Samelis Panagiotis V, Loukas Christos, Kantanoleon Sophia, Lalos Harris, Anoua Nikolaos, Kolovos Panagiotis, Georgiou Flourentzos, Konstantinou Apostolos-Lykourgos
First Orthopaedic Department, Children's General Hospital Panagiotis & Aglaia Kyriakou, Athens, GRC.
Orthopaedics, Orthopaedic Research and Education Center, Attikon University Hospital, Athens, GRC.
Cureus. 2020 Apr 18;12(4):e7718. doi: 10.7759/cureus.7718.
Delayed diagnosis and treatment is a universally reported problem that impairs the prognosis of slipped capital femoral epiphysis (SCFE). Quite frequently, a delayed diagnosis of SCFE is observed in spite of serial admissions and examinations of the limping adolescent. Why do health professionals globally fail to make a definitive diagnosis of SCFE during the first examination of the patient? A retrospective study of 36 adolescents treated for stable SCFE and two adolescents treated for unstable SCFE has been performed. In more than half of the delayed diagnosed stable slips (13/25, 52%), the diagnosis was set after serial examinations of the patient. Health professionals commonly order only the anteroposterior (AP) X-ray view of the pelvis when examining a non-traumatic limping adolescent. The frog lateral (FL) projection is usually spared in an attempt to limit the radiation exposure of the patient, especially in ambulating adolescents with mild symptoms. It is proposed that in the non-traumatic limping adolescent, the FL projection instead of the AP pelvis view should be requested by the health professional in order to timely diagnose a surgical emergency of the adolescent hip such as SCFE.
诊断和治疗延迟是一个普遍报道的问题，它会损害股骨头骨骺滑脱（SCFE）的预后。尽管对跛行青少年进行了多次入院检查，但SCFE的延迟诊断仍屡见不鲜。为什么全球的医疗专业人员在首次检查患者时未能对SCFE做出明确诊断？对36例接受稳定型SCFE治疗的青少年和2例接受不稳定型SCFE治疗的青少年进行了一项回顾性研究。在超过一半延迟诊断的稳定型滑脱病例中（13/25，52%），是在对患者进行多次检查后才做出诊断的。医疗专业人员在检查非创伤性跛行青少年时，通常只要求拍摄骨盆前后位（AP）X线片。为了限制患者的辐射暴露，尤其是对症状较轻的行走青少年，通常不拍摄蛙式侧位（FL）片。建议医疗专业人员在非创伤性跛行青少年中要求拍摄FL片而非AP骨盆位片，以便及时诊断青少年髋部的外科急症，如SCFE。
