{"title":"用原位固定治疗50%的轻度和中度慢性股骨骨干骨骺滑动髋的长期临床效果良好：随访50年的93例髋。","authors":"Terje Terjesen, Anders Wensaas","doi":"10.2106/JBJS.OA.24.00212","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>There is no consensus regarding the initial treatment of slipped capital femoral epiphysis (SCFE). The aim of this study was to analyze the long-term outcome of in situ fixation (ISF) in chronic SCFE.</p><p><strong>Methods: </strong>The study consisted of 79 patients (93 hips), treated with ISF from 1955 to 1993. There were 47 male patients (59%) and 32 female patients with a mean age of 12.8 years (range, 8-16 years) at the time of diagnosis. The mean slip angle was 33.4° (range, 12°-80°). The slip was mild (<30°) in 46 hips (49%), moderate (30°-49°) in 33 (36%), and severe (≥50°) in 14 hips. Long-term clinical outcome was based on the rate of total hip arthroplasty (THA) and the modified Harris Hip Score (mHHS) analyzed by telephone (maximum score 91 points).</p><p><strong>Results: </strong>The mean follow-up time was 51.6 years (range, 30-68 years). Thirty-two hips (34%) had undergone THA at a mean patient age of 55.9 years (range, 21-75 years). The survival rate (percentage of hips that had not undergone THA) was 99% at 20 years of follow-up and fell to 69% (95% confidence interval, 58%-80%) at 50 years. The mean mHHS in 57 of the 61 hips that had not undergone THA was 80.7 points (range, 22-91 points). Good long-term outcome, defined as no THA and mHHS ≥76 points, occurred in 40 of 89 hips (45%). The outcome was worse in hips with severe slips compared with moderate and mild slips (p = 0.020), whereas there was no significant differences between moderate and mild slips (p = 0.817). The only independent risk factor of outcome was high alpha angle.</p><p><strong>Conclusions: </strong>At a mean follow-up of 50 years, the clinical outcome in hips with mild or moderate slipping was good in 50% of the hips, and 27% had been converted to THA. These results are well suited for comparison with future studies of more modern treatment concepts.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002372/pdf/","citationCount":"0","resultStr":"{\"title\":\"Good Long-Term Clinical Outcome in 50% of Hips With Mild and Moderate Chronic Slipped Capital Femoral Epiphysis Treated With in Situ Fixation: 93 Hips With a Follow-up of 50 Years.\",\"authors\":\"Terje Terjesen, Anders Wensaas\",\"doi\":\"10.2106/JBJS.OA.24.00212\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>There is no consensus regarding the initial treatment of slipped capital femoral epiphysis (SCFE). The aim of this study was to analyze the long-term outcome of in situ fixation (ISF) in chronic SCFE.</p><p><strong>Methods: </strong>The study consisted of 79 patients (93 hips), treated with ISF from 1955 to 1993. There were 47 male patients (59%) and 32 female patients with a mean age of 12.8 years (range, 8-16 years) at the time of diagnosis. The mean slip angle was 33.4° (range, 12°-80°). The slip was mild (<30°) in 46 hips (49%), moderate (30°-49°) in 33 (36%), and severe (≥50°) in 14 hips. Long-term clinical outcome was based on the rate of total hip arthroplasty (THA) and the modified Harris Hip Score (mHHS) analyzed by telephone (maximum score 91 points).</p><p><strong>Results: </strong>The mean follow-up time was 51.6 years (range, 30-68 years). Thirty-two hips (34%) had undergone THA at a mean patient age of 55.9 years (range, 21-75 years). The survival rate (percentage of hips that had not undergone THA) was 99% at 20 years of follow-up and fell to 69% (95% confidence interval, 58%-80%) at 50 years. The mean mHHS in 57 of the 61 hips that had not undergone THA was 80.7 points (range, 22-91 points). Good long-term outcome, defined as no THA and mHHS ≥76 points, occurred in 40 of 89 hips (45%). The outcome was worse in hips with severe slips compared with moderate and mild slips (p = 0.020), whereas there was no significant differences between moderate and mild slips (p = 0.817). The only independent risk factor of outcome was high alpha angle.</p><p><strong>Conclusions: </strong>At a mean follow-up of 50 years, the clinical outcome in hips with mild or moderate slipping was good in 50% of the hips, and 27% had been converted to THA. These results are well suited for comparison with future studies of more modern treatment concepts.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>\",\"PeriodicalId\":36492,\"journal\":{\"name\":\"JBJS Open Access\",\"volume\":\"10 2\",\"pages\":\"\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-04-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002372/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JBJS Open Access\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2106/JBJS.OA.24.00212\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/4/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JBJS Open Access","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2106/JBJS.OA.24.00212","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Good Long-Term Clinical Outcome in 50% of Hips With Mild and Moderate Chronic Slipped Capital Femoral Epiphysis Treated With in Situ Fixation: 93 Hips With a Follow-up of 50 Years.
Background: There is no consensus regarding the initial treatment of slipped capital femoral epiphysis (SCFE). The aim of this study was to analyze the long-term outcome of in situ fixation (ISF) in chronic SCFE.
Methods: The study consisted of 79 patients (93 hips), treated with ISF from 1955 to 1993. There were 47 male patients (59%) and 32 female patients with a mean age of 12.8 years (range, 8-16 years) at the time of diagnosis. The mean slip angle was 33.4° (range, 12°-80°). The slip was mild (<30°) in 46 hips (49%), moderate (30°-49°) in 33 (36%), and severe (≥50°) in 14 hips. Long-term clinical outcome was based on the rate of total hip arthroplasty (THA) and the modified Harris Hip Score (mHHS) analyzed by telephone (maximum score 91 points).
Results: The mean follow-up time was 51.6 years (range, 30-68 years). Thirty-two hips (34%) had undergone THA at a mean patient age of 55.9 years (range, 21-75 years). The survival rate (percentage of hips that had not undergone THA) was 99% at 20 years of follow-up and fell to 69% (95% confidence interval, 58%-80%) at 50 years. The mean mHHS in 57 of the 61 hips that had not undergone THA was 80.7 points (range, 22-91 points). Good long-term outcome, defined as no THA and mHHS ≥76 points, occurred in 40 of 89 hips (45%). The outcome was worse in hips with severe slips compared with moderate and mild slips (p = 0.020), whereas there was no significant differences between moderate and mild slips (p = 0.817). The only independent risk factor of outcome was high alpha angle.
Conclusions: At a mean follow-up of 50 years, the clinical outcome in hips with mild or moderate slipping was good in 50% of the hips, and 27% had been converted to THA. These results are well suited for comparison with future studies of more modern treatment concepts.
Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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