Bouchard Marc Daniel, Vescio Bianca G, Munir Mehnaz, Gilbert Justin, de Souza Russell J, Kay Jeffrey, de Sa Darren, Wahi Gita
Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada.
School of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
JBJS Rev. 2025 May 22;13(5). doi: e25.00052. eCollection 2025 May 1.
Childhood obesity is a growing global health crisis with significant health and orthopedic complications such as slipped capital femoral epiphysis (SCFE), a hip disorder characterized by the displacement of the metaphysis relative to the epiphysis. SCFE always requires surgical intervention to prevent severe outcomes such as avascular necrosis, gait abnormalities, and lifelong disability and deformity. Obesity is a well-established risk factor for SCFE; however, emerging evidence suggests that elevated leptin levels may independently contribute to the development of SCFE, regardless of obesity status. This systematic review synthesizes geographic, socioeconomic, age, and sex-related trends in SCFE incidence among children with obesity.
Searches of Embase, OVID Medline, and Emcare databases were performed from inception through October 1, 2024. Observational studies reporting the incidence of SCFE in children and adolescents with obesity (aged ≤18 years) across various geographic populations were included. Studies involving children with other chronic health conditions or animal studies on the physis were excluded. Study quality was evaluated using the methodological index for nonrandomized studies scoring system. Descriptive statistics were presented as absolute frequencies with percentages or as weighted means with corresponding measures of variance where applicable.
Fifteen studies (5,467 patients) from North America, Europe, Asia, and Oceania met inclusion criteria. SCFE patient samples ranged from 55 to 1,630, with some larger cohorts monitoring multiple medical conditions. The mean age was 12.0 years (SD = 0.4), and male-to-female ratios ranged from 1.43:1 to 3.12:1. SCFE incidence varied by region, from 50.5 per 100,000 (Sweden) to 0.33 per 100,000 (South Korea), with a pooled incidence of 9.62 per 100,000. Overweight prevalence was highest in Sweden (66%) and South Korea (67.6%) and lowest in Japan (11.8%). Unilateral SCFE predominated (68.4% to 90.6%). In situ screw fixation was the most common treatment, with 1 study reporting intertrochanteric osteotomy.
Geographic variation in SCFE incidence suggests multifactorial influences beyond obesity, including socioeconomic factors, healthcare access, and genetic predisposition. Limited high-quality comparative studies and inconsistent BMI criteria highlight the need for further research to clarify SCFE risk factors.
Level IV, systematic review. See Instructions for Authors for a complete description of levels of evidence.
儿童肥胖是一个日益严重的全球健康危机，会引发重大的健康和骨科并发症，如股骨头骨骺滑脱（SCFE），这是一种髋关节疾病，其特征是干骺端相对于骨骺发生移位。SCFE总是需要手术干预以防止出现严重后果，如缺血性坏死、步态异常以及终身残疾和畸形。肥胖是SCFE公认的危险因素；然而，新出现的证据表明，无论肥胖状况如何，瘦素水平升高可能独立导致SCFE的发生。本系统评价综合了肥胖儿童中SCFE发病率的地理、社会经济、年龄和性别相关趋势。
检索了Embase、OVID Medline和Emcare数据库，检索时间从建库至2024年10月1日。纳入了报告不同地理人群中肥胖儿童和青少年（年龄≤18岁）SCFE发病率的观察性研究。排除涉及患有其他慢性健康状况儿童的研究或关于生长板的动物研究。使用非随机研究方法学指数评分系统评估研究质量。描述性统计以绝对频率及百分比呈现，或在适用时以加权均值及相应的方差度量呈现。
来自北美、欧洲、亚洲和大洋洲的15项研究（共5467例患者）符合纳入标准。SCFE患者样本数量从55例到1630例不等，一些较大的队列监测了多种疾病。平均年龄为12.0岁（标准差 = 0.4），男女比例从1.43:1到3.12:1不等。SCFE发病率因地区而异，从每10万人50.5例（瑞典）到每10万人0.33例（韩国），合并发病率为每10万人9.62例。超重患病率在瑞典（66%）和韩国（67.6%）最高，在日本（11.8%）最低。单侧SCFE占主导（68.4%至90.6%）。原位螺钉固定是最常见的治疗方法，有1项研究报告了转子间截骨术。
SCFE发病率的地理差异表明，除肥胖外还存在多因素影响，包括社会经济因素、医疗服务可及性和遗传易感性。高质量的比较研究有限且BMI标准不一致，凸显了进一步研究以阐明SCFE危险因素的必要性。
IV级，系统评价。有关证据水平的完整描述，请参阅《作者须知》。
