Ogden J A, Simon T R, Southwick W O
Yale J Biol Med. 1977 Jan-Feb;50(1):17-30.
The radiolucent cartilage space of eighty-three patients with unilateral or bilateral slipped capital femoral epiphysis was measured by a standardized technique. In the majority of patients, whether unilateral or bilateral involvement, there was bilateral narrowing of the cartilage space. In the unaffected hip of unilaterally involved patients, there was a progressive narrowing as skeletal maturity was attained. A concomitant anatomical study of cadaver hips, removed at autopsy from adolescent patients, showed a progressive narrowing of the cartilage as the proximal femur matured. Black females showed most narrowing (minimum cartilage space width), had the narrowest final cartilage space widths, and took the longest to attain this final width. While other racial, sexual and therapeutic groups failed to demonstrate statistically significant differences, the general trend was for females, Blacks, and patients treated by osteotomy to have more joint space narrowing. However, rewidening occurred in most of these affected joint spaces, in contrast to the progressive linear decrease observed in unaffected hips and anatomical specimens. On the basis of this study, we feel that cartilage space narrowing may be anticipated in the post-operative period in most patients treated for slipped capital femoral epiphysis. This narrowing appears to improve with time. Narrowing of greater than one-half the original width, in association with pain and limitation of joint function, probably represents "cartilage necrosis," or pathologic joint space narrowing. Unless the narrowing remains less than one-half to two-thirds of the initial cartilage space for more than twenty-four to thirty-six months, probably no specific surgical treatment should be undertaken, other than observation and protected weight bearing during any painful phase. Plotting the roentgenographic cartilage space width during the three month to thirty-six month phase may be useful in monitoring and predicting the outcome.
采用标准化技术对83例单侧或双侧股骨头骨骺滑脱患者的X线透光软骨间隙进行了测量。在大多数患者中，无论单侧或双侧受累，软骨间隙均呈双侧性变窄。在单侧受累患者未受影响的髋关节中，随着骨骼成熟，软骨间隙逐渐变窄。对青春期患者尸检时取下的尸体髋关节进行的一项解剖学研究表明，随着股骨近端成熟，软骨逐渐变窄。黑人女性软骨间隙变窄最明显（软骨间隙宽度最小），最终软骨间隙宽度最窄，达到最终宽度所需时间最长。虽然其他种族、性别和治疗组未显示出统计学上的显著差异，但总体趋势是女性、黑人以及接受截骨术治疗的患者关节间隙变窄更明显。然而，与未受影响的髋关节和解剖标本中观察到的逐渐线性减小不同，大多数这些受影响的关节间隙出现了重新变宽。基于这项研究，我们认为大多数接受股骨头骨骺滑脱治疗的患者在术后可能会出现软骨间隙变窄。这种变窄似乎会随着时间改善。软骨间隙变窄超过原始宽度的一半，同时伴有疼痛和关节功能受限，可能代表“软骨坏死”或病理性关节间隙变窄。除非软骨间隙变窄在超过24至36个月的时间内仍小于初始软骨间隙的一半至三分之二，否则除了在任何疼痛阶段进行观察和保护性负重外，可能不应进行特殊的手术治疗。绘制3个月至36个月期间的X线软骨间隙宽度图可能有助于监测和预测结果。
