Dept. of Orthopaedics at Skane University Hospital, Dept. of Clinical Sciences, Lund University, Lund, Sweden.
Dept. of Orthopaedics at Skane University Hospital, Dept. of Clinical Sciences, Lund University, Lund, Sweden.
Osteoarthritis Cartilage. 2018 Apr;26(4):557-563. doi: 10.1016/j.joca.2018.01.013. Epub 2018 Feb 7.
Slipped capital femoral epiphysis (SCFE) in adolescence is associated with increased risk of future osteoarthritis (OA). The purpose of this study was to study clinical and radiographic risk factors for early cartilage degeneration after SCFE.
22 patients (44 hips) (mean age 24 years, range 18-27) treated with in situ fixation (The Hansson hook-pin) for stable SCFE on average 11 years previously were investigated. Cartilage status was assessed with delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC). The alpha angle, reflecting femoroacetabular impingement (FAI), and the original slip angle were measured. Clinical outcome was assessed with the Copenhagen hip and groin outcome score (HAGOS) and clinical examination.
The dGEMRIC index was lower in SCFE hips than unaffected hips 456 ms (CI 419-493) vs 521 ms (CI 476-567) (P = 0.03). The difference was larger (mean 21 ms) in anterior than posterior regions of the hip (P = 0.038). The alpha angle was higher in SCFE hips, 61.5° (CI 53.9-69.1) vs 45.6° (CI 43.6-47.6), (P < 0.001). The alpha angle, but not the original slip angle, correlated negatively with the dGEMRIC index (R = -0.40, P = 0.046). There was a positive correlation between HAGOS and the dGEMRIC-index (R = 0.41, P = 0.012).
Early cartilage degeneration after SCFE seems related to persisting FAI in adulthood, rather than the initial slip severity. The correlation between dGEMRIC and HAGOS indicates a clinical relevance of the MRI findings. Our results suggest that FAI after SCFE should be evaluated already after physeal closure in order to predict and possibly prevent future OA development.
青少年骺滑脱（SCFE）与未来骨关节炎（OA）的风险增加有关。本研究的目的是研究 SCFE 后早期软骨退变的临床和影像学危险因素。
研究了 22 例（44 髋）（平均年龄 24 岁，范围 18-27 岁）接受原位固定（汉森钩-钉）治疗的稳定 SCFE 患者，平均随访 11 年。采用延迟钆增强磁共振成像软骨成像（dGEMRIC）评估软骨状态。测量 alpha 角，反映股骨髋臼撞击（FAI），以及原始滑移角。临床结果采用哥本哈根髋关节和腹股沟结局评分（HAGOS）和临床检查进行评估。
SCFE 髋的 dGEMRIC 指数低于未受影响的髋 456ms（CI 419-493）比 521ms（CI 476-567）（P=0.03）。在前部区域，差异较大（平均 21ms）（P=0.038）。SCFE 髋的 alpha 角较高，61.5°（CI 53.9-69.1）比 45.6°（CI 43.6-47.6）（P<0.001）。alpha 角与 dGEMRIC 指数呈负相关（R=-0.40，P=0.046），但原始滑移角无相关性。HAGOS 与 dGEMRIC 指数呈正相关（R=0.41，P=0.012）。
SCFE 后早期软骨退变似乎与成年后持续的 FAI 有关，而与初始滑移程度无关。dGEMRIC 与 HAGOS 的相关性表明 MRI 发现具有临床意义。我们的结果表明，SCFE 后应在骺板闭合后评估 FAI，以预测和可能预防未来 OA 的发展。
