Femur Başı Epifiz Kaymasında Tedavi Yaşının Kötü Sonuç ile İlişkisi

Year 2021, Volume: 5 Issue: 1, 75 - 80, 23.04.2021

Yusuf Alper Katı , İsmail Dikmen

https://doi.org/10.30565/medalanya.838843

Abstract

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.

Keywords

Femur başı epifiz kayması, ,fonksiyonel sonuçlar, , Heyman-Herndon sınıflaması,, tek vida

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

Abstract

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.

Keywords

Slipped Capital Femoral Epiphyses,, treatment outcome,, Heyman and Herndon Classification, single screw

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