中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (27): 4421-4428.doi: 10.12307/2023.631

• 骨与关节综述 bone and joint review • 上一篇    

股骨头骨骺滑脱的临床及影像学特征

高  月，傅紫薇，吴艳波，潘诗农，鲁  钊   

  1. 中国医科大学附属盛京医院放射科，辽宁省沈阳市   110004
  • 收稿日期:2022-06-02 接受日期:2022-08-20 出版日期:2023-09-28 发布日期:2022-11-08
  • 通讯作者: 鲁钊，主治医师，中国医科大学附属盛京医院放射科，辽宁省沈阳市 110004
  • 作者简介:高月，女，1992年生，辽宁省沈阳市人，汉族，2021年中国医科大学毕业，博士，讲师，主要从事运动医学和骨肌影像诊断研究。
  • 基金资助:
    辽宁省自然科学基金指导计划(2019-ZD-0794)，项目负责人：潘诗农

Clinical and imaging features of slipped capital femoral epiphysis

Gao Yue, Fu Ziwei, Wu Yanbo, Pan Shinong, Lu Zhao   

  1. Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
  • Received:2022-06-02 Accepted:2022-08-20 Online:2023-09-28 Published:2022-11-08
  • Contact: Lu Zhao, Attending physician, Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
  • About author:Gao Yue, PhD, Lecturer, Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
  • Supported by:
    the Guidance Program of Natural Science Foundation of Liaoning Province, No. 2019-ZD-0794 (to PSN)

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摘要：


文题释义：

股骨头骨骺滑脱：是股骨近端生长软骨在骺板区域分离造成股骨颈干骺端向外旋转，相对稳定位于髋臼内的股骨头骨骺移位的结果。
股骨髋臼撞击征：是一种不协调的球窝畸形，造成髋关节终末运动时重复接触，产生腹股沟疼痛，并最终使关节盂唇和软骨退化、发生髋关节骨关节炎。患者出现腹股沟疼痛、关节僵硬、肌肉无力和运动表现受损。

背景：股骨头骨骺滑脱是影响儿童和青少年常见的髋关节疾病，造成髋关节疼痛及跛行。股骨头骨骺滑脱的发病率差异很大，病因与性别、机械、内分泌、肥胖和遗传等因素相关。
目的：综述股骨头骨骺滑脱的核心机制，讨论基于病理生理机制的影像学表现及定量指标评价、治疗方法进展及尚未解决的问题。
方法：第一作者以“Slipped epiphysis of femoral head，Complications，AVN，FAI，hip chondrolysis，SCFE imaging diagnose，X-ray，CT，MRI”为英文数据库检索词，以“股骨头骨骺滑脱、并发症、AVN、FAI、软骨溶解、X射线、CT、MRI”为中文数据库检索词，通过计算机检索 PubMed、Web of Science、Embase、中国知网及万方数据库中的相关文献，并进行筛选、评估、归纳，最终纳入63篇相关文献进行综述。
结果与结论：①目前关于股骨头骨骺滑脱发病机制的国际主流观点倾向于机械损伤因素、内分泌因素及肥胖遗传多种因素的共同作用。②影像手段在股骨头骨骺滑脱诊断中可发挥重要作用，X射线片及三维CT在股骨头骨骺滑脱诊断中较为常用，MRI可用来观察除骨质改变以外的骺板水肿等变化。③不同的诊断方式及测量参数能够全面且定量地从骨质改变、软化损伤及肌肉萎缩等方面来评估股骨头骨骺滑脱患者的情况。④股骨头骨骺滑脱的并发症包括股骨头缺血坏死、股骨髋臼撞击征、软骨溶解和退行性关节炎，会造成长期且具有破坏性的临床预后。⑤基于主要病理机制，治疗手段主要包括手术、内分泌及康复治疗，且取得了一定的成果。⑥临床上，股骨头骨骺滑脱患者多因患侧髋部及膝部疼痛及跛行就诊，影像学表现以骺板增宽、股骨头骨骺及干骺端相对移位为主。⑦因此，针对股骨头骨骺滑脱患者临床病理特征及并发症的特点，医生需正确认识影像学检查在股骨头骨骺滑脱中的辅助诊断作用，需要做好患者入院的诊断及病情评估、手术效果评价及术后的随访及单侧股骨头骨骺滑脱患者对侧骨骺滑脱的预测，以期为临床诊疗提供准确客观的诊疗依据。
https://orcid.org/0000-0002-2807-3733 (高月) 
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 股骨头骨骺滑脱, 股骨头骨骺滑脱并发症, 股骨头缺血性坏死, 股骨髋臼撞击症, 髋关节软骨溶解, X射线, CT, MRI

Abstract: BACKGROUND: Slipped capital femoral epiphysis is a common hip disease affecting children and adolescents, causing hip pain and lameness. The incidence of slipped capital femoral epiphysis varies widely, and the etiology is related to gender, mechanical, endocrine, obesity, and genetic factors.   
OBJECTIVE: To review the core mechanism of slipped capital femoral epiphysis, to discuss the imaging manifestations and quantitative index evaluation based on the pathophysiological mechanism, the progress of treatment methods and unresolved problems. 
METHODS: The first author used “slipped epiphysis of femoral head, complications, AVN, FAI, hip chondrolysis, SCFE imaging diagnose, X-ray, CT, MRI” as English search terms, and “slipped epiphysis of femoral head, complications, AVN, FAI, chondrolysis, X-ray, CT, MRI” as Chinese search terms. Relevant articles published in PubMed, Web of Science, Embase, CNKI, and Wanfang databases were searched by computer, and screened and evaluated, summed up, and finally 63 related articles were included for review.  
RESULTS AND CONCLUSION: (1) The current international mainstream views on the pathogenesis of slipped capital femoral epiphysis tend to be the combined effects of mechanical injury factors, endocrine factors and obesity genetic factors. (2) Imaging methods play an increasingly important role in the diagnosis of slipped capital femoral epiphysis. X-ray and three-dimensional CT are more commonly used in the diagnosis of slipped capital femoral epiphysis. MRI can be used to observe changes in epiphyseal plate edema other than bone changes. (3) Different diagnostic methods and measurement parameters can comprehensively and quantitatively evaluate the condition of slipped capital femoral epiphysis patients from the aspects of bone changes, softening injuries and muscle atrophy. (4) Complications of slipped capital femoral epiphysis include avascular necrosis of the femoral head, femoroacetabular impingement sign, chondrolysis, and degenerative arthritis, resulting in long-term and devastating clinical outcomes. (5) Based on the main pathological mechanism, the treatment methods mainly include surgery, endocrine and rehabilitation, and certain results have been achieved. (6) Clinically, patients with slipped capital femoral epiphysis mostly go to the doctor because of pain and claudication in the affected hip and knee. The imaging manifestations are mainly epiphyseal plate widening and relative displacement of femoral head epiphysis and metaphysis. (7) Therefore, in view of the clinicopathological features and complications of patients with slipped capital femoral epiphysis, doctors need to correctly understand the role of imaging in the auxiliary diagnosis of slipped capital femoral epiphysis, and they need to do a good job in the diagnosis and disease assessment on admission, evaluation of surgical effects, and postoperative follow-up, as well as the prediction of contralateral slipped epiphysis in patients with unilateral slipped capital femoral epiphysis, in order to provide an accurate and objective basis for clinical diagnosis and treatment. 

Key words: slipped capital femoral epiphysis, slipped capital femoral epiphysis complication, avascular necrosis of the femoral head, femoroacetabular impingement, hip chondrolysis, X-ray, CT, MRI

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