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DOI: 10.1055/s-0037-1618028
Die Epiphyseolysis capitis femoris
To do or not to do 2010Slipped capital femoral epiphysisTo do or not to do 2010Publikationsverlauf
Publikationsdatum:
26. Dezember 2017 (online)
Zusammenfassung
Die Epiphyseolysis capitis femoris (ECF) ist die häufigste Hüftgelenkserkrankung des Adoleszenten mit einer Inzidenz von 8,3 und die häufigste mit Verzögerung gestellte Diagnose. Die Patienten sind meist adipös und großwüchsig. Es findet sich häufig ein Zusammenhang zwischen der ECF und metabolischen Erkrankungen wie Hyperparathyreoidismus, Hypogonadismus und Wachstumshormonmangel. Die ECF wird in eine stabile und eine instabile Form eingeteilt. Weitere Einteilungen orientieren sich an der Dauer seit Beginn der Symptome oder dem Abrutschwinkel. Die Patienten klagen in der Regel über milde unspezifische Schmerzen in Hüfte und Knie. Röntgenaufnahmen des Beckens sowie die Lauenstein-Aufnahmen beider Hüftgelenke sichern die Diagnose. Das Ziel der Behandlung ist sowohl die Prävention einer fortschreitenden Lyse als auch der Folgeschäden wie der Osteonekrose, der Chondrolyse und der Arthrose. Die Therapie ist immer operativ und besteht entweder in einem „in situ pinning“ mit Kirschnerdrähten oder kanülierten Schrauben, einer Imhäuser-Osteotomie oder einer chirurgischen Hüftluxation mit subkapitaler Korrekturosteotomie zur Reposition der Epiphyse.
Summary
Slipped capital femoral epiphysis is the most common hip disorder in adolescents with a prevalence of 8.3 cases in 100 000 patients and is one of the most commonly missed diagnoses. The physical condition is obesity and growth surges, and the disease is occasionally associated with endocrine disorders like hyperparathyroidism, hypogonadism and growth hormone deficiency. The disease is classified in stable and unstable according to the stability of the physis, according the duration of symptoms or by the amount of slip. Patients usually present with mild pain in hip or knee. Diagnose is confirmed by anteriorposterior and frog-leg lateral views of both hips. The aim of treatment is the prevention of progression of slips and preventation of complications which are femoral head necrosis, chondrolysis and osteoarthrosis. Treatment options range from in situ pinning with Kirschner wires or screw, Imhäuser procedure to surgical hip dislocation with subcapital correction osteotomy.
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