Nicholson Allen D, Huez Coridon M, Sanders James O, Liu Raymond W, Cooperman Daniel R
*Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT †Department of Orthopaedics, University of Rochester School of Medicine, Rochester, NY ‡Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH.
J Pediatr Orthop. 2016 Mar;36(2):132-8. doi: 10.1097/BPO.0000000000000415.
In 2 recent studies, modified Oxford hip scores of 16 through 18 have been shown to predict an extremely high risk of contralateral slipping in unilateral slipped capital femoral epiphysis (SCFE). However, the modified Oxford system is not widely used. This may be due, in part, to the complexity of the scoring system, difficulty in viewing all 5 radiographic features on a single x-ray and phenotypic variation in the features. Ossification of the calcaneal apophysis provides an osteologic marker of skeletal maturation in relation to peak height velocity and has been described previously. We examine the value of the calcaneal apophyseal ossification sequence for predicting modified Oxford hip scores.
We examined 279 pelvis and matching foot x-rays that were taken at the same session from 94 healthy children aged 3 to 18 years. A fellowship-trained pediatric orthopaedist determined the modified Oxford hip score for each hip radiograph. The calcaneal x-rays had been previously graded. Modified Oxford hip scores were compared with calcaneal scores for each set of matched hip and calcaneal x-rays.
Stage 0 to 2 calcanei had 94% of corresponding hip radiographs rated as modified Oxford scores of 16 to 18. Stage 3 calcanei had 54% rated as 16 to 18 and 31% rated as scores 19 to 21. Stage 4 calcanei had 31% rated as scores 19 to 21, and 68% rated as scores 22 to 26. Stage 5 calcanei had 100% rated as 22 to 26. Using data from Popejoy and colleagues' study, the weighted risk of contralateral SCFE was 94% for calcaneal stage 0, 86.5% for calcaneal stage 1, 90.3% for calcaneal stage 2, 55.8% for calcaneal stage 3, 6.1% for calcaneal stage 4, and 0 for calcaneal stage 5.
Calcaneal stages 0 to 3 correspond entirely to modified Oxford scores indicating elevated risk of contralateral SCFE. The calcaneal scoring system has potential for adjunctive use with the modified Oxford score for prediction of contralateral SCFE.
在最近的两项研究中，改良牛津髋关节评分16至18分已被证明可预测单侧股骨头骨骺滑脱（SCFE）对侧滑脱的极高风险。然而，改良牛津系统并未得到广泛应用。这可能部分归因于评分系统的复杂性、在一张x光片上难以查看所有5种影像学特征以及这些特征的表型变异。跟骨骨骺的骨化提供了与身高增长峰值速度相关的骨骼成熟的骨学标志物，此前已有相关描述。我们研究跟骨骨骺骨化序列对预测改良牛津髋关节评分的价值。
我们检查了94名3至18岁健康儿童在同一时段拍摄的279张骨盆及匹配的足部x光片。一名经过专科培训的儿科骨科医生确定每张髋关节x光片的改良牛津髋关节评分。跟骨x光片此前已进行分级。将每组匹配的髋关节和跟骨x光片的改良牛津髋关节评分与跟骨评分进行比较。
0至2期跟骨对应的髋关节x光片中，94%的评分被评为改良牛津评分16至18分。3期跟骨中，54%的评分被评为16至18分，31%的评分被评为19至21分。4期跟骨中，31%的评分被评为19至21分，68%的评分被评为22至26分。5期跟骨的评分全部被评为22至26分。根据波普乔伊及其同事研究的数据，跟骨0期对侧SCFE的加权风险为94%，跟骨1期为86.5%，跟骨2期为90.3%，跟骨3期为55.8%，跟骨4期为6.1%，跟骨5期为0。
跟骨0至3期完全对应于表明对侧SCFE风险升高的改良牛津评分。跟骨评分系统有潜力与改良牛津评分一起辅助用于预测对侧SCFE。
