Wylie James D, Novais Eduardo N
Intermountain Health Care, The Orthopedic Specialty Hospital, Salt Lake City, Murray, UT, 84107, USA.
Boston Children's Hospital, Boston, MA, USA.
Curr Rev Musculoskelet Med. 2019 Jun;12(2):213-219. doi: 10.1007/s12178-019-09547-5.
To review slipped capital femoral epiphysis (SCFE), with a focus on new insights into its etiology and evolving methods of operative fixation.
The epiphyseal tubercle and its size during adolescence are paramount to understanding the mechanism of SCFE. In chronic stable SCFE, the epiphysis rotates about the tubercle protecting the lateral epiphyseal vessels from disruption. In an acute unstable SCFE, the tubercle displaces, increasing the risk of osteonecrosis, also known as avascular necrosis (AVN). Intraoperative stability suggests that stable and unstable SCFE based on ambulation may be inaccurate. For stable SCFE, in situ pinning remains the most accepted treatment for mild slips with delayed symptomatic femoroacetabular impingement (FAI) management. Treatment of moderate to severe stable slips with realignment osteotomy leads to less femoral deformity and potentially better outcomes. However, it has a higher risk of complications, including AVN and chondrolysis. Our knowledge of the etiology for SCFE is evolving. The optimal technique for operative treatment of moderate to severe SCFE is controversial and varies by center. Well-controlled studies of these patients are needed to understand the best treatment for this difficult problem. Furthermore, increasing the awareness about SCFE is paramount to allow for early recognition and treatment of deformity at its early stages and avoiding severe SCFE deformity which has been associated with worse long-term outcomes.
回顾股骨头骨骺滑脱（SCFE），重点关注其病因的新见解以及不断发展的手术固定方法。
青春期的骨骺结节及其大小对于理解SCFE的机制至关重要。在慢性稳定型SCFE中，骨骺围绕结节旋转，保护外侧骨骺血管不受破坏。在急性不稳定型SCFE中，结节移位，增加了骨坏死（也称为缺血性坏死，AVN）的风险。术中稳定性表明，基于行走情况来区分稳定型和不稳定型SCFE可能不准确。对于稳定型SCFE，原位穿针仍然是轻度滑脱伴延迟出现症状性股骨髋臼撞击症（FAI）处理时最被认可的治疗方法。采用截骨矫形治疗中度至重度稳定型滑脱可减少股骨畸形，并可能获得更好的疗效。然而，其并发症风险较高，包括AVN和软骨溶解。我们对SCFE病因的认识正在不断发展。对于中度至重度SCFE的最佳手术治疗技术存在争议，且因中心而异。需要对这些患者进行严格对照研究，以了解针对这一难题的最佳治疗方法。此外，提高对SCFE的认识对于早期识别和治疗畸形、避免与更差长期预后相关的严重SCFE畸形至关重要。
