Shank Craig F, Thiel Eric J, Klingele Kevin E
Mount Carmel Health, Columbus, OH, USA.
J Pediatr Orthop. 2010 Mar;30(2):140-6. doi: 10.1097/BPO.0b013e3181d076b6.
Valgus slipped capital femoral epiphysis (SCFE), defined as posterolateral slippage of the proximal femoral epiphysis on the metaphysis, is an uncommon occurrence. The purpose of this study was to review our institution's experience with valgus SCFE to better describe its prevalence, clinical presentation, and treatment.
Radiographs of patients undergoing treatment of SCFE between 1996 and 2008 were reviewed. Valgus SCFE was identified by increased prominence of the lateral femoral epiphysis relative to the lateral femoral neck and an increased anteroposterior physis shaft angle. We identified 12 patients (16 hips) with valgus SCFE and compared them with 123 cases identified as classic posteromedial SCFE.
The prevalence of valgus SCFE at our institution was 4.7% (12 of 258 patients). Significant differences between patients with valgus SCFE and those with classic SCFE were found for age at presentation (mean 1.1 y younger, P=0.033), sex (58% female vs. 28% male, P=0.044), and classification as atypical SCFE (42% vs. 3%, P<0.001), respectively. Four patients in the valgus group had pituitary and growth hormone dysfunction, and 1 was diagnosed with Stickler syndrome. Hips of valgus patients had a significantly higher mean femoral neck shaft angle (154.3 degrees) as compared with classic SCFE patients (140.5 degrees) (P<0.001). Difficulty placing hardware for in situ fixation was noted in 5 of 11 valgus cases, with 1 case complicated by articular surface penetration and chondrolysis.
Valgus displacement often presents with a relatively normal appearance on anteroposterior radiographs. Valgus SCFE may be associated with obesity, coxa valga, hypopituitarism, and Stickler syndrome. Posterolateral displacement of the femoral epiphysis makes in situ fixation of valgus SCFE more difficult, due to the necessity of a more medial starting point.
Case series, Level IV.
外翻型股骨头骨骺滑脱（SCFE）定义为股骨近端骨骺在干骺端的后外侧移位，较为少见。本研究旨在回顾我院治疗外翻型SCFE的经验，以更好地描述其患病率、临床表现及治疗方法。
回顾1996年至2008年间接受SCFE治疗患者的X线片。外翻型SCFE通过相对于股骨外侧颈，股骨外侧骨骺突出增加以及前后位骨骺干骺端角度增大来确定。我们识别出12例（16髋）外翻型SCFE患者，并将其与123例经典的后内侧SCFE病例进行比较。
我院外翻型SCFE的患病率为4.7%（258例患者中的12例）。外翻型SCFE患者与经典SCFE患者在就诊年龄（平均小1.1岁，P = 0.033）、性别（女性58%对男性28%，P = 0.044）以及非典型SCFE分类（42%对3%，P < 0.001）方面存在显著差异。外翻组中有4例患者存在垂体及生长激素功能障碍，1例被诊断为施蒂克勒综合征。与经典SCFE患者（140.5度）相比，外翻患者的髋部平均股骨颈干骺端角度显著更高（154.3度）（P < 0.001）。11例外翻病例中有5例在原位固定时放置硬件困难，1例并发关节面穿透和软骨溶解。
外翻移位在前后位X线片上通常表现为相对正常的外观。外翻型SCFE可能与肥胖、髋外翻、垂体功能减退和施蒂克勒综合征有关。由于需要更内侧的起始点，股骨骨骺的后外侧移位使得外翻型SCFE的原位固定更加困难。
病例系列，IV级。
