Der Orthopäde

, Volume 39, Issue 10, pp 1009–1021

Epiphysenlösung

  • C. Zilkens
  • M. Jäger
  • B. Bittersohl
  • Y.-J. Kim
  • M.B. Millis
  • R. Krauspe
CME Weiterbildung · Zertifizierte Fortbildung

Zusammenfassung

Die Epiphyseolysis capitis femoris (ECF) ist eine häufige Hüfterkrankung des Heranwachsenden und sollte so früh wie möglich diagnostiziert und operativ therapiert werden. Ätiologisch werden verschiedene biomechanische, biochemische und genetische Faktoren diskutiert. Die Klassifikation der ECF erfolgt nach ihrer Akuität, klinisch und/oder radiomorphologisch. Avaskuläre Nekrosen (AVN) und Chondrolysen treten häufiger bei operierten als bei nichtoperierten Patienten auf. Mittel- und langfristige Folgeschäden nach ECF sind ein Funktionsverlust und eine Coxarthrose aufgrund eines femoroazetabulären Impingements (FAI) oder aufgrund von Komplikationen (AVN, Chondrolyse). Bei milden Abrutschwinkeln werden günstigere Langzeitverläufe beschrieben als bei moderaten oder schweren Abrutschwinkeln. Hochgradige instabile ECF profitieren von einer Reposition, während bei der chronischen ECF eine Osteotomie indiziert sein kann. Traditionelle Osteotomien wie die Imhäuser- oder Southwick-Osteotomie bieten ein hohes Maß an Sicherheit, die Korrektur liegt jedoch entfernt von der eigentlichen Deformität. Die chirurgische Hüftluxation mit nach Ganz modifizierter Dunn-Osteotomie reduziert die Gefahr einer Überdehnung oder eines Risses des Retinakulums während der Kallusresektion am Schenkelhals und erlaubt eine anatomische Reposition der Kalotte. In Fällen mit FAI aufgrund von milden Deformitäten sollte die Wiederherstellung des Kopf-Hals-Übergangs via Arthroskopie oder chirurgische Hüfluxation in Erwägung gezogen werden, bevor ein höhergradiger Knorpelschaden entstanden ist.

Schlüsselwörter

Epiphysen Hüftkopfnekrose Coxarthrose Knorpel Osteotomie 

Slipped capital femoral epiphysis

Abstract

Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescence and should be diagnosed and treated surgically as soon as possible. The etiology, biomechanical, biochemical and hereditary factors are still under investigation. The classification of SCFE is based on the acuteness, clinical and radiomorphological findings. Avascular necrosis of the epiphysis (AVN) and chondrolysis occur more often in operated than in non-operated patients. Medium and long-term sequelae of SCFE are loss of function and degenerative joint disease due to femoroacetabular impingement (FAI) or consequences from complications such as AVN and chondrolysis. For mild slips the long-term prognosis is better than for moderate or severe slips. Higher grade unstable SCFE may benefit from reduction while in chronic slips corrective osteotomy may be indicated. Traditional osteotomy procedures, such as Imhäuser or Southwick intertrochanteric osteotomy are safe procedures but correct the deformity distant from the site of the deformity. The surgical dislocation with modified Dunn osteotomy according to Ganz allows the preparation of an extended retinacular soft tissue flap and offers an extensive subperiosteal exposure of the circumference of the femoral neck before reducing the slipped epiphysis anatomically. In cases of FAI due to mild deformities restoration of the head-neck offset via hip arthroscopy or surgical dislocation should be considered before higher grade cartilage damage occurs.

Keywords

Epiphysis Femur head necrosis Osteoarthritis, hip Cartilage Osteotomy 

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© Springer-Verlag 2010

Authors and Affiliations

  • C. Zilkens
    • 1
  • M. Jäger
    • 1
  • B. Bittersohl
    • 1
  • Y.-J. Kim
    • 2
  • M.B. Millis
    • 2
  • R. Krauspe
    • 1
  1. 1.Orthopädische Klinik und PoliklinikUniversitätsklinikum DüsseldorfDüsseldorfDeutschland
  2. 2.Orthopaedic DepartmentChildren‘s Hospital Boston, Harvard Medical SchoolBostonUSA

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