Danino Baruch, Singh Satbir, Shi Junxin, Yang Jingzhen, Samora Walter P, Iobst Christopher A, Klingele Kevin E
Nationwide Children's Hospital, Columbus, Ohio, USA.
The Department of Pediatric Orthopaedics, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Israel.
J Child Orthop. 2020 Oct 1;14(5):387-396. doi: 10.1302/1863-2548.14.200080.
The study aimed to develop a scoring system based on clinical and radiological findings to predict the risk of a sequential slipped capital femoral epiphysis (SCFE).
Paediatric patients with unilateral SCFE and at least two years of radiographic follow-up were screened for inclusion. Medical records were reviewed for multiple variables including age, gender, body mass index (BMI), stability of SCFE, and time to sequential presentation. Radiographic analysis included triradiate physeal status, Risser staging, superior epiphyseal extension ratio (EER), posterior epiphyseal angle (PEA), posterior sloping angle (PSA) and slip severity.
In total, 163 patients (88 male, 54%, 75 female, 46%) met inclusion criteria. Of those, 65 (40%) with a mean age of 11.9 ± 1.3 years developed sequential SCFE at a mean of 9.8 ± 6.4 months after the initial slip. Eight independent variables were statistically different (p < 0.05) between unilateral and sequential groups. Following multivariate analysis, Risser stage and triradiate status were no longer significant and did not influence the strength of the final model (overall area under the curve (AUC) = 0.954) and were consequently excluded. We developed the PASS score using three radiographic parameters using chosen cut-off values that were close to their maximized value and weighted the point value assigned to each parameter based on the strength of predictor.
A PASS score of three or higher predicts a high probability of sequential SCFE with 95% confidence and may warrant prophylactic screw fixation. PASS score calculation can be used to predict a sequential SCFE and provide an objective method to determine the utility prophylactic screw fixation.
II.
本研究旨在基于临床和影像学检查结果开发一种评分系统，以预测继发性股骨头骨骺滑脱（SCFE）的风险。
筛选出单侧SCFE且有至少两年影像学随访资料的儿科患者纳入研究。查阅病历，记录包括年龄、性别、体重指数（BMI）、SCFE的稳定性以及出现继发性滑脱的时间等多个变量。影像学分析包括三骨骺骺板状态、Risser分期、上骨骺延伸率（EER）、后骨骺角（PEA）、后倾斜角（PSA）以及滑脱严重程度。
共有163例患者（88例男性，占54%；75例女性，占46%）符合纳入标准。其中，65例（40%）平均年龄为11.9±1.3岁，在初次滑脱后平均9.8±6.4个月出现继发性SCFE。单侧组和继发性组之间有8个独立变量存在统计学差异（p<0.05）。多因素分析后，Risser分期和三骨骺状态不再具有显著性，且不影响最终模型的强度（曲线下总面积（AUC）=0.954），因此被排除。我们使用三个影像学参数开发了PASS评分，采用接近其最大值的选定临界值，并根据预测因子的强度对每个参数赋予的分值进行加权。
PASS评分为3分或更高预测继发性SCFE的可能性很高，置信度为95%，可能需要进行预防性螺钉固定。PASS评分计算可用于预测继发性SCFE，并为确定预防性螺钉固定的实用性提供一种客观方法。
II级。
