Slipped capital femoral epiphysis: Radiographic images may support earlier diagnosis
Slipped capital femoral epiphysis (SCFE)是最常见的青春期髋关节疾病，影响每10万儿童10.8。
Although early intervention leads to better outcomes, SCFE is often not diagnosed in its earliest stages because a lack of clinical suspicion delays diagnosis. Even if a physician suspects the condition, signs of early stage SCFE may not be visible on radiographic images, further complicating the diagnostic process.
A team of researchers at Boston Children’s Hospital, led by orthopedic surgeon医学博士Eduardo Novais，已经确定了一个射线照相符号，该标志可以帮助临床医生较早地识别病情。
图1：X光片上的周围透核仁
了解SCFE的机制
该研究源于一系列研究，阐明了SCFE的机制。尽管传统上，这种病态被描述为股骨骨epiphysizy of the phyphysy的滑移，但最近的研究表明，位移实际上是旋转的问题，而epiphyseal结节是旋转的支点。如果是这样，则无法识别出在SCFE早期阶段发生的细微位移的标准方法，例如Klein方法或Southwick角度，它将无法识别出那种微妙的位移类型。
The team at Boston Children’s theorized that if the epiphyseal tubercle stabilizes the epiphysis, the abnormal mechanical environment associated with SCFE could lead to a concentration of stress around the tubercle. Such stress could cause changes in the area that could be identified on radiographs. In a recent study, the team evaluated the presence ofperitubercle lucency(Figure 1) as an indicator of micro-instability around the epiphyseal tubercle and, more importantly, early stage SCFE.
Figure 2: MRI (left) showing peritubercle edema suggestive of SCFE compared to a radiographic image of the same hip with peritubercle lucency
Radiographic images compared to MRI and a new classification of SCFE
为了检验其理论，该团队邀请了五名独立观察者，以盲目评估71例患者的X光片，以在存在或不存在周围的Lucency。所有患者以前都经过了MRI的评估，以评估前滑移或最小移位的SCFE。60％（43）已确认SCFE。
将放射线照相图像与MRI上的SCFE指示进行比较（图2），小组发现，X光片上周围的Lucency符号的存在是准确的，具有高灵敏度和特异性，可用于诊断前滑移状况或最小位移的SCFE。
The team also proposed a new classification for SCFE based on the relationship of the epiphyseal tubercle and the metaphyseal fossa (Figure 3).
Implications for diagnosis and treatment
这项研究正在进行中。将来，结果可以帮助骨科医生及早诊断SCFE，并在病情有机会进步之前开始临床干预。此外，对SCFE机制的更完整了解可能对临床和手术治疗有影响。
Figure 3: Proposed new SCFE classification based on the relationship of the tubercle and its metaphyseal socket
Articles referenced
Maranho DA, Bixby SD, Miller PE, Hosseinzadeh S, George M, Kim YJ, Novais EN.What Is the Accuracy and Reliability of the Peritubercle Lucency Sign on Radiographs for Early Diagnosis of Slipped Capital Femoral Epiphysis Compared With MRI as the Gold Standard?Clin Orthop Relat Res. 2020 Jan 21.
Maranho DA, Bixby S, Miller PE, Novais EN.基于邻骨结节和形而上学插座的射线照相关系，用于滑倒资本股骨骨分析的新型分类系统。J Bone Joint Surg Open Access. 2019;4: e0033.
Maranho DA，Miller PE，Novais EN。The Peritubercle Lucency Sign is a Common and Early Radiographic Finding in Slipped Capital Femoral Epiphysis.J Pediatr Orthop. 2018 Aug; 38(7):e371-e376.
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