Maranho D A, Davila-Parrilla A, Miller P E, Kim Y-J, Novais E N, Millis M B
Department of Orthopedic Surgery, Boston Children's Hospital, Boston, USA.
Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
J Child Orthop. 2018 Oct 1;12(5):444-453. doi: 10.1302/1863-2548.12.180057.
To investigate changes in acetabular morphology during the follow-up of slipped capital femoral epiphysis (SCFE) and search for factors associated with acetabular dysplasia at skeletal maturity.
We evaluated 108 patients with unilateral SCFE (mean age at slip, 12.3 years sd 1.7) to skeletal maturity, with a minimum follow-up of two years (median 4.5 years; interquartile range 3.2 to 6.2). Acetabular parameters obtained from initial and most recent radiographs included the lateral centre-edge angle (LCEA), Tönnis angle (TA) and acetabular depth-width ratio (ADR). Acetabular dysplasia was considered for LCEA < 20° or TA > 10°. Femoral parameters consisted of the most recent head diameter, neck-shaft angle, neck length, articulotrochanteric distance and alpha angle.
At SCFE onset, the affected hip showed a slightly lower LCEA (26.4° sd 6.1° 27.3° sd 5.7°; p = 0.01) and ADR (330 sd 30 340 sd 30; p < 0.001) compared with the uninvolved hip. At final follow-up, the affected hip showed lower LCEA (24.5° sd 7.6° 28.8°sd 6.6°; p < 0.001) and ADR (330 sd 40 350 sd 40; p < 0.001), and TA was larger (5.5° sd 5.4° 2.3° sd 4.2°; p < 0.001) compared with the uninvolved hip. Acetabular dysplasia was observed in 27 (25%) of 108 hips with SCFE. Femoral head overgrowth, age at slip and SCFE severity were independent factors associated with acetabular dysplasia (p < 0.05).
Acetabular coverage and depth are not increased in SCFE, and the acetabular coverage tends to decrease up to skeletal maturity. A potential disturbance in the acetabular growth and remodelling exists mainly for young children with severe SCFE, and a potential for acetabular insufficiency may be observed at the diagnosis and follow-up of SCFE.
Prognostic Level IV.
研究股骨头骨骺滑脱（SCFE）随访期间髋臼形态的变化，并寻找骨骼成熟时与髋臼发育不良相关的因素。
我们评估了108例单侧SCFE患者（滑脱时平均年龄12.3岁，标准差1.7）直至骨骼成熟，最短随访2年（中位数4.5年；四分位间距3.2至6.2年）。从初始和最近的X线片获得的髋臼参数包括外侧中心边缘角（LCEA）、Tönnis角（TA）和髋臼深度-宽度比（ADR）。LCEA<20°或TA>10°时考虑髋臼发育不良。股骨参数包括最近的股骨头直径、颈干角、颈长、关节转子间距离和α角。
SCFE发病时，患侧髋关节的LCEA（26.4°±6.1°对27.3°±5.7°；p=0.01）和ADR（330±30对340±30；p<0.001）略低于未受累侧髋关节。在末次随访时，患侧髋关节的LCEA（24.5°±7.6°对28.8°±6.6°；p<0.001）和ADR（330±40对350±40；p<0.001）更低，且TA更大（5.5°±5.4°对2.3°±4.2°；p<0.001）。108例SCFE髋关节中有27例（25%）观察到髋臼发育不良。股骨头过度生长、滑脱时的年龄和SCFE严重程度是与髋臼发育不良相关的独立因素（p<0.05）。
SCFE患者髋臼覆盖度和深度未增加，髋臼覆盖度在骨骼成熟前有降低趋势。主要在患有严重SCFE的幼儿中存在髋臼生长和重塑的潜在干扰，在SCFE的诊断和随访中可能观察到髋臼功能不全的可能性。
预后IV级。
