儿童股骨头缺血坏死疗效评价和合理治疗方法的研究

Evaluation Criterion of Legg-perthes Efficacy And Screening of Reasonable Treatment Method.

目的探讨建立一个全面、客观、实用的小儿股骨头缺血坏死疗效评价标准,并以此标准筛选出小儿股骨头缺血坏死的合理治疗方法。方法从儿童股骨头缺血坏死的临床症状和X线表现拟定一个能全面反映该病疗效的评定标准,对以往采用保守治疗、滑膜切除、滑膜切除加股骨颈钻孔减压、滑膜切除加股骨颈钻孔减压加骨盆内移截骨术、髋周软组织松解加滑膜切除五种方法治疗,且时间达3年以上的病例进行随诊检查,然后按此标准和以往的一些标准分别进行评分及相互比较。结果邸氏法和我们所拟订的标准对儿童股骨头缺血坏死的评价有显著性差异,邸氏法标准明显偏低。各治疗组患儿的临床症状和体征均有明显改善,但X线征的改善普遍不甚满意。改良Chiari骨盆内移截骨术组股骨头覆盖率明显高于其他治疗组,头的圆度和shenton线连续性亦较其他组好,优良率与其他组有显著性差异。CatterllⅡ期的疗效较CatterllⅢ和CatterallⅣ期好。改良Chiari骨盆内移截骨术组负重与不负重组相互无显著性差异。结论十项二十分法较邸氏法更为严格。改良Chiari骨盆内移截骨术组在上述五个治疗组中疗效最佳,但仍不够理想。

Objective To explore an objective comprehensive and pratical evaluation criterion for ischemia and necrosis of femoral headat the same time according to the criteria screen out a reasonable therapeutic way. Method On the basis of clinical symptom and radiographic manifestation of ischemia and necrosis of femoral head of the childrenan evaluation criterion which can comprehensive reflect the efficacy of the disease was formulatedfive item therapeutic groups including conservative treatment,synovectomy,synovectomy combined with femoral neck drilling hole depressure,synovectomy plus femoral neck drilling hole depressure at the same timeit combined with pelvis internal mobile osteotomyrelaxation of peri-hip soft tissue combined with synovectomy,then these cases were followed for over three yearsand according this criterion and other criterion to judge score respectivelyobtaing results were compared each other. Results There was significant difference between the criteria developed by Di and us.Each treatment way can obviously ameliorate clinical symptom and physical signbut there was not satisfactory improvement of radiographic sign.There was significant difference in efficacy between Chiari group and the others.The efficacy of patients of CatterllⅡwas better than that of CatterllⅢ and CatterllⅣ.No evident differences were found between the results of weight loading and without weight loading in Chiari osteotomy group. Conclusions Improved chiari pelvic internal mobile osteotomy group is best operation way in the five therapeutic groups,but still not enough ideal way.Ten inem twenty cents score method is more strictness than that of Di's method. 