骨盆内移截骨术治疗大龄儿童Perthes病的长期随访研究

Long-term follow-up results of Perthes disease in older children treated with surgical containment methods

目的评价Chiari骨盆内移截骨术治疗8岁以上儿童Perthes病的远期疗效,探讨影响儿童Perthes病预后的因素。方法1986年6月至2002年12月,共手术包容治疗8岁以上、Herring外侧柱分型达B型以上Perthes病患儿103例(116髋),69例(72髋)获得长期随访,平均随访时间97个月(38～196个月)。69例(72髋)中,根据Herring分型,B型30髋,B/C型22髋,C型20髋;男48例(50髋),女21例(22髋);8～10岁患儿47例(49髋),10～14岁患儿22例(23髋)。术前X线片显示25髋存在明显半脱位。全部患儿均接受Chiari骨盆内移截骨术治疗。结果全部病例术后均获得满意包容,无半脱位,未出现骨关节炎。按照改良Stulberg分级标准:(1)StulbergⅠ、Ⅱ级31髋,其中HerringB型19髋,B/C型9髋,C型3髋;StulbergⅢ级33髋,其中HerringB型10髋,B/C型11髋,C型12髋;Stul-bergⅣ、Ⅴ级8髋,其中HerringB型1髋,B/C型2髋,C型5髋。(2)男性患儿预后达StulbergⅠ、Ⅱ级者占48%,而女性患儿仅为23%。(3)8～10岁年龄组预后达StulbergⅠ、Ⅱ级者占55%,10～14岁年龄组仅为17%。结论对发病年龄≥8岁的HerringB、B/C与C型患儿应给予手术包容治疗,Chiari骨盆内移截骨术可达到手术包容效果。Herring分型对Perthes病的严重程度和预后的评估有明确指导作用。

Objective To evaluate the long-term results of Chiari osteotomy in the treatment of Legg-Calvé-Perthes disease for the patients of 8 years old or above and discuss the factors that influence the prognosis of this disease. Methods There were 116 hips of 103 patients of Perthes disease treated with Chiari osteotomy between June 1986 and December 2002. All patients were 8 years old or above. 72 hips of these cases acquired follow-up, the meaning follow-up duration was 97 months （range, 38-196 months）. According to lateral pillar classification, 30 hips were classified as group B, 22 hips as B/C group, 20 hips as C group. There were 50 hips in male, 22 hips in female, 47 patients between 8 and 10 years old, 22 cases between 10 and 14 years old. X-ray showed 25 hips with subluxation of femoral head preoperatively. Results According to the revised Stulberg classification system： （1）31 hips had Stulberg class Ⅰ , Ⅱ outcome, in which B group accounted for 19 of 30 hips, the hips in group C had the worst results： of 20 hips, only 3 had a Stulberg class Ⅰ or Ⅱ outcome, the results for the hips in lateral B/C border group were intermediate between those groups B and C. 33 hips had Stulberg class Ⅲ, in which B group had 10 hips, B/C group had 11 hips, C group had 12 hips. 8 hips had Stulberg class Ⅳ or Ⅴ, B group had 1 hip, B/C group had 2 hips, C group had 5 hips. （2）All cases had a satisfied containment, no one had subluxation after Chiari osteotomy. （3）48% of male patients had a Stulberg class Ⅰ or Ⅱ outcome, in contrast, only 23% of female had the comparable outcome. （4）55% of the group of 8 to 10 years old patients had a Stulberg class Ⅰ or Ⅱ outcome, in comparison with 17% from the group of 10 to 14 years old cases. Conclusion The patients older than 8 years at the onset of disease and in the lateral pillar B or C group should be treated with surgical containment, Chiari osteotomy can fulfill such task. The gender, the age of onset, especially the lateral pillar classification strongly correlate with the outcome of Perthes disease, and the latter can help us to evaluate the severity degree of the disease and the prognosis.