组合式手术治疗儿童Perthes病

Combined operation for treatment Legg-Perthes diseases

[目的]介绍内容包含改良Chiari髂骨截骨、髋关节部分滑膜切除、股骨颈钻孔减压、髂腰肌延长和股内收松解的组合式手术治疗Perthes病的技术操作关键和远期效果。[方法]对应用本术式治疗已逾3年的Perthes病儿童进行回顾随诊，通过查体和摄X线片评定治疗效果。[结果]82例得到3年以上随诊，采用自拟的从临床症状、患肢短缩、头骺覆盖率、头骺形状和关节转子间距五个选项，每项按优、良、差分别计0、1或2分的五项十分法作疗效评定，得分之和1〉9分为优，7～8分为良，5～6分为可，〈5分为差。结果59例优良，优良率为75．6％。[结论]以改良Chiari术为核心的组合式手术是目前还不具有病因性治疗之Perthes病的一种较为满意的治疗选择。

[ Objective] To present the key technique of combining procedures of Chiari＇s ilium osteotomy, partial synovectomy of the hip joint, femur neck drilling decompression, iliopsoas muscle lengthening and detachment of adductor muscles of the femur for treating Legg -Perthes disease and the long -term results of combination treatment. [ Method] A retrospective study of treating children with Legg - Perthes disease was carefully carried out. All patients enrolled were followed up more than 3 years after operation. The results of serial radiographs and physical examination of all patients were reviewed. [ Result] The long - term results of 82 children with Legg - Perthes were evaluated according to 5 - item and ten score system including clinical presentation, limb shortage, acetabula socket coverage of the femur capital epiphysis, shape of the capital ipiphysis and the intertroehanteric distance. Each item was classified into 3 degrees （0, 1, or 2） respectively. Score sum ≥9 was rated as being excellent. The score sum 7 to 8 was evaluated as being good and that reaching 5 to 6 as being fair. The sum 〈 5 as being poor. Fifty - nine in 82 children enrolled had good to excellent results according to classification system. [ Conclusion ] This combined operation is a feasible method for treating Legg - Perthes disease.