Terjesen T, Wensaas A
Department of Orthopaedics, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway.
Department of Orthopaedics, Akershus University Hospital 1487 Lørenskog, Norway.
J Child Orthop. 2017 Apr;11(2):114-119. doi: 10.1302/1863-2548-11-160285.
Predictive factors for long-term outcome after fixation for chronic slipped capital femoral epiphysis (SCFE) have so far not been systematically analysed. The aims of this study were to define predictors for long-term outcome and to assess the association between initial grade of slipping and post-slip deformities.
We studied 51 patients (60 hips) with chronic SCFE treated with fixation. There were 31 males and 20 females with a mean age of 12.9 years. The mean follow-up was 39.0 years (21.1 to 56.8). Post-slip deformity was defined as abnormal alpha (a) angles in anteroposterior (AP) and lateral radiographs; AP angle of 74° and lateral angle of 63° were used as cutoffs between normal and abnormal α-angles. Harris hip score (HHS) less than 85 points was classified as a poor clinical outcome and osteoarthritis was a poor radiographic outcome.
The mean slip angle was 31.7° (12° to 77°). The mean AP α-angle was 67.4° (36° to 111°) and the mean lateral α-angle was 57.1° (22° to 104°). Post-slip deformities developed in almost one-third of hips with a mild degree of slipping and in about half the hips with more pronounced degrees of slipping. The long-term outcome was good in 40 hips (67%) and poor in 20 hips. A small AP α-angle was the only independent prognostic factor for a good combined clinical and radiographic outcome.
Post-slip deformity, defined as an abnormally high AP α-angle, is the most important prognostic factor for poor long-term clinical and radiographic outcome in chronic SCFE treated with fixation.
迄今为止，对于慢性股骨头骨骺滑脱（SCFE）固定术后长期预后的预测因素尚未进行系统分析。本研究的目的是确定长期预后的预测因素，并评估初始滑脱程度与滑脱后畸形之间的关联。
我们研究了51例接受固定治疗的慢性SCFE患者（60髋）。其中男性31例，女性20例，平均年龄12.9岁。平均随访时间为39.0年（21.1至56.8年）。滑脱后畸形定义为前后位（AP）和侧位X线片上异常的α角；AP角74°和侧角63°被用作正常与异常α角的分界值。Harris髋关节评分（HHS）低于85分被分类为临床预后不良，骨关节炎被分类为放射学预后不良。
平均滑脱角为31.7°（12°至77°）。平均AP α角为67.4°（36°至111°），平均侧位α角为57.1°（22°至104°）。几乎三分之一轻度滑脱的髋关节和大约一半滑脱程度更明显的髋关节出现了滑脱后畸形。40髋（67%）长期预后良好，20髋预后不良。小的AP α角是临床和放射学综合预后良好的唯一独立预后因素。
定义为异常高的AP α角的滑脱后畸形是接受固定治疗的慢性SCFE长期临床和放射学预后不良的最重要预后因素。
