背景:滑脱的股骨骨phy(SCFE)发生在青少年中,发病率约为每100000名儿童中的10名。出现单侧SCFE的儿童发生对侧SCFE的可能性是普通人群的2335倍。已建议增加对侧滑脱风险的预后因素包括年轻患者,潜在的内分泌紊乱,生长激素的使用和较高的射线照相后倾角。然而,对于健康的患者,未受影响的一侧预防性固定的利弊仍然存在很多争论。
目的:探讨对侧髋关节固定术的风险,并评估对侧髋关节预防性固定术的(缺点)优势。
方法:在Embase进行了系统的文献检索,Medline,WebofScience核心合集和Cochrane数据库。搜索词包括\'滑脱的资本股骨骨,\'\'固定,\'\'对侧,\'和衍生品。获得的文章的资格由作者独立评估,并通过交叉引用纳入其他相关文章。如果出版物提供了主要是单侧SCFE的其他健康儿童的数据以及预防性固定其不受影响的一侧的结果,则认为它们有资格纳入。或对侧滑脱及其并发症的发生率。作者通过非随机研究标准的方法学指标独立评估了纳入文章的研究质量。
结果:在293种确定的独特出版物中,我们纳入了26项研究,共1,897例患者.1762名患者(14%)随后出现对侧滑脱。此外,38%的患者在对侧出现了随后的滑脱,而没有出现临床症状。文献中预防性固定对侧髋关节的最直言不讳的优点是预防(无症状)滑倒,从而降低血管坏死(AVN)的风险增加,凸轮形态和骨关节炎。缺点包括感染风险增加,AVN,种植体周围骨折,由于生长指导而导致的固定丧失以及硬件迁移和形态变化。这些风险,然而,似乎仅偶然发生,与实际SCFE所涉及的风险相比通常是轻微的.
结论:在其他方面健康的单侧SCFE患者中,预防性固定未受影响的一侧的优点似乎大于缺点。治疗的最终决定仍然取决于患者。
BACKGROUND: Slipped capital femoral epiphysis (SCFE) occurs in adolescents and has an incidence of around 10 per 100000 children. Children presenting with a unilateral SCFE are 2335 times more likely to develop a contralateral SCFE than the general population. Prognostic factors that have been suggested to increase the risk of contralateral slip include a younger patient, an underlying endocrine disorder, growth hormone use and a higher radiographic posterior sloping angle. However, there is still much debate on the advantages and disadvantages of prophylactic fixation of the unaffected side in an otherwise healthy patient.
OBJECTIVE: To investigate the risk rate of contralateral SCFE and assess the (dis)advantages of prophylactic fixation of the contralateral hip.
METHODS: A systematic literature search was performed in the Embase, Medline, Web of Science Core Collection and Cochrane databases. Search terms included \'slipped capital femoral epiphysis,\' \'fixation,\' \'contralateral,\' and derivatives. The eligibility of the acquired articles was independently assessed by the authors and additional relevant articles were included through cross-referencing. Publications were considered eligible for inclusion if they presented data about otherwise healthy children with primarily unilateral SCFE and the outcomes of prophylactically pinning their unaffected side, or about the rates of contralateral slips and complications thereof. The study quality of the included articles was assessed independently by the authors by means of the methodological index for non-randomized studies criteria.
RESULTS: Of 293 identified unique publications, we included 26 studies with a total of 12897 patients. 1762 patients (14%) developed a subsequent symptomatic contralateral slip. In addition, 38% of patients developed a subsequent slip on the contralateral side without experiencing clinical symptoms. The most outspoken advantage of prophylactic fixation of the contralateral hip in the literature is prevention of an (asymptomatic) slip, thus reducing the increased risk of avascular necrosis (AVN), cam morphology and osteoarthritis. Disadvantages include an increased risk of infection, AVN, peri-implant fractures, loss of fixation as well as migration of hardware and morphologic changes as a consequence of growth guidance. These risks, however, appeared to only occur incidentally and were usually mild compared to the risks involved with an actual SCFE.
CONCLUSIONS: The advantages of prophylactic pinning of the unaffected side in otherwise healthy patients with unilateral SCFE seem to outweigh the disadvantages. The final decision for treatment remains to be patient-tailored.