带旋髂深血管蒂骨膜瓣植入治疗儿童Perthes病的远期疗效分析

Long-term effect analysis of treating Perthes disease with vascular pedicled iliac periosteal flap graft

目的:观察带旋髂深血管蒂骨膜瓣植入治疗儿童Perthes病的远期疗效。方法:对采用带旋髂深血管蒂骨膜瓣植入术治疗的49例(53髋)4～12岁Perthes病患儿远期疗效进行分析;其中Herring B型17例(19髋),B/C型21例(23髋),C型11例(11髋);术后系统随访3～16年。结果:术后Harris评分较术前明显提高(P<0.01)。StulbergⅠ、Ⅱ级39髋,其中HerringB型16髋,B/C型19髋,C型4髋;StulbergⅢ级10髋,其中Herring B型3髋,B/C型3髋,C型4髋;StulbergⅣ级4髋,其中Herring B/C型1髋,C型3髋。B、B/C型术后Stulberg分级差异无统计学意义(P>0.05),B、B/C型与C型术后Stulberg分级差异有统计学意义(P<0.01)。男37例(41髋)预后达StulbergⅠ、Ⅱ级34髋,女12例(12髋)预后达StulbergⅠ、Ⅱ级5髋。4～7岁患儿33例(37髋)预后达StulbergⅠ、Ⅱ级32髋,8～12岁患儿16例(16髋)预后达StulbergⅠ、Ⅱ级7髋。结论:带旋髂深血管蒂骨膜瓣植入治疗儿童Perthes病可取得良好远期效果。Herring外侧柱分型、患儿发病年龄和性别对Perthes病的预后评估有明确指导作用。

Objective：To evaluate the long-term effects of vascular pedicled iliac periosteal flap graft on Perthes disease. Methods：Fifty-three hips of 49 patients with Perthes disease were treated with vascular pedicled iliac periosteal flap. All cases were followed-up for 3 to 16 years. According to the lateral pillar classification,19 hips were B type,23 hips as B/C type and 11 hips as C type. Results： The Harris hip scores were obviously improved after treatment（ P 〈 0.01 ）. According to the Stulberg classification system modified,39 hips were Stulbergclass Ⅰor Ⅱ grade including 16 hips as Herring B type, 19 hips as B/C type and 4 hips as C type. Ten hips were Stulbergclass Ⅲ grade including 3 hips as Herring B type,3 hips as B/C type and 4 hips as C type. Four hips were Stulbergclass Ⅳ grade including 1 hip as B/C type and 3 hips as C type. There was not statistical difference between the Stulberg grades of B and B/C type postoperation（P 〉 0.05）. Compared with C type, the Stulberg grades of B and B/C type had significantly different（P 〈 0.01 ）. The prognosis of 34 hips in male（41 hips） and 5 hips in female（ 12 hips） were Stulbergclass Ⅰ orⅡ grade. The prognosis of 32 hips in 4 to 7 years children（37 hips） and 7 hips in 8 to 12 years children（ 16 hips） were Stulbergclass Ⅰ orⅡ grade. Conclusions：The effects of treating Perthes disease with vascular pedicled iliac periosteal flap graft are good. The lateral pillar classification, the age and gender of patients can help us to evaluate prognosis.