Department of Orthopaedics, Washington University in St Louis, St Louis, MO.
J Pediatr Orthop. 2021 Jul 1;41(6):e398-e403. doi: 10.1097/BPO.0000000000001797.
Slipped capital femoral epiphysis (SCFE) is a common hip problem in children. The resulting deformity can cause impingement similar to cam-type idiopathic femoroacetabular impingement (FAI). Although there are similarities between FAI and SCFE, deformity patterns, severity, and time of onset of symptoms varies, which may impact management. The purpose of this study was to describe patterns of articular cartilage damage in patients undergoing surgical hip dislocation for sequelae of SCFE in comparison to patients undergoing arthroscopic surgery for primary FAI.
Patients were identified who underwent surgical treatment for hip pain due to primary FAI (cam type) or sequelae of SCFE. Clinical data and radiographic measurements were recorded. Cartilage was assessed intraoperatively. Severity was classified using the modified Beck classification, while location was classified into 6 sectors. Statistical analysis was performed to test for differences in demographic and radiographic characteristics between the SCFE and FAI patients. χ2 or Fisher exact tests were used to evaluate trends in patterns of acetabular and femoral cartilage wear between SCFE and FAI groups.
The SCFE group had 28 hips compared with 304 in the FAI group. SCFE patients were younger (19 vs. 32, P<0.001), had higher body mass index (30±5.9 vs. 24±4.8, P<0.001), and were more often male (61% vs. 27%, P<0.001). Deformity severity based on α-angle was higher in the SCFE group [AP 74 vs. 55 (P=0.001) and Dunn 72 vs. 58 (P<0.001)]. There were no significant differences with regards to lateral center edge angle, anterior center edge angle, or Tonnis angle. In both groups the most common locations for cartilage lesions in both groups were the anterior peripheral and superolateral peripheral regions with fewer but more widely distributed femoral head lesions. The SCFE group had higher rates of femoral head and superolateral central cartilage lesions compared with the FAI group. There was no statistical difference between high-grade femoral or acetabular cartilage lesions between groups.
Patients with SCFE were younger at the time of surgery and presented with more severe deformity based on radiographic α-angle compared to patients with FAI. Our results suggest higher prevalence of femoral head lesions and more diffuse cartilage injury in patients with SCFE. This study can be used to support early surgical intervention in patients with symptomatic sequelae of SCFE due to risk of premature joint damage.
Level III-prognostic study.
股骨头骨骺滑脱（SCFE）是儿童常见的髋关节问题。由此导致的畸形可引起类似于凸轮型特发性髋关节撞击症（FAI）的撞击。尽管 FAI 和 SCFE 之间存在相似之处，但畸形模式、严重程度和症状出现时间有所不同，这可能会影响治疗方法。本研究旨在描述因 SCFE 后遗症而接受手术髋关节脱位治疗的患者与因原发性 FAI（凸轮型）而接受关节镜手术治疗的患者的关节软骨损伤模式。
确定因原发性 FAI（凸轮型）或 SCFE 后遗症而接受髋关节疼痛手术治疗的患者。记录临床数据和影像学测量值。术中评估软骨。使用改良 Beck 分类法对严重程度进行分类，同时将位置分为 6 个扇区。进行统计分析以检验 SCFE 和 FAI 患者在人口统计学和影像学特征方面的差异。χ2 或 Fisher 确切检验用于评估 SCFE 和 FAI 组之间髋臼和股骨软骨磨损模式的趋势。
SCFE 组有 28 个髋关节，FAI 组有 304 个髋关节。SCFE 患者更年轻（19 岁 vs. 32 岁，P<0.001），体重指数更高（30±5.9 比 24±4.8，P<0.001），且更多为男性（61% vs. 27%，P<0.001）。根据 α 角，SCFE 组的畸形严重程度更高[AP 为 74°比 55°（P=0.001），Dunn 为 72°比 58°（P<0.001）]。外侧中心边缘角、前中心边缘角或 Tonnis 角无显著差异。在两组中，最常见的软骨病变部位均为前外周和超外侧外周区域，但股骨头上的病变较少但分布更广。与 FAI 组相比，SCFE 组的股骨头和超外侧中央软骨病变发生率更高。两组中股骨或髋臼软骨高级别病变的发生率无统计学差异。
与 FAI 患者相比，SCFE 患者在手术时更年轻，且根据影像学 α 角，其畸形更为严重。我们的研究结果表明，SCFE 患者的股骨头病变发生率更高，且软骨损伤更广泛。本研究可用于支持因存在早期关节损伤风险而对有症状的 SCFE 后遗症患者进行早期手术干预。
III 级-预后研究。
