Análise retrospectiva dos desfechos clínicos e radiológicos após a osteotomia de Dunn modificada em pacientes com escorregamento epifisário proximal do fêmur estável, crônico e moderado a grave

Resumo

Objetivo O manejo do escorregamento epifisário proximal do fêmur (EEPF) foi completamente transformado pela osteotomia de Dunn modificada, uma osteotomia de realinhamento subcapital por meio da técnica segura de luxação cirúrgica originalmente descrita por Ganz. O objetivo deste estudo foi avaliar os desfechos clínicos e radiológicos de pacientes com EEPF moderado a grave após a osteotomia de Dunn modificada.

Métodos Um total de 15 pacientes (16 quadris, com um caso bilateral; 12 homens, 3 mulheres) com idade entre 10,2 e 17 anos (média: 14,3) e EEPF crônico, estável e moderado a grave (moderado = 6; grave = 10) foram submetidos à osteotomia de Dunn modificada como tratamento. A amplitude de movimento (ADM) da articulação do quadril e os escores de quadril de Harris (HHS) e Merle d'Aubigné (MdA) foram utilizados para avaliações clínicas. A avaliação radiográfica usou os ângulos de Southwick e alfa.

Resultados No acompanhamento mais recente (média: 8,6 anos; 3,1–14), a média da ADM da articulação do quadril, o HHS médio (pré-operatório: 69,20 ± 5,94; pós-operatório: 86 ± 7,37, p < 0,00001) e o MdA médio (pré-operatório: 12,47 ± 1,13; pós-operatório: 14,27 ± 1,83, p < 0,00001) demonstraram melhoras clínicas estatisticamente significativas. Os resultados radiológicos demonstraram melhoras no ângulo Southwick médio (pré-operatório: 56,60 ± 12,89°; pós-operatório: 16,4 ± 4,69°, p < 0,00001) e no ângulo alfa (pré-operatório: 101,87 ± 12,88°; pós-operatório: 29,33 ± 7,29°, p < 0,00001). Foram observadas duas complicações pós-operatórias significativas: necrose avascular (NAV) da cabeça femoral e infecção profunda.

Conclusão De acordo com os achados do estudo, a osteotomia de Dunn modificada é uma opção terapêutica segura e eficaz no EEPF estável, crônico e moderado a grave, com risco controlável de complicações.

Palavras-chave

escorregamento das epífises proximais do fêmur - osteonecrose - osteotomia - quadril

Trabalho desenvolvido no Departamento de Ortopedia e Traumatologia, GMERS Medical College and General Hospital, Himmatnagar, Sabarkantha, Gujarat, Índia.

Publication History

Received: 12 March 2024

Accepted: 21 May 2024

Article published online:
21 December 2024

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