Clinical and imaging features of slipped capital femoral epiphysis
2023, 27 (27):
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.
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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.