezhiyan SHANMUGAM, Nicola MAFFULLI

Stabil femur başı epifiz kaymasında Southwick osteotomisi: Uzun dönem sonuçlar

Amaç: Orta dereceden ileri dereceye kadar olan kronik stabil femur başı epifiz kayması (FBEK) femur başında ve asetabulumda kalıcı bozukluklara neden olur. Bu yazıda, femur başında düzensizliğin de eşlik ettiği, stabil kronik orta veya ileri derecede FBEK için yapılan Southwick işleminin tekmerkezli uzun dönem sonuçları sunuldu. Çalışma planı: Ocak 1978 - Ocak 1990 tarihleri arasında, büyüme plağı kapalı ya da yarı kapalı, kayma miktarı 30°-70° arasında olan kronik stabil FBEK’li 20 hastaya (16 kız, 4 erkek; ort. yaş 13; dağılım 11-15) 22 Southwick osteotomisi uygulandı. Osteotomilerin hepsi aynı cerrah tarafından yapıldı. Hastaların ortalama takip süresi 22 yıl (dağılım 16-28 yıl) idi. Sonuçlar: Eksternal rotasyon deformitesi düzeltildi ve Trendelenburg bulgusu ameliyattan altı ay sonra tüm hastalarda neredeyse tamamen kayboldu. Radyografik olarak tüm hastalarda ameliyattan sonraki iki ay içinde osteotomi bölgesinde tam kaynama sağlandı. Hiçbir hastada epifizyel kayma görülmedi. Enfeksiyon ya da avasküler nekroza rastlanmadı. Sadece bir hastada sekiz ay içinde tamamen iyileşen kondroliz görüldü. Son kontrollerde ekstremite uzunluğu 18 hastada eşitti. İki hastada ortalama 0.8 cm kısalık görüldü. Sekiz hastada (%36.4) dejeneratif eklem hastalığına ilişkin radyografik bulgu saptandı, bunlardan hiçbiri semptomatik değildi. Çıkarımlar: Orta-ileri derecede FBEK’nin Southwick osteotomisi ile tedavisi güvenli, fakat teknik olarak zor bir yöntemdir. Komplikasyon oranı düşüktür ve iyi ve öngörülebilir bir sonuç sağlar.

Anahtar Kelimeler:

Osteotomi, Femur başı, Femur başı nekrozu, Tekrarlama, Kalça eklemi, Tedavi sonucu, İzleme çalışmaları, Asetabulum, Epifiz kayması, Zaman faktörleri

Southwick osteotomy in stable slipped capital femoral epiphysis: A long-term outcome study

Objectives: Moderate to severe chronic stable slipped capital femoral epiphysis (SCFE) produce permanent irregularities in the femoral head and acetabulum. We report a single centre long-term outcome study of Southwick’s procedure for the management of moderate or severe stable chronic SCFE with irregularity of the femoral head. Methods: In the period from January 1978 to January 1990, 20 patients (16 girls, 4 boys; mean age 13 years; range 11 to 15 years) underwent 22 Southwick osteotomies for chronic stable SCFE with closure or partial closure of the growth plate and a slip between 30° and 70°. All osteotomies were performed by the same surgeon. Patients were followed-up for an average of 22 years (range 16 to 28 years). Results: External rotation deformity was corrected, and the Trendelenburg sign was hardly observable in any of the patients from six months of surgery. Radiographically, all patients showed full consolidation of the osteotomy within two months of surgery. There was no further epiphyseal slipping. We did not encounter any infection or avascular necrosis. Only one patient developed chondrolysis, which resolved fully in eight months. At the latest follow-up, no limb length discrepancy was seen in 18 patients, while two patients had a mean of 0.8 cm shortening. Eight patients (36.4%) showed radiographic evidence for degenerative joint disease, but none were symptomatic. Conclusion: The management of chronic stable (moderate to severe) SCFE by Southwick’s osteotomy is safe, but technically demanding. It affords good predictable outcome with a low complication rate.

Keywords:

Osteotomy Femur Head, Femur Head Necrosis, Recurrence, Hip Joint, Treatment Outcome, Follow-Up Studies, Acetabulum, Epiphyses, Slipped, Time Factors,

___

1. 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.
2. Carney BT, Weinstein SL, Noble J. Long-term follow-up of slipped capital femoral epiphysis. J Bone Joint Surg [Am] 1991;73:667-74.
3. Cigala F, Sadile F. Southwick’s osteotomy in the treatment of chronic slipped upper femoral epiphysis. Fixation with AO blade plate. Ital J Orthop Traumatol 1984;10:461-8.
4 Cigala F, Sadile F. Southwick’s osteotomy in the treatment of chronic slipped upper femoral epiphysis: fixation with AO blade-plate. Adv Orthop Surg 1985;9:108-11.
5. Ogden JA, Simon TR, Southwick WO. Cartilage space width in slipped capital femoral epiphysis: the relationship to cartilage necrosis. Yale J Biol Med 1977;50:17-30.
6. Ireland J, Newman PH. Triplane osteotomy for severely slipped upper femoral epiphysis. J Bone Joint Surg [Br] 1978;60:390-3.
7. Muller ME, Allgower M, Schneider R, Willenegger H, editors. Fratture prossimali del femore. In: Manuale dell’Osteosintesi. Tecniche raccomandate dal gruppo AO. 3rd ed. Berlin: Springer-Verlag; 1993. p. 145-92.
8. Arnold P, Jani L, Scheller G, Herrwerth V. Results of treating slipped capital femoral epiphysis by pinning in situ. [Article in German] Orthopade 2002;31:880-7.
9. Diab M, Daluvoy S, Snyder BD, Kasser JR. Osteotomy does not improve early outcome after slipped capital femoral epiphysis. J Pediatr Orthop B 2006;15:87-92.
10. Cullu E, Damgaci K, Savk SO. In situ pinning on slipped femoral capital epiphysis with a single cannulated screw. [Article in Turkish] Ulus Travma Acil Cerrahi Derg 2005;11:212-7.
11. Gicquel P, Giacomelli MC, Karger C, Clavert JM. The limping child with a painful hip. [Article in French] Rev Prat 2006;56:172-8.
12. Sibinski M, Synder M, Borowski A, Grzegorzewski A. Remodeling after in situ pinning for slipped capital femoral epiphysis. [Article in Polish] Chir Narzadow Ruchu Ortop Pol 2004;69:321-4.
13. Adamczyk MJ, Weiner DS, Hawk D. A 50-year experience with bone graft epiphysiodesis in the treatment of slipped capital femoral epiphysis. J Pediatr Orthop 2003;23:578-83.
14. Schmidt TL, Cimino WG, Seidel FG. Allograft epiphysiodesis for slipped capital femoral epiphysis. Clin Orthop Relat Res 1996;(322):61-76.
15. Maussen JP, Rozing PM, Obermann WR. Intertrochanteric corrective osteotomy in slipped capital femoral epiphysis. A long-term follow-up study of 26 patients. Clin Orthop Relat Res 1990;(259):100-10.
16. Rao JP, Francis AM, Siwek CW. The treatment of chronic slipped capital femoral epiphysis by biplane osteotomy. J Bone Joint Surg [Am] 1984;66:1169-75.
17. Southwick WO. Compression fixation after biplane intertrochanteric osteotomy for slipped capital femoral epiphysis. A technical improvement. J Bone Joint Surg [Am] 1973;55:1218-24.
18. Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg [Am] 1967;49:807-35.
19. Southwick WO. Slipped capital femoral epiphysis. J Bone Joint Surg [Am] 1984;66:1151-2.
20. El-Mowafi H, El-Adl G, El-Lakkany MR. Extracapsular base of neck osteotomy versus Southwick osteotomy in treatment of moderate to severe chronic slipped capital femoral epiphysis. J Pediatr Orthop 2005;25:171-7.
21. Seller K, Wild A, Westhoff B, Raab P, Krauspe R. Radiological evaluation of unstable (acute) slipped capital femoral epiphysis treated by pinning with Kirschner wires. J Pediatr Orthop B 2006;15:328-34.
22. 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;62:561-70.
23. Jofe MH, Lehman W, Ehrlich MG. Chondrolysis following slipped capital femoral epiphysis. J Pediatr Orthop B 2004;13:29-31.
24. Judet J, Judet R, Guignard J. Coxa vara in adolescents. Treatment and results. [Article in French] Rev Chir Orthop 1961;47:138-55.