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股骨头骨骺滑脱中的骨骺成角及相关空间定位：内翻和外翻滑脱的理论模型及生物力学解释

Epiphyseal Angulation and Related Spatial Orientation in Slipped Capital Femoral Epiphysis: Theoretical Model and Biomechanical Explanation of Varus and Valgus Slip.

作者信息

Gautier Emanuel, Passaplan Caroline, Gautier Lucienne

机构信息

Department of Orthopaedic Surgery, HFR-Cantonal Hospital, Fribourg, Switzerland.

Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland.

出版信息

JB JS Open Access. 2020 Dec 23;5(4). doi: 10.2106/JBJS.OA.20.00099. eCollection 2020 Oct-Dec.

DOI:10.2106/JBJS.OA.20.00099
PMID:33376931
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7757839/
Abstract

UNLABELLED

The management of slipped capital femoral epiphysis (SCFE) is controversial. Surgical decision-making is based regularly on the chronicity, stability, and severity of the slip. The purpose of this study was to determine the true angulation and spatial orientation of the epiphysis in hips with SCFE and contralateral hips.

METHODS

Eighteen hips in 18 patients with SCFE were included in the analysis. Trigonometric calculations, based on angle measurements using 2 conventional radiographs in planes that are perpendicular to each other, were used to determine the angulation of the epiphysis and its orientation in space.

RESULTS

The mean absolute epiphyseal obliquity of the SCFE hips was 56.2° and the spatial orientation was 36.5°. The mean obliquity of the contralateral side was 34.0°, with a related spatial orientation of 16.8°. The maximum error can reach up to 9.9° (or 41%) when comparing the calculated angles with the angle measurements on radiographs.

CONCLUSIONS

On standard radiographs, the epiphyseal angulation in SCFE is consistently underestimated. As a consequence, the assigned classification of some patients may be 1 severity group too low, which impacts the value of traditional severity classification for surgical decision-making. The analysis of the spatial orientation of the slip with the concomitant direction of the resultant shear can partially explain varus and valgus slip in SCFE.

LEVEL OF EVIDENCE

Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

未标注

股骨头骨骺滑脱（SCFE）的治疗存在争议。手术决策通常基于滑脱的慢性程度、稳定性和严重程度。本研究的目的是确定患有SCFE的髋关节以及对侧髋关节中骨骺的真实角度和空间方向。

方法

分析纳入了18例患有SCFE的患者的18个髋关节。基于在相互垂直平面上使用2张传统X线片测量的角度进行三角计算，以确定骨骺的角度及其在空间中的方向。

结果

SCFE髋关节的平均绝对骨骺倾斜度为56.2°，空间方向为36.5°。对侧的平均倾斜度为34.0°，相关空间方向为16.8°。将计算角度与X线片上的角度测量值进行比较时，最大误差可达9.9°（或41%）。

结论

在标准X线片上，SCFE中的骨骺角度始终被低估。因此，一些患者的指定分类可能低1个严重程度组，这影响了传统严重程度分类在手术决策中的价值。对滑脱的空间方向与合成剪切力的伴随方向进行分析，可以部分解释SCFE中的内翻和外翻滑脱。

证据水平

诊断性IV级。有关证据水平的完整描述，请参阅作者指南。

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