小结
定义
股骨头骨骺滑脱症 (SCFE) 是青春期最常见的髋部疾病。 一般发生于由股骨近端生长板虚弱导致股骨头骨骺移位时。
SCFE 属于误称；实际上是干骺端向前向上移位导致的滑脱。[1][2] 生长板虚弱可因各种因素引起，包括肥胖对生长板造成的应力以及全垂体功能减退症、甲状腺功能减退症及肾性骨营养不良等内分泌紊乱。青春期的快速生长期可能也会导致骺板弱化。[1] 沿股骨颈上缘皮质绘制 Klein 线。前后位/蛙式侧位平片显示 Klein 线未贯穿 SCFE 患者髋部的股骨头。外翻型 SCFE 为股骨近端干骺端上骨骺向后外侧滑脱。[3][Figure caption and citation for the preceding image starts]: 沿股骨颈上缘皮质绘制 Klein 线。正常的 Klein 线会贯穿骨骺。异常的 Klein 线不会贯穿骨骺，因为股骨颈已相对于骨骺向近侧和前侧移动本图由医学博士 John M. Flynn 提供 [Citation ends].
病史和体格检查
关键诊断因素
- 存在的危险因素
- 体重（＞第 90 百分位数）
- 行走时患腿外旋
其他诊断因素
- 腹股沟或膝部疼痛
- 双侧髋部疼痛
- 特伦德伦堡步态
- 关节活动度受限
- 体重（＜ 第 50 百分位数）
- 甲状腺功能减退症或全垂体功能减退症症状
- 肾功能衰竭
- 近期外伤
危险因素
- 青春期
- 肥胖
- 男性
- 内分泌系统疾病
- 血统
- 地理区域
- 既往接受过放射治疗
诊断性检查
首要检查
- 双侧前后位 X 线平片检查
- 蛙式侧位 X 线平片检查
需考虑的检查
- 生化检查
- 血清甲状腺功能检测
- 血清生长激素
治疗流程
不稳定型 SCFE
稳定型 SCFE
迟发性畸形
撰稿人
作者
Randall T. Loder, MD
George J. Garceau Professor of Pediatric Orthopaedic Surgery
Indiana University School of Medicine
Indianapolis
IN
利益声明
RTL receives book royalties and performs legal consultancy. RTL is an author of a number of references cited in this topic.
鸣谢
Dr Randall T. Loder would like to gratefully acknowledge Dr John M. Flynn, Dr Purushottam A. Gholve, Dr Danielle B. Cameron, and Dr Patrick O'Toole, previous contributors to this topic.
利益声明
JMF, PAG, DBC, and PO declare that they have no competing interests.
同行评议者
James McCarthy, MD, FAAOS, FAAP
Associate Professor
Department of Orthopedics and Rehabilitation
University of Wisconsin School of Medicine and Public Health
Madison
WI
利益声明
JM declares that he has no competing interests.
D. Philip Thomas, MB, BS, FRCS
Consultant Orthopaedic Surgeon and Honorary Lecturer
University Hospital of Wales
Cardiff
UK
利益声明
DPT declares that he has no competing interests.
Nicholas M. Clarke, ChM, FRCS
Professor
Consultant Orthopaedic Surgeon
Developmental Origins of Health and Disease (DOHaD)
School of Medicine
University of Southampton
Southampton
UK
利益声明
NMC has received honoraria for visiting professorships in North America and also for lectures in respect of congenital hip dysplasia. He is also a founding member of the International Hip Dysplasia Institute, which has received charitable funding.
鉴别诊断
- 髋骨折
- 缺血性坏死
- Legg-Calve-Perthes 病
更多 鉴别诊断指南
- 股骨头骨骺滑脱症切开复位术
更多 指南
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