Azzopardi Thomas, Sharma Sunil, Bennet George C
Department of Orthopaedic Surgery, Royal Hospital for Sick Children, Glasgow, UK.
J Pediatr Orthop B. 2010 Jan;19(1):13-8. doi: 10.1097/BPB.0b013e32832e0b6c.
Slipped capital femoral epiphysis (SCFE) is rare in children aged less than 10 years, and its management in this age group raises a number of different considerations. We present a series of 10 children aged less than 10 years who presented with SCFE to our institution between 1993 and 2005. Case notes and radiographic review were carried out. There were six boys and four girls, with an age range of 5.2-9.9 years. Mean follow-up was 50 months (22-90). The mean duration of symptoms was 54 days (1-196). Five cases were bilateral. The second slip occurred at a mean interval of 14 months (11-22) after the first slip. There were 12 stable and three unstable slips. One child had hypothyroidism and another oculocutaneous albinism. The remaining children had normal genetic and endocrine profiles. Six children were severely obese, one obese, two overweight, and one within the normal range. Multiple pins were used in nine hips and a single cannulated screw was used in six hips. Complications include loss of fixation in five hips treated with multiple pins, which were revised between 2 months and 2 years from the initial surgery, and one superficial wound infection. There were no cases of avascular necrosis or chondrolysis. In conclusion, obesity is closely related to the development of SCFE in younger children. A technique that preserves physeal growth should be used for in-situ fixation. Multiple pins preserve capital femoral physeal growth, but at the cost of a high complication rate. Strong consideration for prophylactic pinning of the contralateral hip is recommended.
儿童股骨头骨骺滑脱（SCFE）在10岁以下儿童中较为罕见，该年龄组的治疗需要考虑诸多不同因素。我们报告了1993年至2005年间在我院就诊的10例10岁以下SCFE患儿。对病历和影像学资料进行了回顾。患儿中6例为男孩，4例为女孩，年龄范围为5.2 - 9.9岁。平均随访时间为50个月（22 - 90个月）。症状平均持续时间为54天（1 - 196天）。5例为双侧发病。第二次滑脱发生在第一次滑脱后平均14个月（11 - 22个月）。12例为稳定型滑脱，3例为不稳定型滑脱。1例患儿患有甲状腺功能减退症，另1例患有眼皮肤白化病。其余患儿遗传和内分泌指标正常。6例患儿严重肥胖，1例肥胖，2例超重，1例体重正常。9例髋关节采用多枚钢针固定，6例髋关节采用单枚空心螺钉固定。并发症包括9例采用多枚钢针固定的髋关节中有5例出现内固定松动，在初次手术后2个月至2年进行了翻修，以及1例表浅伤口感染。未发生股骨头缺血坏死或关节软骨溶解病例。总之，肥胖与年幼儿童SCFE的发生密切相关。原位固定应采用保留骨骺生长的技术。多枚钢针可保留股骨头骨骺生长，但并发症发生率较高。建议对侧髋关节预防性钢针固定应予以充分考虑。
