改良Chiari髂骨截骨组合术治疗儿童Perthes病的手术时机及疗效评定标准

Optimal timing and assessment of post-operative results following modified Chiari ilium osteotomy for Perthes disease in children

x目的探讨改良Chiari髂骨截骨治疗儿童Perthes病的手术时机与疗效评定标准。方法1986年6月至2004年12月，采用改良Chiari髂骨截骨、髋关节滑膜切除、股骨颈钻孔减压、髂腰肌延长和股内收肌松解的组合式手术治疗Perthes病患儿234例，其中得到3年以上随访者108例，男61例，女47例；年龄3岁2个月～13岁6个月，平均7岁3个月。根据术前骨盆x线片按Catterall法分期，I期10例，Ⅱ期31例，Ⅲ期32例，Ⅳ期35例。采用邸建德等、Green等和Mose的Perthes病疗效评定标准为基础，自行制定五项十分法进行疗效评定，即临床症状、患肢长度、头骺覆盖率、头骺形状和关节转子间距等，满分为10分，总分I〉9分为优，7-8分为良，5-6分为可，≤4分为差。结果108例患儿随访时间3～12年，平均5年8个月。术后无一例发生血管及神经损伤、切口感染、骨不连等并发症。患儿术前存在的轻度髋内旋和外展活动障碍及关节疼痛均消失。根据五项十分法进行疗效评定，I期优良率90．00％，Ⅱ期优良率90．32％，二者平均为90．24％；llI期优良率68．75％，Ⅳ期优良率68．57％，二者平均为68．66％。早期（Ⅰ、Ⅱ期）优良率明显好于晚期（Ⅲ、Ⅳ期）。结论早期采用改良Chiari髂骨截骨治疗儿童Perthes病的效果明显好于晚期。五项十分法的疗效评定标准可较好地对患儿术后的远期效果作出前瞻性评估。

Objective To explore the surgical designing, optimal timing and assessment of post-op- erative results for modified Chiari ilium osteotomy in treatment of children Perthes disease. Methods From June 1986 to December 2004, 234 children with Perthes disease were operated by the combining procedures of modified Chiari ilium osteotomy, partial synovectomy of hip joint, femur neck drilling decompress, ilio- psoas muscle lengthening and detachment of adductor muscles of the femur. Among them 108 cases were regularly followed up more than 3 years. There were 61 males and 47 females, with the mean age of 7 years and 3 months （ranged from 3 years and 2 months to 13 years and 6 months）. According to preoperative radio- graphs, there were 10 cases for Catterall I, 31 for H, 32 for Ⅲ, and 35 for IV. The long-term post-operative results of 108 children were evaluated according 5-items （clinical presentation, length of limb shortage, percentage of femur capital coverage, shape of femur capital epiphysis and artieulo-trochanteric distance） and 10-score system. The score sum ≥9 was evaluated as excellent, 7-8 as good, 5-6 as fair, and less than 4 as bad respectively. Results One hundred and eight patients were followed up 3 to 12 years （average 5 years and eight months）. No complications were found such as neurovascular injury, infection, and bone union. The hip intorsion, abduction disturbance, and arthralgia disappeared after operation. The overall rate of good to excellent result in Catterall Ⅰ and Ⅲ groups was 90.24%, while that of Catterall m and IV groups was 68.66%. Conclusion This combining procedures of modified Chiari ilium osteotomy can be an alternative appropriately to treat Perthes disease in children, especially good for the early patients.