Loder R T
Department of Orthopaedic Surgery, Indiana University School of Medicine and James Whitcomb Riley Children's Hospital, Indianapolis, Indiana, 46202USA.
J Child Orthop. 2017 Apr;11(2):154-159. doi: 10.1302/1863-2548-11-170005.
To survey the spectrum of surgical care in children with slipped capital femoral epiphysis (SCFE). This information is valuable in counselling the patient about the future treatment course.
Data for this study were obtained from the Pediatric Hospital Information System (PHIS) between 2004 and 2015. For all patients with an ICD9 diagnosis of 732.2, gender, ethnicity, hospital, medical record number, date of birth/admission/discharge, type of admission, length of stay, disposition and treatment(s) rendered were collected.
A total of 13 168 procedures were performed in 11 058 unique SCFE patients, or 1.2 procedures per patient. Primary procedures were those performed for the initial treatment of the SCFE and secondary procedures as reconstructive and salvage. The majority (11 693, 88.8%) were primary. There was significant variation in the ratio of primary and secondary procedures by institution. There was a decline in fixation as the initial SCFE treatment with an increase in open reduction and internal fixation over the 12-year span. Similarly, there was a significant increase in the number of secondary procedures over time as well as complications and implant removal. There was no change over time in the diagnosis of avascular necrosis.
The average number of surgical procedures in patients was in the range of 1 to 6 and varied widely by hospital. Each physician should know his/her own hospital's data for the percentage of subsequent procedures so as to counsel the patient and family properly. The increasing number of complications over time may reflect the increasing number of more complex procedures.
调查儿童股骨头骨骺滑脱（SCFE）的外科治疗范围。该信息对于向患者咨询未来治疗过程具有重要价值。
本研究数据来自2004年至2015年的儿科医院信息系统（PHIS）。对于所有国际疾病分类第九版（ICD9）诊断为732.2的患者，收集其性别、种族、医院、病历号、出生日期/入院/出院日期、入院类型、住院时间、出院去向及所接受的治疗。
11058例独特的SCFE患者共进行了13168例手术，即每位患者平均进行1.2例手术。初次手术是指对SCFE进行初始治疗的手术，二次手术则为重建和挽救性手术。大多数（11693例，88.8%）为初次手术。不同机构的初次和二次手术比例存在显著差异。在这12年期间，作为SCFE初始治疗的固定术比例下降，切开复位内固定术比例上升。同样，随着时间的推移，二次手术的数量以及并发症和植入物取出的数量也显著增加。随着时间的推移，缺血性坏死的诊断没有变化。
患者的平均手术数量在1至6例之间，且因医院而异。每位医生应了解自己医院后续手术百分比的数据，以便为患者及其家属提供恰当的咨询。随着时间的推移并发症数量的增加可能反映了更复杂手术数量地增加。
