小儿股骨头骨软骨炎伴有软骨内成骨障碍

Childhood osteochondritis of femoral head with impaired intrachondral bone formation

目的:分析小儿股骨头骨软骨炎(Perthes病)的病理改变。材料与方法:小儿股骨头骨软骨炎75例,男56例,女19例。单侧发病64例(85%),双侧11例(15%)。3例新生儿尸检,均经股动脉灌注墨汁和微粒钡混合液,进行股骨头骨骺微血管摄影。结果:骨骺变化多样,股骨头骨骺囊状破坏27例(36%),骨骺碎裂25例(33%),扁平致密骨骺25例(33%)。并见1例无骨骺,干骺端致密凹陷、骺早闭等。干骺端变粗变短高达45例(60%),几乎都有干骺囊状破坏,包括单囊7例和多囊34例,囊内多数可见死骨。干骺端中心“V”形凹陷14例,其中8例可见死骨。髋臼发育不良、股骨头外移包括脱位者共46例(61%),Shenton线不连者28例(37%)。有10例既有股骨头骨骺干骺坏死,又有关节间隙狭窄,考虑为儿童Perthes病合并强直性髋关节炎。股骨颈垂线征Sagging rope sign17例。髋内翻7例,髋外翻4例。75例中各种骺线异常者共55例(73%)。结论:小儿Perthes病是伴有软骨内成骨障碍的综合病理改变疾患。

Objective： To analyse the pathological change of childhood osteochondritis of femoral head or Perthes＇ disease. Methods： A prepared mixture of Chinese ink and microgranuated barium was introduced into the femoral artery and microangiography of the epiphysis of the femoral head was taken in 3 child cadaver,and 75 cases of childhood osteochondritis of femoral neck were undergone hip radiography, of them, 56 were male and 19 female, with unilateral affection in 64 cases （85%） and bilateral in 11 （15%）. Results： The changes of the epiphysis were various： cystic destruction in the epiphysis of the femoral head was noted in 27 cases （360%）, epiphyseal disruption in 25 cases （33%）, flatening and condensation of epiphysis in 25 cases（33 %） and, in 1 case only, metaphyseal condensation and concavity with premature closure of the epiphysis without visualization of the epiphysis thickening and shortening of the metaphysis were found in as much as 45 cases （60 %）. Cystic destruction in metaphysis was noted in most of them with a single cyst in 7 cases and multiple cysts in 34 cases. Sequestrum was found in most of the cysts. Metaphyseal central ＂V＂ shaped concavity was noted in 14 cases with sequestrum in 8 of them. Acetabular dysplasia with femoral head lateral displacement or dislocation was found in 46 cases （61% ）. Noncontinuous Shenton＇s line was found in 28 cases. In 10 cases, femoral epiphyseal and metaphyseal necrosis together with joint space narrowing was noted; consequently, Perthes＇ disease complicated with ankylosing arthritis of the hip joint was considered. Sagging rope sign of femoral neck was noted in 17 cases, coxa vara in 7 and coxa valga in 4. Various anomalies of the epiphyseal lines were found in 55 （73 %） of 75 cases. Conclusion：Childhood Perthes＇ disease can be considered as a syndrome of impaired intracondral bone formation involving not only the femoral head but also the surrounding bones.