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Femur Başı Epifiz Kaymasında Tedavi Yaşının Kötü Sonuç ile İlişkisi

Yıl 2021, Cilt: 5 Sayı: 1, 75 - 80, 23.04.2021
https://doi.org/10.30565/medalanya.838843

Öz

Amaç; Femur başı epifiz kayması (FBEK), femur başı epifizinin femur boynundan kayması ile karakterize bir adolesan dönem hastalığıdır. Bu çalışmada amaç; FBEK tanısı almış hastaların cerrahi tedavi sonuçlarını klinik ve radyolojik olarak inceleyerek klinik sonuca etki eden faktörleri değerlendirmektir.


Yöntem; 2015-2019 tarihleri arasında polikliniğe başvuran, FBEK tanısı ile cerrahi tedavi uygulanan ve en az takip süresi bir yıl olan hastalar çalışmaya alındı. 7 erkek ve 4 kız toplam 11 hasta, ortalama 27 ay (12-47) takip edildi. Southwick yöntemi ile kayma miktarı ölçüldü. Preoperatif dönemde ve postoperatif dönemde kalça klinik değerlendirmesi Heyman ve Herndon Sınıflaması kullanılarak yapıldı.


Bulgular; Hastaların yaş ortalaması 12,45(10-14) idi. Peroperatif dönemde hastaların VKİ ortalaması 26,15(20,45-32,34) kg/cm2 olarak ölçüldü. Etkilenen kalçaların yan grafileri çekildi ve Southwick değerleri ortalama 45,490(24,30-65,70) olarak ölçüldü. Klinik olarak Heyman ve Herndon sınıflaması iki grupta değerlendirildi. Birinci grup ile ikinci grup arasında cinsiyet, taraf, VKİ, Southwick değeri, ilk semptom ile başvuru arası süre ve de başvuru ile tanı arasında geçen süre ile ilişkili anlamlı bir fark tespit edilmedi. Postoperatif Heyman ve Herndon sınıflaması mükemmel ve iyi olarak değerlendirilen birinci grubun yaş ortalaması, orta ve kötü olan ikinci gruba göre istatistiksel olarak daha küçüktü (p=0.016).Ayrıca tedavi edilen hiçbir hastada klinik skor olumsuz yönde değişim gözlenmezken 6 hastada iyileşme gözlendi ve preoperatif skor postoperatif değerlendirmeye göre anlamlı olarak artmış olduğu tespit edildi (p=0.014).

Sonuç; FBEK olan hastalarda tek kanüllü vida ile olduğu pozisyonda tespit ve erken cerrahi tedavi iyi klinik sonuçların elde edilmesinde önemli iki faktördür. Daha büyük yaşta FBEK tanısı konan hastaların da kötü klinik sonuçlar ile birlikte olabileceği öngörülebilir.

Kaynakça

  • 1. Fedorak GT, DeRosa DC, Brough AK, Miyamoto RH. Increased time between diagnosis and surgery in slipped capital femoral epiphysis results in increased radiographic deformity. J Pediatr Orthop B. 2018;12(3):232-35. doi:10.1302/1863-2548.12.170178.
  • 2. Canale ST. Fractures and dislocation in children. In: Canale ST, ed. Campbell’s Operative Orthopaedics, 10th ed. St Louis: Mosby; 1998:1481-83. eBook ISBN: 9780323091367
  • 3. Kocher MS, Bishop JA, Weed B, Hresko MT, Millis MB, Kim YJ, et al. Delay in diagnosis of slipped capital femoral epiphysis. Pediatrics. 2004;113(4):e322-5. doi: 10.1542/peds.113.4.e322.
  • 4. Hall JE. The results of treatment of slipped femoral epiphysis. J Bone Joint Surg [Br] 1957;39-B:659-73. doi: 10.1302/0301-620x.39b4.659
  • 5. Rahme D, Comley A, Foster B, Cundy P. Consequences of diagnostic delays in slipped capital femoral epiphysis. J Pediatr Orthop. 2006;15(2):93-7. doi: 10.1097/01.bpb.0000188251.24771.c9.
  • 6. Günaydın B, Taşkıran MC, Turgut A, In situ pinning of stable type mild and moderately slipped femoral capital epiphysis with single screw fixation. Med Bull Sisli Etfal Hosp. 2015;49(1):40-5. doi: 10.5350/SEMB.20140807081830
  • 7. Kay RM. Slipped capital femoral epiphysis. In: Lovell and Winter's Pediatric Orthopaedics, 6th, Morrissey RT, Weinstein SL (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1085. ISBN: 978-1-97-510866-3
  • 8. 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 Aug;75(8):1134-40. doi: 10.2106/00004623-199308000-00002.
  • 9. Aronson DD, Carlson WE. Slipped capital femoral epiphysis. A prospective study of fixation with a single screw. J Bone Joint Surg Am. 1992;74(6):810-9. Erratum in: J Bone Joint Surg Am 1992;74(8):1274. PMID: 1634571.
  • 10. Boero S, Brunenghi GM, Carbone M, Stella G, Calevo MG. Pinning in slipped capital femoral epiphysis: long-term follow-up study. J Pediatr Orthop B. 2003;12(6):372-9. doi: 10.1097/01.bpb.0000079202.23239.64.
  • 11. Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am. 1967;49(5):807-35. PMID: 6029256.
  • 12. Heyman CH, Herndon CH. Epiphy seodesis for early slipping of the upper femoral epiphysis. J Bone Joint Surg Am. 1954;36-A(3):539-55. PMID: 13163086.
  • 13. Moreira JF, Neves MC, Lopes G, Gomes AR. Slipped capital femoral epiphysis. A report of 4 cases occurring in one family. Int Orthop. 1998;22(3):193-6. doi: 10.1007/s002640050240.
  • 14. Poussa M, Schlenzka D, Yrjönen T. Body mass index and slipped capital femoral epiphysis. J Pediatr Orthop B. 2003;12(6):369-71. doi: 10.1097/01.bpb.0000079201.23239.bf.
  • 15. Cobanoglu M, Cullu E, Ozkan I. Femur başı epifizinin hafif veya orta şiddetli kaymasında tek vida ile olduğu pozisyonda tespit ne kadar etkilidir? [How effective is in situ pinning with single screw fixation in mildly or moderately slipped capital femoral epiphysis?]. Eklem Hastalik Cerrahisi. 2014;25(1):30-5. Turkish. doi: 10.5606/ehc.2014.07.
  • 16. Betz RR, Steel HH, Emper WD, Huss GK, Clancy M. Treatment of slipped capital femoral epiphysis. Spica-cast immobilization. J Bone Joint Surg Am. 1990;72(4):587-600. PMID: 2324147.
  • 17. Meier MC, Meyer LC, Ferguson RL. Treatment of slipped capital femoral epiphysis with a spica cast. J Bone Joint Surg Am. 1992;74(10):1522-9. PMID: 1469012.
  • 18. Boyer DW, Mickelson MR, Ponseti IV. Slipped capital femoral epiphysis. Long-term follow-up study of one hundred and twenty-one patients. J Bone Joint Surg Am. 1981;63(1):85-95. PMID: 7451529.
  • 19. Nonweiler B, Hoffer M, Weinert C, Rosenfeld S. Percutaneous in situ fixation of slipped capital femoral epiphysis using two threaded Steinmann pins. J Pediatr Orthop. 1996;16(1):56-60. doi: 10.1097/00004694-199601000-00011.
  • 20. Mooney JF 3rd, Sanders JO, Browne RH, Anderson DJ, Jofe M, Feldman D, et al. Management of unstable/acute slipped capital femoral epiphysis: results of a survey of the POSNA membership. J Pediatr Orthop. 2005;25(2):162-6. doi: 10.1097/01.bpo.0000151058.47109.fe.
  • 21. 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(5):578-83. doi: 10.1097/00004694-200309000-00003.
  • 22. Arnold P, Jani L, Soloniewicz A. Stellenwert und Ergebnisse der subkapitalen Osteotomie bei der Epiphyseolysis capitis femoris lenta mit hochgradigem Abrutsch der Epiphyse [Significance and results of subcapital osteotomy in severe slipped capital femoral epiphysis]. Orthopade. 2002 Sep;31(9):908-13. German. doi: 10.1007/s00132-002-0380-3.
  • 23. Günay H, Küçük L, Sözbilen MC, Bİçer EK, Çobanoğlu M. Does the number of engaged screw threads affect the stability of slipped capital femoral epiphysis in the in situ fixation? İzmir Dr. Behçet Uz Çocuk Hast. Dergisi 2017;7(1):39-44. doi: 10.5222/buchd.2017.039
  • 24. Cullu E, Damgaci K, Savk SO. Femur başi epifiz kaymasinda olduğu pozisyonda tek vida ile tespit [In situ pinning on slipped femoral capital epiphysis with a single cannulated screw]. Ulus Travma Acil Cerrahi Derg. 2005;11(3):212-7. Turkish. PMID: 16100666.
  • 25. Loder RT, Aronson DD, Greenfield ML. The epidemiology of bilateral slipped capital femoral epiphysis. A study of children in Michigan. J Bone Joint Surg Am. 1993;75(8):1141-7. doi: 10.2106/00004623-199308000-00003.
  • 26. Riad J, Bajelidze G, Gabos PG. Bilateral slipped capital femoral epiphysis: predictive factors for contralateral slip. J Pediatr Orthop. 2007;27(4):411-4. doi: 10.1097/01.bpb.0000271325.33739.86.
  • 27. Popejoy D, Emara K, Birch J. Prediction of contralateral slipped capital femoral epiphysis using the modified Oxford bone age score. J Pediatr Orthop. 2012;32(3):290-4. doi: 10.1097/BPO.0b013e3182471eb4.
  • 28. 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(8):1134-40. doi: 10.2106/00004623-199308000-00002.
  • 29. Aversano, M. W., Moazzaz, P., Scaduto, A. A., & Otsuka, N. Y. Association between body mass index-for-age and slipped capital femoral epiphysis: the long-term risk for subsequent slip in patients followed until physeal closure. Journal of children's orthopaedics, 2016;10(3):209–213. doi: 10.1007/s11832-016-0731-y.

Relationship between Treatment Age and Poor Outcome in Slipped Capital Femoral Epiphysis

Yıl 2021, Cilt: 5 Sayı: 1, 75 - 80, 23.04.2021
https://doi.org/10.30565/medalanya.838843

Öz

Aim; Slipped capital femoral epiphysis(SCFE) is an adolescent disease characterized by the slippage of the femoral head epiphysis from the femoral neck. The aim of this study is evaluate the factors affecting clinical outcome the surgical treatment of patients diagnosed with SCFE.


Methods; Patients who were admitted to the orthopedic outpatient clinic with the complaint of gait disturbance and underwent surgery with a diagnosis of SCFE and were followed for minimum one year were screened between January 2015 and December 2019. A total of 11 patients, 7 boys and 4 girls, included in the study, were followed mean 27 months (12-47). The degree of deviation was measured with Southwick's method. Both preoperative and postoperative hip clinical evaluation was performed using Heyman and Herndon Classification.


Results; The mean age of the patients was 12.45 (10-14). In the perioperative period, the mean BMI of the patients was measured as 26.15 (20.45-32.34) kg/cm2. Lateral radiographs of the affected hips were taken and measured using the Southwick method, and the mean angle was 45,490 (24,30-65,70). Heyman and Herndon classification was evaluated in two main groups clinically. There was no statistically significant difference between the first group and the second group in terms of gender, side, BMI, Southwick value, time between the first symptom and presentation, and the time between presentation and diagnosis. However, the mean age of the first group, whose postoperative Heyman and Herndon classification was evaluated as excellent and good, was statistically lower than the second group (p = 0.016). In addition, while no negative change was observed in the clinical score in any of the treated patients, improvement was observed in 6 patients and it was found that the preoperative score was significantly increased compared to the postoperative evaluation (p = 0.014).


Conclusion; In situ fixation with a single cannulated screw and early surgical treatment are two important factors in achieving good clinical results in patients with SCFE. It should be kept in mind that patients diagnosed with SCFE at an older age may also be associated with poor clinical results.

Kaynakça

  • 1. Fedorak GT, DeRosa DC, Brough AK, Miyamoto RH. Increased time between diagnosis and surgery in slipped capital femoral epiphysis results in increased radiographic deformity. J Pediatr Orthop B. 2018;12(3):232-35. doi:10.1302/1863-2548.12.170178.
  • 2. Canale ST. Fractures and dislocation in children. In: Canale ST, ed. Campbell’s Operative Orthopaedics, 10th ed. St Louis: Mosby; 1998:1481-83. eBook ISBN: 9780323091367
  • 3. Kocher MS, Bishop JA, Weed B, Hresko MT, Millis MB, Kim YJ, et al. Delay in diagnosis of slipped capital femoral epiphysis. Pediatrics. 2004;113(4):e322-5. doi: 10.1542/peds.113.4.e322.
  • 4. Hall JE. The results of treatment of slipped femoral epiphysis. J Bone Joint Surg [Br] 1957;39-B:659-73. doi: 10.1302/0301-620x.39b4.659
  • 5. Rahme D, Comley A, Foster B, Cundy P. Consequences of diagnostic delays in slipped capital femoral epiphysis. J Pediatr Orthop. 2006;15(2):93-7. doi: 10.1097/01.bpb.0000188251.24771.c9.
  • 6. Günaydın B, Taşkıran MC, Turgut A, In situ pinning of stable type mild and moderately slipped femoral capital epiphysis with single screw fixation. Med Bull Sisli Etfal Hosp. 2015;49(1):40-5. doi: 10.5350/SEMB.20140807081830
  • 7. Kay RM. Slipped capital femoral epiphysis. In: Lovell and Winter's Pediatric Orthopaedics, 6th, Morrissey RT, Weinstein SL (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1085. ISBN: 978-1-97-510866-3
  • 8. 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 Aug;75(8):1134-40. doi: 10.2106/00004623-199308000-00002.
  • 9. Aronson DD, Carlson WE. Slipped capital femoral epiphysis. A prospective study of fixation with a single screw. J Bone Joint Surg Am. 1992;74(6):810-9. Erratum in: J Bone Joint Surg Am 1992;74(8):1274. PMID: 1634571.
  • 10. Boero S, Brunenghi GM, Carbone M, Stella G, Calevo MG. Pinning in slipped capital femoral epiphysis: long-term follow-up study. J Pediatr Orthop B. 2003;12(6):372-9. doi: 10.1097/01.bpb.0000079202.23239.64.
  • 11. Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am. 1967;49(5):807-35. PMID: 6029256.
  • 12. Heyman CH, Herndon CH. Epiphy seodesis for early slipping of the upper femoral epiphysis. J Bone Joint Surg Am. 1954;36-A(3):539-55. PMID: 13163086.
  • 13. Moreira JF, Neves MC, Lopes G, Gomes AR. Slipped capital femoral epiphysis. A report of 4 cases occurring in one family. Int Orthop. 1998;22(3):193-6. doi: 10.1007/s002640050240.
  • 14. Poussa M, Schlenzka D, Yrjönen T. Body mass index and slipped capital femoral epiphysis. J Pediatr Orthop B. 2003;12(6):369-71. doi: 10.1097/01.bpb.0000079201.23239.bf.
  • 15. Cobanoglu M, Cullu E, Ozkan I. Femur başı epifizinin hafif veya orta şiddetli kaymasında tek vida ile olduğu pozisyonda tespit ne kadar etkilidir? [How effective is in situ pinning with single screw fixation in mildly or moderately slipped capital femoral epiphysis?]. Eklem Hastalik Cerrahisi. 2014;25(1):30-5. Turkish. doi: 10.5606/ehc.2014.07.
  • 16. Betz RR, Steel HH, Emper WD, Huss GK, Clancy M. Treatment of slipped capital femoral epiphysis. Spica-cast immobilization. J Bone Joint Surg Am. 1990;72(4):587-600. PMID: 2324147.
  • 17. Meier MC, Meyer LC, Ferguson RL. Treatment of slipped capital femoral epiphysis with a spica cast. J Bone Joint Surg Am. 1992;74(10):1522-9. PMID: 1469012.
  • 18. Boyer DW, Mickelson MR, Ponseti IV. Slipped capital femoral epiphysis. Long-term follow-up study of one hundred and twenty-one patients. J Bone Joint Surg Am. 1981;63(1):85-95. PMID: 7451529.
  • 19. Nonweiler B, Hoffer M, Weinert C, Rosenfeld S. Percutaneous in situ fixation of slipped capital femoral epiphysis using two threaded Steinmann pins. J Pediatr Orthop. 1996;16(1):56-60. doi: 10.1097/00004694-199601000-00011.
  • 20. Mooney JF 3rd, Sanders JO, Browne RH, Anderson DJ, Jofe M, Feldman D, et al. Management of unstable/acute slipped capital femoral epiphysis: results of a survey of the POSNA membership. J Pediatr Orthop. 2005;25(2):162-6. doi: 10.1097/01.bpo.0000151058.47109.fe.
  • 21. 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(5):578-83. doi: 10.1097/00004694-200309000-00003.
  • 22. Arnold P, Jani L, Soloniewicz A. Stellenwert und Ergebnisse der subkapitalen Osteotomie bei der Epiphyseolysis capitis femoris lenta mit hochgradigem Abrutsch der Epiphyse [Significance and results of subcapital osteotomy in severe slipped capital femoral epiphysis]. Orthopade. 2002 Sep;31(9):908-13. German. doi: 10.1007/s00132-002-0380-3.
  • 23. Günay H, Küçük L, Sözbilen MC, Bİçer EK, Çobanoğlu M. Does the number of engaged screw threads affect the stability of slipped capital femoral epiphysis in the in situ fixation? İzmir Dr. Behçet Uz Çocuk Hast. Dergisi 2017;7(1):39-44. doi: 10.5222/buchd.2017.039
  • 24. Cullu E, Damgaci K, Savk SO. Femur başi epifiz kaymasinda olduğu pozisyonda tek vida ile tespit [In situ pinning on slipped femoral capital epiphysis with a single cannulated screw]. Ulus Travma Acil Cerrahi Derg. 2005;11(3):212-7. Turkish. PMID: 16100666.
  • 25. Loder RT, Aronson DD, Greenfield ML. The epidemiology of bilateral slipped capital femoral epiphysis. A study of children in Michigan. J Bone Joint Surg Am. 1993;75(8):1141-7. doi: 10.2106/00004623-199308000-00003.
  • 26. Riad J, Bajelidze G, Gabos PG. Bilateral slipped capital femoral epiphysis: predictive factors for contralateral slip. J Pediatr Orthop. 2007;27(4):411-4. doi: 10.1097/01.bpb.0000271325.33739.86.
  • 27. Popejoy D, Emara K, Birch J. Prediction of contralateral slipped capital femoral epiphysis using the modified Oxford bone age score. J Pediatr Orthop. 2012;32(3):290-4. doi: 10.1097/BPO.0b013e3182471eb4.
  • 28. 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(8):1134-40. doi: 10.2106/00004623-199308000-00002.
  • 29. Aversano, M. W., Moazzaz, P., Scaduto, A. A., & Otsuka, N. Y. Association between body mass index-for-age and slipped capital femoral epiphysis: the long-term risk for subsequent slip in patients followed until physeal closure. Journal of children's orthopaedics, 2016;10(3):209–213. doi: 10.1007/s11832-016-0731-y.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Araştırma Makalesi
Yazarlar

Yusuf Alper Katı 0000-0003-2706-3813

İsmail Dikmen 0000-0003-0272-2069

Yayımlanma Tarihi 23 Nisan 2021
Gönderilme Tarihi 10 Aralık 2020
Kabul Tarihi 8 Şubat 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 5 Sayı: 1

Kaynak Göster

Vancouver Katı YA, Dikmen İ. Relationship between Treatment Age and Poor Outcome in Slipped Capital Femoral Epiphysis. Acta Med. Alanya. 2021;5(1):75-80.

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