Zusman Natalie L, Goldstein Rachel Y, Yoo Jung U
Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR.
J Pediatr Orthop. 2024 Jan 1;44(1):e30-e34. doi: 10.1097/BPO.0000000000002539. Epub 2023 Sep 29.
Slipped capital femoral epiphysis (SCFE) is a disorder of the proximal femoral physis occurring in late childhood and adolescence. Previously postulated risk factors include obesity and endocrinopathies. The purpose of this investigation was to identify risk factors for developing SCFE, as well as postslip osteonecrosis (ON), among the United States pediatric population.
A national database investigation was performed using PearlDiver Technologies, Inc., queried for SCFE and ON using International Classification of Disease codes (2010 to 2020). Regression analyses to determine the risk of developing a SCFE, and ON after a patient has already been diagnosed with a SCFE ("postslip"). Propensity matching between SCFE and control groups generated a pseudo-randomization model to compare the relative risk.
There were 11,465 patients with SCFE available in the database, matched with 134,680 controls. After matching, vitamin D deficiency, obesity, hypothyroidism, and growth hormone use were risk factors for developing SCFE [relative risk ranges from 1.42 (95% CI: 1.21-1.39, vitamin D deficiency) to 3.45 (95% CI: 3.33-3.57, obesity)]. ON risk factors were vitamin D deficiency [1.65 (1.26-2.14)] and hypothyroidism [1.49 (1.10-2.07)].
This United States national database study quantified risk factors of developing an SCFE and postslip ON. Obesity is the most significant risk factor for the development of a slip, but not ON. Growth hormone use, hypothyroidism, and vitamin D deficiency are also risk factors for SCFE development, whereas only the latter two were associated with ON. These findings demonstrate the public health implications of obesity and comorbid conditions in pediatric hip pathology.
Level III.
股骨头骨骺滑脱（SCFE）是一种发生于儿童晚期和青少年期的近端股骨骨骺疾病。先前推测的风险因素包括肥胖和内分泌疾病。本研究的目的是确定美国儿科人群中发生SCFE以及滑脱后骨坏死（ON）的风险因素。
使用PearlDiver Technologies公司进行全国性数据库调查，利用国际疾病分类代码（2010年至2020年）查询SCFE和ON。进行回归分析以确定发生SCFE的风险，以及患者已被诊断为SCFE（“滑脱后”）后的ON风险。SCFE组与对照组之间的倾向匹配产生了一个伪随机化模型，以比较相对风险。
数据库中有11465例SCFE患者，与134680例对照匹配。匹配后，维生素D缺乏、肥胖、甲状腺功能减退和使用生长激素是发生SCFE的风险因素[相对风险范围从1.42（95%CI：1.21 - 1.39，维生素D缺乏）到3.45（95%CI：3.33 - 3.57，肥胖）]。ON的风险因素是维生素D缺乏[1.65（1.26 - 2.14）]和甲状腺功能减退[1.49（1.10 - 2.07）]。
这项美国全国性数据库研究量化了发生SCFE和滑脱后ON的风险因素。肥胖是发生滑脱的最主要风险因素，但不是发生ON的风险因素。使用生长激素、甲状腺功能减退和维生素D缺乏也是SCFE发生的风险因素，而只有后两者与ON相关。这些发现表明肥胖和合并症在儿童髋关节病理学中的公共卫生意义。
三级。
