Karagüven Doğaç, Demir Pervin, Yüksel Selcen, Ömeroğlu Hakan
Department of Orthopaedics and Traumatology, Faculty of Medicine, Ufuk University, Ankara, Turkey.
Department of Biostatistics, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey.
J Child Orthop. 2023 Jun 12;17(4):299-305. doi: 10.1177/18632521231177272. eCollection 2023 Aug.
The aim of this expert consensus study was to establish consensus on the treatment of different types of slipped capital femoral epiphysis and on the use of prophylactic screw fixation of the contralateral unaffected side.
In this study, a four-round Delphi method was used. Questionnaires including all possible theoretical slip scenarios were sent online to 14 participants, experienced in the field of children's orthopedics and in the treatment of hip disorders in children.
In-situ fixation was considered to be the first treatment choice in all types of mild slip scenarios and in moderate, stable ones. Performing in-situ fixation was not favored in moderate, unstable, and in all severe slip scenarios. In moderate to severe, unstable slip scenarios, there was consensus on the use of gentle closed or open reduction and internal fixation. Any consensus was not established in the optimal treatment of severe, stable slips. There was also consensus on the use of prophylactic screw fixation of the contralateral side in case of co-existing endocrine disorder and younger age.
The establishment of consensus on the treatment of all types of slipped capital femoral epiphysis even among the experienced surgeons does not seem to be possible. The severity of the slip and stability of the slip are the primary and secondary determinants of the surgeons' treatment choices, respectively. In-situ fixation is still the preferred treatment option in several slip types. Gentle capital realignment by closed or open means is recommended in displaced, unstable slips. Prophylactic screw fixation of the contralateral side is indicated under certain circumstances.
level V.
本专家共识研究的目的是就不同类型的股骨头骨骺滑脱的治疗以及对侧未受影响侧预防性螺钉固定的使用达成共识。
在本研究中，采用了四轮德尔菲法。将包括所有可能的理论滑脱情况的问卷在线发送给14名在儿童骨科领域和儿童髋部疾病治疗方面有经验的参与者。
原位固定被认为是所有类型轻度滑脱情况以及中度、稳定滑脱情况的首选治疗方法。在中度、不稳定以及所有重度滑脱情况中，不倾向于进行原位固定。在中度至重度、不稳定滑脱情况中，对于采用轻柔的闭合或开放复位及内固定达成了共识。在重度、稳定滑脱的最佳治疗方面未达成任何共识。对于存在内分泌紊乱且年龄较小的情况，对侧预防性螺钉固定的使用也达成了共识。
即使在经验丰富的外科医生中，就所有类型的股骨头骨骺滑脱的治疗达成共识似乎也是不可能的。滑脱的严重程度和滑脱的稳定性分别是外科医生治疗选择的主要和次要决定因素。原位固定在几种滑脱类型中仍然是首选的治疗选择。对于移位、不稳定的滑脱，建议通过闭合或开放方式进行轻柔的股骨头复位。在某些情况下，建议对侧进行预防性螺钉固定。
V级。
