Hip Impingement of severe SCFE patients after in situ pinning causes decreased flexion and forced external rotation in flexion on 3D-CT.

IF 1.3 4区 医学 Q3 ORTHOPEDICS Journal of Childrens Orthopaedics Pub Date : 2023-08-29 eCollection Date: 2023-10-01 DOI:10.1177/18632521231192462
Till D Lerch, Young-Jo Kim, Ata Kiapour, Adam Boschung, Simon D Steppacher, Moritz Tannast, Klaus A Siebenrock, Eduardo N Novais
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Abstract

Introduction: In situ pinning is an accepted treatment for stable slipped capital femoral epiphysis. However, residual deformity of severe slipped capital femoral epiphysis can cause femoroacetabular impingement and forced external rotation.

Purpose/questions: The aim of this study was to evaluate the (1) hip external rotation and internal rotation in flexion, (2) hip impingement location, and (3) impingement frequency in early flexion in severe slipped capital femoral epiphysis patients after in situ pinning using three-dimensional computed tomography.

Patients and methods: A retrospective Institutional Review Board-approved study evaluating 22 patients (26 hips) with severe slipped capital femoral epiphysis (slip angle > 60°) using postoperative three-dimensional computed tomography after in situ pinning was performed. Mean age at slipped capital femoral epiphysis diagnosis was 13 ± 2 years (58% male, four patients bilateral, 23% unstable, 85% chronic). Patients were compared to contralateral asymptomatic hips (15 hips) with unilateral slipped capital femoral epiphysis (control group). Pelvic three-dimensional computed tomography after in situ pinning was used to generate three-dimensional models. Specific software was used to determine range of motion and impingement location (equidistant method). And 22 hips (85%) underwent subsequent surgery.

Results: (1) Severe slipped capital femoral epiphysis patients had significantly (p < 0.001) decreased hip flexion (43 ± 40°) and internal rotation in 90° of flexion (-16 ± 21°, IRF-90°) compared to control group (122 ± 9° and 36 ± 11°). (2) Femoral impingement in maximal flexion was located anterior to anterior-superior (27% on 3 o'clock and 27% on 1 o'clock) of severe slipped capital femoral epiphysis patients and located anterior to anterior-inferior (38% on 3 o'clock and 35% on 4 o'clock) in IRF-90°. (3) However, 21 hips (81%) had flexion < 90° and 22 hips (85%) had < 10° of IRF-90° due to hip impingement and 21 hips (81%) had forced external rotation in 90° of flexion (< 0° of IRF-90°).

Conclusion: After in situ pinning, patient-specific three-dimensional models showed restricted flexion and IRF-90° and forced external rotation in 90° of flexion due to early hip impingement and residual deformity in most of the severe slipped capital femoral epiphysis patients. This could help to plan subsequent hip preservation surgery, such as hip arthroscopy or femoral (derotation) osteotomy.

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严重SCFE患者原位钉扎后的髋关节撞击导致3D-CT上屈曲减少和强迫外旋。
引言:原位钉扎是治疗稳定滑脱的股骨干骺的一种公认的治疗方法。然而,严重滑脱的股骨头骨骺的残余畸形会导致股骨髋臼撞击和强迫外旋。目的/问题:本研究的目的是评估(1)髋关节屈曲时的外旋和内旋,(2)髋关节撞击位置,以及(3)严重滑动的股骨干骺患者原位钉扎后早期屈曲时的撞击频率。患者和方法:一项由机构审查委员会批准的回顾性研究,评估了22例(26髋)严重股骨头骨骺滑脱(滑脱角 > 60°)。诊断为股骨头骨骺滑脱的平均年龄为13岁 ± 2. 年(58%为男性,4例为双侧,23%为不稳定,85%为慢性)。将患者与单侧股骨头骺滑脱的对侧无症状髋关节(15髋)(对照组)进行比较。原位钉扎后的骨盆三维计算机断层扫描用于生成三维模型。使用特定的软件来确定运动范围和撞击位置(等距法)。22个髋关节(85%)接受了后续手术。结果:(1)严重滑脱型股骨头骨骺患者有显著性差异(p 结论:原位钉扎后,患者特异性三维模型显示,大多数严重股骨干骺滑脱患者由于早期髋关节撞击和残余畸形,屈曲受限,IRF-90°,90°屈曲时被迫外旋。这可能有助于计划后续的髋关节保护手术,如髋关节镜检查或股骨(旋转)截骨。
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来源期刊
Journal of Childrens Orthopaedics
Journal of Childrens Orthopaedics Medicine-Orthopedics and Sports Medicine
CiteScore
2.70
自引率
14.30%
发文量
61
审稿时长
23 weeks
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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