Park Sangdo, Hsu Jason E, Rendon Norma, Wolfgruber Hayley, Wells Lawrence
Department of Orthopaedic Surgery, The Childrens Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA.
J Pediatr Orthop. 2010 Oct-Nov;30(7):683-9. doi: 10.1097/BPO.0b013e3181efb888.
Prophylactic pinning of the uninvolved side after unilateral slipped capital femoral epiphysis (SCFE) is controversial. The posterior sloping angle (PSA) has previously been proposed to predict contralateral slip. The purpose of this study was to determine whether the PSA can predict subsequent slip after unilateral SCFE, and if so, whether a sex difference exists.
A retrospective case-control study was performed comparing 51 patients who initially presented with unilateral SCFE and subsequently developed contralateral slip (Bilateral) with 51 patients who had unilateral SCFE only (Unilateral). Data collected included age, sex, ethnicity, and PSA.
The patients in the Bilateral group had significantly higher PSA (14.5±6.1 vs. 10.6±5.3, P=0.001) and were younger (11.3±1.5 vs.12.3±1.2, P<0.001) than the patients in the Unilateral group. A receiver-operating characteristic curve demonstrated that the threshold for pinning a contralateral hip with PSA >12.66 yields an area under the curve of 67%. When the analysis was repeated with respect to sex, girls in the Bilateral group had significantly higher PSA (15.9±6.3 vs. 10.1±6.0, P=0.002) and were younger (10.7±1.1 vs.11.9±1.0, P<0.001) than the girls in the Unilateral group. Among boys, these associations were not significant. A receiver-operating characteristic curve demonstrated that the threshold for pinning a contralateral hip with PSA >13 in girls yields an area under the curve of 76%.
PSA is predictive of contralateral slip in patients presenting with unilateral SCFE. However, it is more predictive in girls, and we recommend considering prophylactic pinning in girls with PSA >13.
Level III.
单侧股骨头骨骺滑脱（SCFE）后对未受累侧进行预防性固定存在争议。先前有人提出后倾角度（PSA）可预测对侧滑脱。本研究的目的是确定PSA是否能预测单侧SCFE后的后续滑脱，如果可以，是否存在性别差异。
进行一项回顾性病例对照研究，比较51例最初表现为单侧SCFE且随后发生对侧滑脱（双侧组）的患者与51例仅患有单侧SCFE的患者（单侧组）。收集的数据包括年龄、性别、种族和PSA。
双侧组患者的PSA显著高于单侧组（14.5±6.1对10.6±5.3，P = 0.001），且年龄更小（11.3±1.5对12.3±1.2，P < 0.001）。受试者操作特征曲线表明，PSA>12.66时对侧髋关节固定的阈值产生的曲线下面积为67%。按性别重复分析时，双侧组女孩的PSA显著高于单侧组女孩（15.9±6.3对10.1±6.0，P = 0.002），且年龄更小（10.7±1.1对11.9±1.0，P < 0.001）。在男孩中，这些关联不显著。受试者操作特征曲线表明，女孩中PSA>13时对侧髋关节固定的阈值产生的曲线下面积为76%。
PSA可预测单侧SCFE患者的对侧滑脱。然而，它在女孩中预测性更强，我们建议对PSA>13的女孩考虑进行预防性固定。
三级。
