髂骨与转子间联合截骨术治疗Perthe’s病

Salter osteotomy and intertrochanteric varus combination osteotomy for treatment of severe Perthe's disease

目的探讨Slter骨盆截骨与转子间内翻联合截骨术治疗Pcrthe’s病的疗效和影响因素。方法对9例有股骨头骨骺塌陷和包容不良合并半脱位的5～13岁(平均7.4岁)患儿,同时完成Salter骨盆截骨和转子间内翻联合截骨术,利用转子间取出的楔形骨块行髂骨截骨间隙内嵌入植骨,6例双截骨端用双克氏针交叉固定,3例髂骨截骨端双克氏针交叉固定,转子间截骨端用90°小钢板固定。结果术后随访4～8年,全部顺利完成骨愈合,X线形态测量包容良好,头基本恢复圆形,临床Harri’s评分平均术前78分改善到术后随访时的98分,取得良好的治疗效果。结论Slter骨盆截骨与转子间内翻联合截骨对Perthe’s病的扁平化后遗症和继发性髋臼指数增高的防止效果满意,对年龄小、病程短、髋关节形态明显异常者矫治效果更好。

Objective: To investigate the results of Salter osteotomy and intertrochanteric varus combined osteotomy for treatment of Perthe' s disease and the factors influencing results.Method:There were 9 cases with Perthe's disease treated by Salter osteotomy and intertrochanteric varus combination osteotomy, with method of wedge bone block taken from trochanteric accomplished impaction graft in ilium gaps, the patients averaged 7.4 years(during 5～13 years), 6 cases fixation used Kirschner's wire cross in two position and 3 cases used Kirschner's wire cross fixation in ilium position and 90 degree angel plate fixation in trochanteric position. Result: Post-operative follow-up for 4～8 yeas, good bony healing in all cases.Clinical results according to Harris score improved from average 78 points pre-operation to 98 points at the final follow-up. Radio-graphical appearance showed good curative rate and progressive spherical remodeling of femoral head.Conclusion:This combined osteotomy procedure is more effective than other methods for treatment of Perthe's disease, it can achieve excellent result to prevent formation of coxa plana and secondary acetabula dysplasia.