Xu Zihang, Zhu Lei, Kong Laifa, Qian Yuwang, Zhang Xin, Feng Yuchong, Wu Yiming, Shi Tao
Department of Pediatric Orthopedic Surgery, Jinhua Maternity and Child Health Care Hospital, Jinhua, Zhejiang, China.
School of Medicine, Xiamen University, Xiamen, Fujian, China.
PLoS One. 2025 Jul 30;20(7):e0329275. doi: 10.1371/journal.pone.0329275. eCollection 2025.
The risk factors for avascular necrosis (AVN) in patients with unstable slipped capital femoral epiphysis (SCFE) were controversial and multifactorial. This meta-analysis summarizes existing evidence to identify risk factors for AVN.
Search strategies followed the recommendations of the Cochrane Collaboration. Electronic searches such as PubMed, Embase, Web of Science, Cochrane were systematically searched for publications concerning risk factors for unstable SCFE from the inception date to October 2024. The RevMan 5.3 software and Stata 17.0 software were used for the meta-analysis. Finally, publication bias and sensitivity analysis were carried out.
This study included 16 articles involving 688 hips. We found that the overall incidence of AVN was 23%. Our research indicated that male gender (OR = 2.37; 95% CI = 1.23 to 4.58, P = 0.01), the moderate and severe slip (OR = 0.09; 95% CI = 0.02 to 0.37, P < 0.001), the acute slip (OR = 3.93; 95% CI = 1.55 to 9.95, P = 0.004), reduction (OR = 0.87; 95% CI = 0.24 to 3.20, P = 0.84) especially closed reduction (OR = 4.33; 95% CI = 1.09 to 17.28, P = 0.04) were important risk factors for postoperative AVN, while age (MD = -0.58;95% CI = -1.34 to 0.18, P = 0.13), the side of hip (OR = 0.89; 95% CI = 0.44 to 1.80, P = 0.74), the number of implants (OR = 0.87; 95% CI = 0.24 to 3.20, P = 0.84), delayed surgery (OR = 0.64; 95% CI = 0.38 to 1.09, P = 0.10) and capsular decompression (OR = 0.80; 95% CI = 0.32 to 1.99, P = 0.63) were not.
In summary, the pooled incidence of AVN after unstable SCFEs was 23% and the available evidence demonstrated that being male, having a moderate or severe slip (slip angle ≥ 30°), having an acute slip (symptoms ≤ 3 weeks), and undergoing reduction, especially closed reduction, are important risk factors for postoperative AVN.
IV. This study was registered as PROSPERO 2024 CRD42024566661.
不稳定型股骨头骨骺滑脱（SCFE）患者发生股骨头缺血性坏死（AVN）的危险因素存在争议且具有多因素性。本荟萃分析总结现有证据以确定AVN的危险因素。
检索策略遵循Cochrane协作网的建议。对PubMed、Embase、Web of Science、Cochrane等电子数据库进行系统检索，以查找从起始日期至2024年10月有关不稳定型SCFE危险因素的出版物。使用RevMan 5.3软件和Stata 17.0软件进行荟萃分析。最后，进行发表偏倚和敏感性分析。
本研究纳入16篇文章，涉及688个髋关节。我们发现AVN的总体发生率为23%。我们的研究表明，男性（OR = 2.37；95%CI = 1.23至4.58，P = 0.01）、中度和重度滑脱（OR = 0.09；95%CI = 0.02至0.37，P < 0.001）、急性滑脱（OR = 3.93；95%CI = 1.55至9.95，P = 0.004）、复位（OR = 0.87；95%CI = 0.24至3.20，P = 0.84）尤其是闭合复位（OR = 4.33；95%CI = 1.09至17.28，P = 0.04）是术后AVN的重要危险因素，而年龄（MD = -0.58；95%CI = -1.34至0.18，P = 0.13）、髋关节侧别（OR = 0.89；95%CI = 0.44至1.80，P = 0.74）、植入物数量（OR = 0.87；95%CI = 0.24至3.20，P = 0.84）、延迟手术（OR = 0.64；95%CI = 0.38至1.09，P = 0.10）和关节囊减压（OR = 0.80；95%CI = 0.32至1.99，P = 0.63）则不是。
总之，不稳定型SCFE术后AVN的合并发生率为23%，现有证据表明男性、存在中度或重度滑脱（滑脱角≥30°）、急性滑脱（症状≤3周）以及进行复位，尤其是闭合复位，是术后AVN的重要危险因素。
IV。本研究已在PROSPERO注册（注册号：2024 CRD42024566661）。
