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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(04): e632-e638
DOI: 10.1055/s-0042-1758362
Artigo Original
Ortopedia Pediátrica

Técnica de Dunn modificada no escorregamento da epífise femoral proximal com instabilidade: Experiência unicêntrica de médio prazo[*]

Article in several languages: português | English
Frederico Coutinho de Moura Vallim 
1   Médico Ortopedista, Especialista em Cirurgião Ortopédico Pediátrico, Hospital Estadual da Criança, Rio de Janeiro, RJ, Brasil
,
Henrique Abreu da Cruz 
1   Médico Ortopedista, Especialista em Cirurgião Ortopédico Pediátrico, Hospital Estadual da Criança, Rio de Janeiro, RJ, Brasil
,
Carlos Francisco Bittencourt Silva 
1   Médico Ortopedista, Especialista em Cirurgião Ortopédico Pediátrico, Hospital Estadual da Criança, Rio de Janeiro, RJ, Brasil
,
Caroline Sandra Gomes de Abreu 
1   Médico Ortopedista, Especialista em Cirurgião Ortopédico Pediátrico, Hospital Estadual da Criança, Rio de Janeiro, RJ, Brasil
,
Ricardo Carneiro Rodrigues 
1   Médico Ortopedista, Especialista em Cirurgião Ortopédico Pediátrico, Hospital Estadual da Criança, Rio de Janeiro, RJ, Brasil
,
Marcio Garcia Cunha 
2   Médico Ortopedista, Chefe da Ortopedia Pediátrica, Hospital Estadual da Criança, Rio de Janeiro, RJ, Brasil
› Author Affiliations Suporte Financeiro Os autores declaram que não receberam apoio financeiro para o preparo deste manuscrito.
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Resumo

Objetivo Avaliar a segurança e a reprodutibilidade da cirurgia para escorregamento da epífise femoral proximal (EEPF) com instabilidade por meio da técnica de Dunn modificada em uma coorte unicêntrica no Brasil.

Métodos Analisamos de forma retrospectiva uma coorte de pacientes submetidos a esse procedimento por um único cirurgião especialista em preservação do quadril. Avaliamos os dados demográficos e os ângulos radiográficos quanto ao risco relativo (RR) de necrose avascular (NAV) por meio do modelo de regressão log-binomial com efeitos simples e aleatórios.

Resultados Entre os 30 pacientes (30 quadris) com idade média de 11,79 anos no momento da cirurgia, havia 17 meninos e 18 quadris esquerdos. O procedimento ocorreu em média 11,5 dias após o escorregamento. O tempo médio de acompanhamento foi de 38 meses. O ângulo de Southwick pré-operatório foi, em média, de 60,69° contra 4,52° após o procedimento (p < 0,001). O maior ângulo de escorregamento pré-operatório foi associado ao desenvolvimento de NAV (RR: 1,05; intervalo de confiança de 95% [IC95%]: 1,02–1,07; p < 0,01). A frequência geral de NAV foi de 26,7%. De acordo com a Escala de Quadril de Harris (Harris Hip Score), a função foi boa ou excelente em 86% dos quadris sem complicações, e ruim em 87,5% dos casos com NAV. Não houve relação estatística entre sangramento epifisário e desenvolvimento de NAV (p = 0,82).

Conclusão A técnica de Dunn modificada restaura o alinhamento femoral e a função articular após o EEPF com instabilidade na ausência de complicações. Além disso, mostrou-se passível de reprodução em nossa população, com frequência de necrose da cabeça femoral de 26%.

Palavras-chave

escorregamento das epífises proximais do fêmur - necrose da cabeça do fêmur - osteotomia - quadril

* Estudo conduzido no Hospital Estadual da Criança, Rio de Janeiro, RJ, Brasil.




Publication History

Received: 10 March 2022

Accepted: 12 September 2022

Article published online:
21 July 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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