School of Nursing, Chengdu University, Chengdu, China.
Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
J Orthop Surg Res. 2024 Sep 11;19(1):560. doi: 10.1186/s13018-024-05070-7.
Transient synovitis of the hip is the most common cause of limping in paediatric emergency departments. There is no consensus regarding routine follow-up after hip synovitis among children, and there are no standardized criteria for selecting cases that warrant follow-up due to persistent or recurring symptoms to rule out the possibility of Legg-Calvé-Perthes disease. Delayed treatment of Legg-Calvé-Perthes disease may increase the risk of developing early secondary coxarthrosis. Understanding the prevalence of Legg-Calvé-Perthes disease among paediatric patients with transient synovitis of the hip is of paramount importance and could empower both parents and paediatricians to make well-informed decisions when selecting follow-up care for children, thus ensuring that no cases of Legg-Calvé-Perthes disease are missed among diagnosis paediatric patients with transient synovitis of the hip. The aim of this review was to estimate the prevalence of Legg-Calvé-Perthes disease among paediatric patients with transient synovitis of the hip.
This study was conducted in strict accordance with the PRISMA guidelines and was registered with PROSPERO. The PubMed, Embase, and Cochrane Library databases were comprehensively searched up to July 2024 to identify relevant studies. The inclusion criteria were as follows: patients diagnosed with transient synovitis of the hip; patients aged up to 18 years; and studies with a minimum of 10 cases of paediatric transient synovitis of the hip. To pool the prevalence rates from individual studies, we utilized a random-effects meta-analysis. To assess the quality of the included studies in detail, we employed the Joanna Briggs Institute's quality assessment checklist.
A total of 19 studies were ultimately included for the final analysis, with 2,617 paediatric cases of transient synovitis of the hip. The results of meta-analysis revealed that the pooled prevalence estimate of Legg-Calvé-Perthes disease among all paediatric patients with transient synovitis of the hip was 2.7% (95% CI 1.4-5.1). Significant heterogeneity was observed across the studies included in this analysis (I = 79.990%; P = 0.000). The pooled prevalence estimate of Legg-Calvé-Perthes disease among paediatric patients with recurrent or persistent transient synovitis of the hip was 36.3% (95% CI 21.6-54.2). Significant heterogeneity was also observed across the studies included in this analysis (I = 51.519%; P = 0.036). Furthermore, the follow-up period varied from 6 weeks to 24 months. The primary diagnostic imaging modality utilized for identifying Perthes disease was X-ray.
Our study revealed that among paediatric patients with transient synovitis of the hip, routine X-ray follow-up of the hips after 6 weeks to rule out Legg-Calvé-Perthes disease is warranted only in patients who exhibit persistent or recurrent symptoms.
髋关节一过性滑膜炎是小儿急救科跛行最常见的原因。对于髋关节滑膜炎患儿，常规随访尚无共识，也没有标准化的标准来选择需要因持续或反复症状进行随访的病例，以排除 Legg-Calvé-Perthes 病的可能性。延迟治疗 Legg-Calvé-Perthes 病可能会增加发生早期继发性髋关节骨关节炎的风险。了解髋关节一过性滑膜炎患儿中 Legg-Calvé-Perthes 病的患病率至关重要，这可以使家长和儿科医生在为儿童选择随访护理时做出明智的决策，从而确保在诊断为髋关节一过性滑膜炎的儿童中不会漏诊任何 Legg-Calvé-Perthes 病病例。本综述的目的是估计髋关节一过性滑膜炎患儿中 Legg-Calvé-Perthes 病的患病率。
本研究严格按照 PRISMA 指南进行，并在 PROSPERO 上进行了注册。全面检索了 PubMed、Embase 和 Cochrane 图书馆数据库，截至 2024 年 7 月，以确定相关研究。纳入标准为：诊断为髋关节一过性滑膜炎的患者；年龄在 18 岁以下；至少有 10 例小儿髋关节一过性滑膜炎。为了从个体研究中汇总患病率，我们使用了随机效应荟萃分析。为了详细评估纳入研究的质量，我们使用了 Joanna Briggs 研究所的质量评估清单。
最终共有 19 项研究纳入最终分析，共纳入 2617 例小儿髋关节一过性滑膜炎。荟萃分析结果显示，所有髋关节一过性滑膜炎患儿中 Legg-Calvé-Perthes 病的总体患病率估计为 2.7%（95%CI 1.4-5.1）。该分析纳入的研究存在显著异质性（I=79.990%；P=0.000）。在反复发作或持续性髋关节一过性滑膜炎的患儿中，Legg-Calvé-Perthes 病的患病率估计为 36.3%（95%CI 21.6-54.2）。该分析纳入的研究也存在显著异质性（I=51.519%；P=0.036）。此外，随访时间从 6 周到 24 个月不等。用于识别 Perthes 病的主要诊断影像学方法是 X 射线。
我们的研究表明，在髋关节一过性滑膜炎的患儿中，只有在出现持续或反复症状的情况下，才需要在 6 周后对髋关节进行常规 X 射线随访以排除 Legg-Calvé-Perthes 病。
