Kazan medical journalKazan medical journal0368-48142587-9359Eco-Vector180110.17816/KMJ1801Research ArticleA method of surgical treatment of unstable severe forms of juvenile femoral head epiphysiolysisPulatovA Rpar@weborto.netMineevV V-Ural Scientific and Research Institute of Traumatology and Orthopedics named after V.D. Chaklin, Ekaterinburg, Russia1512201394683884328032016Copyright © 2013, Pulatov A.R., Mineev V.V.2013Aim. To analyze the long-term results of the designed method for the open epiphysis reduction in patients with severe unstable forms of juvenile femoral head epiphysiolysis. Methods. The article describes the method of surgical treatment of severe forms of unstable juvenile femoral head epiphysiolysis and long-term outcomes in 21 patients. The indications for the method were the unstable form of juvenile femoral head epiphysiolysis and slipped capital femoral epiphysis with a slip angle of more than 40 degrees. The age of patients at time of treatment ranged from 11 to 16 years, follow-up period - from 2 to 15 years. Five patients underwent a comprehensive biomechanical study within one year after surgery. Results. The early and late results of the femoral head epiphysis open reduction were analyzed. Positive results were obtained in 19 cases (good results in 17, satisfactory in 2). The complication rate was 14.3% and included 3 cases of avascular femoral head necrosis, no cases of chondrolysis were revealed. According to biomechanical examination data performed in five patients 1 year after the surgery, almost complete functional recovery of the musculoskeletal system was revealed. Conclusion. Analysis of the results showed that being properly executed the open reduction of the femoral head with a corrective femoral neck osteotomy allowed to restore normal anatomic proportions and function of the affected joint, positive result was maintained for the entire follow-up period.juvenile epiphysiolysisunstable formopen reductionavascular necrosisюношеский эпифизеолизнестабильная формаоткрытая репозицияаваскулярный некроз[Пулатов А.Р., Минеев В.В.; заявитель и патентообладатель Уральский НИИТО. Способ хирургического лечения тяжёлых нестабильных форм юношеского эпифизеолиза головки бедренной кости. Патент на изобретение №2405489 РФ, МКИ7 А 61 В 17/56. - Бюлл. №34 от 10.12.2010.][Пулатов А.Р. Юношеский эпифизеолиз головки бедренной кости. Диагностика, лечение. - Екатеринбург: ИД ИздатНаукаСервис, 2009. - 140 с.][Dunn D.M., Angel J.C. Replacement of the femoral head by open operation in severe adolescent slipping of the upper femoral epiphysis // J. Bone Jt. Surg. - 1978. - Vol. 60-B, N 3. - P. 394-403.][Engelhardt P., Roesler H. Radiometry of epiphyseolysis capitis femoris. A comparison of conventional roentgen study with axial computerized tomography // Z. Orthop. - 1987. - Vol. 125, N 2. - Р. 177-182.][Exner G.U., Schai P.A., Notzli H.P. Therapie der akuten Epiphysenlosung des Huftkopfes und klinische Behandlungsergebnisse // Orthopäde. - 2002. - Vol. 31. - P. 857-865.][Frick S.L., Casey V. Acute on chronic, unstable slipped capital femoral epiphysis // AO DIALOGUE. - 2007. - Vol. 1. - Р. 40-43.][Ireland J., Newman P.H. Triplane osteotomy for severely slipped upper femoral epiphysis // J. Bone Jt. Surg. - 1978. - Vol. 60-A, N 3. - Р. 390-393.][Leunig M., Slongo T., Kleinschmidt M., Ganz R. Subcapital correction osteotomy in slipped capital femoral epiphysis by means of surgical hip dislocation // Oper. Orthop. Traum. - 2007. - Vol. 19, N 4. - P. 389-410.][Loder R.T., Richards B.S., Shapiro P.S., Reznick L.R. Acute slipped capital femoral epiphysis: the importance of physeal stability // J. Bone Jt. Surg. - 1993. - Vol. 75-A. - P. 1134-1140.][Parsch K., Weller S., Parsch D. Open reduction and smooth Kirschner wire fixation for unstable slipped capital femoral epiphysis // J. Pediatr. Orthop. - 2009. - Vol. 29, N 1. - P. 1-8.][Peterson M.D., Weiner D.S., Green N.E., Terry C.L. Acute slipped capital femoral epiphysis: the value and safety of urgent manipulative reduction // J. Pediatr. Orthop. - 1997. - Vol. 17, N 5. - P. 648-654.][Phillips S.A., Griffiths W.E., Clarke N.M. The timing of reduction and stabilisation of the acute, unstable, slipped upper femoral epiphysis // J. Bone Jt. Surg. Br. - 2001. - Vol. 83, N 7. - P. 1046-1049.][Tokmakova K.P., Stanton R.P., Mason D.E. Factors influencing the development of osteonecrosis in patients treated for slipped capital femoral epiphysis // J. Bone Jt. Surg. Am. - 2003. - Vol. 85-A, N 5. - P. 798-801.][Witbreuk M., Besselaar P., Eastwood D. Current practice in the management of acute/unstable slipped capital femoral epiphyses in the United Kingdom and the Netherlands: results of a survey of the membership of the British Society of Children’s Orthopaedic Surgery and the Werkgroep Kinder Orthopaedie // J. Pediatr. Orthop. B. - 2007. - Vol. 16, N 2. - P. 79-83.]