Aversano Michael W, Moazzaz Payam, Scaduto Anthony A, Otsuka Norman Y
Department of Orthopedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, 301 East 17th Street, New York, NY, USA.
Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA.
J Child Orthop. 2016 Jun;10(3):209-13. doi: 10.1007/s11832-016-0731-y. Epub 2016 Apr 19.
Children who present with idiopathic slipped capital femoral epiphysis (SCFE) have an increased risk of developing bilateral disease. Predicting which patients will develop problems with bilateral hips is important for determining treatment algorithms. This is a retrospective observational study that evaluates the relationship and risk between body mass index (BMI)-for-age and unilateral and bilateral SCFE in patients followed until physeal closure.
This is a retrospective study of all patients with SCFE presenting to one institution from 1998-2005. Using the Center for Disease Control (CDC) references, BMI-for-age was calculated for each patient. The patients were followed up until complete closure of the bilateral proximal femoral physes, which was considered completion of the study. Statistical analysis for significant differences between groups was performed using the Kruskal-Wallis test for equality of populations. A logistic regression, controlling for age and gender, was used to identify BMI-for-age as a risk factor and to determine the significance of the odds ratios (ORs) for the relevant categorical variables-obese, overweight and healthy weight.
Eighty patients (56 male, 24 female) presented to a single institution between 1998 and 2005 with a diagnosis of SCFE. The mean age of patients was 12.2 years at initial presentation (range 8.5-16). Forty-eight patients (32 male, 16 female) presented with unilateral SCFE, with 22 of the 48 patients having a BMI for-age percentile ≥95 %. Thirty-two patients (24 male, 8 female) presented with bilateral SCFE, with 29 of the 32 patients having a BMI-for-age percentile ≥95 %. Patients with a BMI-for-age ≥95 % had a significantly increased risk of presentation with bilateral slips (OR 4.83; relative risk [RR] 3.01; p < 0.05]. All but one patient in this study with bilateral SCFE or unilateral SCFE with subsequent contralateral involvement had a BMI-for-age ≥85 % (44 out of 45 patients). Additionally, the overall risk of developing bilateral SCFE until physeal closure with a BMI-for-age ≥95 % was significantly increased (OR 3.84; RR 2.02; p < 0.05; number needed to treat [NNT] 3.01).
Previous work has established a relationship between BMI and SCFE. The CDC BMI-for-age growth charts more accurately measure obesity in the pediatric population compared to BMI and are therefore a more appropriate reference tool. This study demonstrates an association between obesity measured by BMI-for-age percentiles and SCFE. This study also demonstrates an association between BMI-for-age and risk for bilateral SCFE at presentation as well as overall incidence of developing bilateral SCFE in the obese pediatric population. By defining the at-risk population through BMI-for-age, physicians can screen the pediatric patient population and provide early strategies for therapeutic weight loss which may reduce the incidence of SCFE.
出现特发性股骨头骨骺滑脱（SCFE）的儿童发生双侧病变的风险增加。预测哪些患者双侧髋关节会出现问题对于确定治疗方案很重要。这是一项回顾性观察研究，评估了在随访至骨骺闭合的患者中，年龄别体重指数（BMI）与单侧和双侧SCFE之间的关系及风险。
这是一项对1998年至2005年在某一机构就诊的所有SCFE患者的回顾性研究。根据疾病控制中心（CDC）的参考标准，计算每位患者的年龄别BMI。对患者进行随访，直至双侧股骨近端骨骺完全闭合，此时视为研究结束。使用Kruskal-Wallis检验对总体进行平等性分析，以检验组间的显著差异。采用逻辑回归分析，控制年龄和性别因素，将年龄别BMI确定为风险因素，并确定相关分类变量（肥胖、超重和健康体重）的优势比（OR）的显著性。
1998年至2005年期间，80例患者（56例男性，24例女性）在某一机构被诊断为SCFE。患者初次就诊时的平均年龄为12.2岁（范围8.5 - 16岁）。48例患者（32例男性，16例女性）表现为单侧SCFE，其中48例患者中有22例年龄别BMI百分位数≥95%。32例患者（24例男性，8例女性）表现为双侧SCFE，其中32例患者中有29例年龄别BMI百分位数≥95%。年龄别BMI≥95%的患者出现双侧滑脱的风险显著增加（OR 4.83；相对风险[RR] 3.01；p < 0.05）。本研究中，除1例患者外，所有双侧SCFE或单侧SCFE随后对侧受累的患者年龄别BMI≥85%（45例患者中的44例）。此外，年龄别BMI≥95%的患者在骨骺闭合前发生双侧SCFE的总体风险显著增加（OR 3.84；RR 2.02；p < 0.05；治疗所需人数[NNT] 3.01）。
先前的研究已经确立了BMI与SCFE之间的关系。与BMI相比，CDC年龄别BMI生长图表能更准确地衡量儿科人群的肥胖情况，因此是更合适的参考工具。本研究表明，年龄别BMI百分位数所衡量的肥胖与SCFE之间存在关联。本研究还表明，年龄别BMI与就诊时双侧SCFE的风险以及肥胖儿科人群中双侧SCFE发生的总体发生率之间存在关联。通过年龄别BMI确定高危人群，医生可以对儿科患者群体进行筛查，并提供早期治疗性体重减轻策略，这可能会降低SCFE的发生率。
