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Authors
Advisor(s)
Abstract(s)
Objetivo
A epifisiólise proximal do fémur (EPF) é uma patologia importante da anca, já que afeta
indivíduos em fase de desenvolvimento, maioritariamente dos 11 aos 15 anos. Sobre os
casos unilaterais primários paira sempre o risco de sofrer EPF contralateral. O objetivo
desta revisão sistemática é analisar a incidência e complicações de epifisiólise
contralateral subsequente a epifisiólise proximal do fémur em crianças anteriormente
saudáveis.
Métodos e Materiais
Esta revisão sistemática da literatura foi realizada de acordo com as diretrizes PRISMA
(Preferred Reporting Items for Systematic Reviews e Meta-Analysis).
A PubMed/Medline foi a base de dados eletrónica utilizada para a pesquisa de literatura
a 14 de agosto de 2023, com os termos de pesquisa “slipped capital femoral epiphysis”,
“SCFE” e “contralateral”. Foram considerados critérios de inclusão: casos em humanos;
crianças anteriormente saudáveis com EPF unilateral primária; dados de incidência e
complicações de EPF contralateral; população em estudo com idade inferior a 18 anos
aquando do diagnóstico primário de epifisiólise e que não tenham realizado fixação
profilática contralateral. Os critérios de exclusão foram: casos de epifisiólise bilateral ao
diagnóstico primário; crianças com doenças subjacentes; casos submetidos a fixação
profilática contralateral e ainda crianças não acompanhadas até ao atingimento da
maturidade óssea.
Foram pesquisados dados como incidência de epifisiólise contralateral, proporção
masculino: feminino, tempo entre as duas epifisiólise, tempo de follow-up de cada
estudo e complicações detetadas e extraídos e sintetizados numa tabela no Microsoft®
Word (Microsoft, Washington, WA, EUA) .
Resultados
De 182 artigos primariamente identificados, obteve-se 44 após aplicação dos critérios de
inclusão e exclusão: 28 estudos retrospetivos, 13 estudos prospetivos e três estudos de
caso-controle, que perfazem um total de 16888 crianças saudáveis com epifisiólise
proximal do fémur unilateral primária e que não foram submetidas a fixação cirúrgica
contralateral profilática. De 16888 crianças incluídas no estudo, 14,6% (9-69%) apresentaram epifisiólise
contralateral à posteriori, sendo que 89% destes (2178 casos) eram sintomáticos.
Relativamente às complicações, com uma incidência total de 19,5%, coxartrose e conflito
femoro-acetabular foram as mais frequentes nesta amostra de população (29,3% e 15,5%,
respetivamente), tendo outras complicações como condrólise e necrose avascular
ocorrido em cerca de 1-7,5% dos casos.
Conclusão
A elevada variação da incidência de epifisiólise contralateral (6-69%) e a elevada
frequência de complicações (19,5%) a curto e longo prazo elevam a necessidade de uma
vigilância clínica e imagiológica mais apertada de todos os casos de epifisiólise unilateral,
para que o diagnostico da EPF contralateral seja o mais precoce possível.
Title The aim of this systematic review is to analyze the incidence and complications of contralateral epiphysis slippage subsequent to unilateral slipped capital femoral epiphysis (SCFE) in previously healthy children. Methods and Materials This systematic literature review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. PubMed/Medline was the electronic database used for literature search up to August 14, 2023, using the search terms "slipped capital femoral epiphysis," "SCFE," and "contralateral." Inclusion criteria comprised human cases; previously healthy children with unilateral primary SCFE; data on incidence and complications of contralateral SCFE; study population aged under 18 at the primary SCFE diagnosis and not subjected to contralateral prophylactic fixation. Exclusion criteria included cases of bilateral epiphysis slippage at the primary diagnosis, children with underlying diseases, cases subjected to contralateral prophylactic fixation, and children not followed until skeletal maturity. Relevant data - contralateral epiphysis slippage incidence, male-to-female ratio, time between the two slippages, follow-up duration of each study, and detected complications - were extracted and synthesized into a table using Microsoft® Word. Results Out of 182 initially identified articles, 44 met the inclusion and exclusion criteria, including 28 retrospective studies, 13 prospective studies, and 3 case-control studies, totaling 16,888 previously healthy children with unilateral primary SCFE without prophylactic fixation of contralateral unaffected hip. Among the 16,888 children included, 14.6% (9-69%) experienced subsequent contralateral epiphysis slippage, with 89% of these cases (2178) being symptomatic. Regarding complications, with a cumulative incidence of 19.5%, osteoarthritis and femoroacetabular impingement (pistol-grip and type-CAM deformities) were the most frequent in this population sample, 29.3% and 15.5% respectively, while other complications such as chondrolysis and avascular necrosis occurred in approximately 1-7.5% of cases. Conclusion The high variation in contralateral epiphysis slippage incidence (6-69%) from study to study and the concerning short and long-term complication risk rate (19.5%) emphasize the need for closer clinical and imaging surveillance of all unilateral slipped capital femoral epiphysis cases. This is essential for early diagnosis of contralateral SCFE or attempting prevention through prophylactic surgery
Title The aim of this systematic review is to analyze the incidence and complications of contralateral epiphysis slippage subsequent to unilateral slipped capital femoral epiphysis (SCFE) in previously healthy children. Methods and Materials This systematic literature review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. PubMed/Medline was the electronic database used for literature search up to August 14, 2023, using the search terms "slipped capital femoral epiphysis," "SCFE," and "contralateral." Inclusion criteria comprised human cases; previously healthy children with unilateral primary SCFE; data on incidence and complications of contralateral SCFE; study population aged under 18 at the primary SCFE diagnosis and not subjected to contralateral prophylactic fixation. Exclusion criteria included cases of bilateral epiphysis slippage at the primary diagnosis, children with underlying diseases, cases subjected to contralateral prophylactic fixation, and children not followed until skeletal maturity. Relevant data - contralateral epiphysis slippage incidence, male-to-female ratio, time between the two slippages, follow-up duration of each study, and detected complications - were extracted and synthesized into a table using Microsoft® Word. Results Out of 182 initially identified articles, 44 met the inclusion and exclusion criteria, including 28 retrospective studies, 13 prospective studies, and 3 case-control studies, totaling 16,888 previously healthy children with unilateral primary SCFE without prophylactic fixation of contralateral unaffected hip. Among the 16,888 children included, 14.6% (9-69%) experienced subsequent contralateral epiphysis slippage, with 89% of these cases (2178) being symptomatic. Regarding complications, with a cumulative incidence of 19.5%, osteoarthritis and femoroacetabular impingement (pistol-grip and type-CAM deformities) were the most frequent in this population sample, 29.3% and 15.5% respectively, while other complications such as chondrolysis and avascular necrosis occurred in approximately 1-7.5% of cases. Conclusion The high variation in contralateral epiphysis slippage incidence (6-69%) from study to study and the concerning short and long-term complication risk rate (19.5%) emphasize the need for closer clinical and imaging surveillance of all unilateral slipped capital femoral epiphysis cases. This is essential for early diagnosis of contralateral SCFE or attempting prevention through prophylactic surgery
Description
Keywords
Adolescente Complicações Contralateral Criança Epifisiólise Proximal do Fémur Incidência