股骨颈干角滑脱的临床稳定性与术中稳定性不相关。
Clinical stability of slipped capital femoral epiphysis does not correlate with intraoperative stability.
机构信息
Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland.
出版信息
Clin Orthop Relat Res. 2012 Aug;470(8):2274-9. doi: 10.1007/s11999-012-2339-y. Epub 2012 Apr 10.
BACKGROUND
The most important objective of clinical classifications of slipped capital femoral epiphysis (SCFE) is to identify hips associated with a high risk of avascular necrosis (AVN)--so-called unstable or acute slips; however, closed surgery makes confirmation of physeal stability difficult. Performing the capital realignment procedure in SCFE treatment we observed that clinical estimation of physeal stability did not always correlate with intraoperative findings at open surgery. This motivated us to perform a systematic comparison of the clinical classification systems with the intraoperative observations.
QUESTIONS/PURPOSES: We asked: (1) Is the classification of an acute versus chronic slip based on the duration of symptoms sensitive and specific in detecting intraoperative disrupted physes in patients with SCFE? (2) Is the stable/unstable classification system based on clinical symptoms sensitive and specific in detecting intraoperative disrupted physes in patients with SCFE?
METHODS
We retrospectively reviewed 82 patients with SCFE treated by open surgery between 1996 and 2009. We classified the clinical stability of all hips using the classifications based on onset of symptoms and on function. We classified intraoperative stability as intact or disrupted. We determined the sensitivity and specificity of two classification systems to determine intraoperative stability.
RESULTS
Complete physeal disruption at open surgery was seen in 28 of the 82 hips (34%). With classification as acute, acute-on-chronic, and chronic, the sensitivity for disrupted physes was 82% and the specificity was 44%. With the classification of Loder et al., the values were 39% and 76%, respectively.
CONCLUSION
Current clinical classification systems are limited in accurately diagnosing the physeal stability in SCFE.
LEVEL OF EVIDENCE
Level III, retrospective diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
滑离性股骨骨骺炎（SCFE）临床分类最重要的目标是确定那些存在高缺血性坏死（AVN）风险的髋关节，即所谓的不稳定或急性滑脱；然而，闭合手术使得确认骺板稳定性变得困难。在 SCFE 的治疗中进行股骨头再排列术时，我们发现骺板稳定性的临床评估并不总是与开放性手术中的术中发现相关。这促使我们对临床分类系统与术中观察进行系统比较。
问题/目的：我们提出以下问题：（1）基于症状持续时间的急性与慢性滑脱分类在检测 SCFE 患者术中破坏骺板时是否具有敏感性和特异性？（2）基于临床症状的稳定/不稳定分类系统在检测 SCFE 患者术中破坏骺板时是否具有敏感性和特异性？
方法
我们回顾性分析了 1996 年至 2009 年间接受开放性手术治疗的 82 例 SCFE 患者。我们使用基于症状起始和功能的分类来分类所有髋关节的稳定性。我们将术中稳定性分为完整或破坏。我们确定了两种分类系统来确定术中稳定性的敏感性和特异性。
结果
在 82 髋中，28 髋（34%）在开放性手术中出现完全骺板破坏。在急性、急性慢性和慢性分类中，骺板破坏的敏感性为 82%，特异性为 44%。使用 Loder 等的分类，其值分别为 39%和 76%。
结论
目前的临床分类系统在准确诊断 SCFE 骺板稳定性方面存在局限性。
证据水平
III 级，回顾性诊断研究。欲了解完整的证据水平描述，请参见作者指南。
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