Bond Elizabeth C, Phillips Paul, Larsen Peter D, Hunt Lynette, Willoughby Richard
1 Orthopaedic Department, Wellington Regional Hospital, Wellington, New Zealand.
2 Christchurch Hospital, Christchurch, New Zealand.
J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499018822234. doi: 10.1177/2309499018822234.
In recent years, there has been a trend toward more aggressive management of slipped capital femoral epiphysis (SCFE) with acute anatomical realignment; however, the literature is unclear with regard to the indications for this.
QUESTIONS/PURPOSES: To collect long-term patient-reported outcome scores on a group of SCFE patients using modern hip scores. The second aim was to determine whether there is a threshold level of deformity beyond which patients have predictably poor outcomes following in situ pinning.
Patients presenting with SCFE between 2000 and 2009 completed a survey consisting of three modern hip scores and were classified into poor, intermediate, and good outcome groups. The posterior slope angle (PSA) was used to measure slip deformity. We examined the relationship between patient characteristics and functional outcomes. The relationship between PSA score and overall outcome was examined using receiver operator curve (ROC) analysis.
The total study population was 63; 14% patients had poor, 29% had intermediate, and 57% had good functional outcomes. The mean Non-Arthritic Hip Scores (NAHSs) for those with poor outcomes was 51, 76 in the intermediate group, and 95 in the good group ( p <0.001). PSA was significantly lower in those with good functional outcomes. ROC analysis demonstrated that a higher PSA was moderately predictive of a poor clinical outcome (area under the curve of 0.668). In both the poor and intermediate outcome groups, 50% of patients had a PSA of 40° or greater, whereas only 31% of those with good clinical outcomes had PSA of 40° or greater.
A significant proportion of post-SCFE patients have ongoing suboptimal hip function after pinning in situ. Those with a PSA more than 40° have a higher chance of a poor outcome.
近年来，对于股骨头骨骺滑脱（SCFE）采用急性解剖复位进行更积极治疗的趋势日益明显；然而，关于这种治疗的适应症，文献中并不明确。
问题/目的：使用现代髋关节评分系统收集一组SCFE患者的长期患者报告结局评分。第二个目的是确定是否存在一个畸形阈值，超过该阈值，原位穿针固定术后患者的预后可预测地较差。
2000年至2009年间出现SCFE的患者完成了一项包含三个现代髋关节评分的调查，并被分为预后差、中等和良好三组。使用后倾角（PSA）来测量滑脱畸形。我们研究了患者特征与功能结局之间的关系。使用受试者操作特征曲线（ROC）分析来研究PSA评分与总体结局之间的关系。
总研究人群为63例；14%的患者预后差，29%的患者预后中等，57%的患者功能结局良好。预后差的患者平均非关节炎髋关节评分（NAHSs）为51分，中等组为76分，良好组为95分（p<0.001）。功能结局良好的患者PSA显著更低。ROC分析表明，较高的PSA对不良临床结局有中度预测性（曲线下面积为0.668）。在预后差和中等的两组中，50%的患者PSA为40°或更高，而临床结局良好的患者中只有31%的PSA为40°或更高。
相当一部分SCFE患者原位穿针固定术后髋关节功能仍不理想。PSA超过40°的患者预后不良的可能性更高。
