儿童股骨头缺血性坏死临床分型的新特点

New characteristics of clinical classification for avascular necrosis of the femoral head in children

学术背景:儿童股骨头缺血性坏死又称Legg-Calvé-Perthes病,目前病因仍不清楚,疾病分型和治疗方式不统一,预后结果也不同。因而在病程活动期需要一种简单、实用、可靠的临床分型来指导治疗,预测结果。目的:总结和分析临床上常用的Legg-Calvé-Perthes病分型标准和各自的优缺点,为预测结果以及指导治疗提供依据。检索策略:由本文作者应用计算机检索Medline数据库1970-01/2007-09有关Perthes病分型标准方面的文献,检索词"Perthes,classification",限定文章语言种类为英文。对资料进行初审,并查找全文。纳入标准:①Perthes病的X射线、骨扫描和MRI分型标准。②各分型可靠性及与预后相关性的研究。排除标准:重复性研究。共检索到有关Perthes病分型标准方面的文献76篇,符合纳入标准的文献32篇。文献评价:纳入的32篇文献中有关X射线检查方面的文献24篇,有关骨扫描成像方面的文献4篇,有关MRI成像方面的文献4篇。资料综合:Legg-Calvé-Perthes病临床分型的相关研究有很多,但结论尚不一致。可靠而统一的临床分型有助于骨科医生早期发现影响预后的危险因素,及早采取治疗措施,从而预防股骨头的畸形变。理想的分型标准应该可以在病程早期应用,可靠性和一致性好,与疾病的预后密切相关。结论:Legg-Calvé-Perthes病X射线分型在临床上比较常用,但难以在病程早期使用。骨扫描可以提前预测结果,但存在辐射危险性。MRI的灵敏度和分辨率高,发现头坏死塌陷征象早,MRI分型具有很好的发展前景和利用价值,但尚需长期的临床随访结果。

BACKGROUND： The etiological factor of pediatric avascular necrosis of the femoral head （Legg-Calvé-Perthe disease） is unclear right now, and the disease typing, treatment and prognosis outcome are also different. Thus a simple, practical and reliable clinical classification is necessary to guide treatment and estimate result. OBJECTIVE： To summarize and analyze the criteria commonly used for Legg-Calvé-Perthe disease in clinical typing as well as their advantage and shortcoming, which provides evidences for the treatment and instruction. RETRIEVAL STRATEGY： A computer-based search of Medline database was undertaken to identify the articles regarding the classification criteria for Perthes disease, published between January 1970 and September 2007, with the key items of ＂Perthes, classification＂ in English. After the primary check, the full-texts of the remained articles were looked for. Inclusion criteria： ①X-ray, bone scanning and MRI classification criteria for Perthes disease.②the study of the correlation between the classification reliability and the prosthesis. Exclusion criteria： repeated researches. Totally 76 articles about the classification criteria for Perthes disease were retrieved, and 32 of them were in accordance with the inclusion criteria. LITERATURE EVALUATION： Among 32 included articles, 24 ones concerned with X-ray examination, 4 with bone scanning image, and 4 with MRI image. DATA SYNTHESIS： There were many related researches to the clinical classification of Legg-Calvé-Pertbe disease, but uniform conclusion is absent. A reliable and unified clinical classification is beneficial for the orthopaedic physicians to find out the risk factors at early stage, and take therapeutic measures as soon as possible, so as to prevent the malformation of the femoral head. Ideal classification criteria with good reliability and consistency, are closely related to the disease prosthesis, and should be used at early stage. CONCLUSION： X-ray typing is commonly used in the clinical classification for Legg-Calvé-Perthe disease, but it is difficult to apply at early stage. Bone scanning can forecast results, and also induce irradiation. Due to good sensitivity and high resolution, MRI has an earlier effect on detecting necrosis and collapse, and is potential for further development and application, however, it also calls on a long-term clinical follow-ups.