比较股骨内翻截骨联合Salter截骨与骨盆三联截骨治疗重度Perthes病

Surgical methods for severe Perthes disease： combined Salter innominate osteotomy with femoral varus os-teotomy VS triple pelvic osteotomy

目的比较股骨内翻＋Salter截骨术与骨盆三联截骨两种手术方式对Perthes病严重病例的疗效，分析影响预后的相关因素。方法对2006年1月至2010年1月北京积水潭医院d,JL骨科收治的43例严重Perthes病例进行回顾性分析。按手术方式分为股骨内翻＋Salter截骨手术组（26例）及骨盆三联截骨手术组（17例），通过改良Stulberg分型评估预后，比较手术效果。将年龄分组（低年龄组6～8岁，高年龄组〉8岁），Catterall分期，外侧柱分级带入回归分析，分析相关影响因素。结果43例患儿，男40例，女3例；发病年龄（8．16±1．79）岁；随访时间（52．58±14．45）个月。股骨内翻联合Salter截骨与骨盆三联截骨两组比较术后疗效，差异无统计学意义（P=0．544）。Catterall分期是影响预后的独立危险因素。结论股骨内翻＋Salter截骨术及骨盆三联截骨术均可以用于治疗Perthes病严重病例。发病年龄及Catterall分期是影响预后的相关因素。年龄越大，骨骺受损越严重的病例，预后越差，应及早手术治疗。

Objective To compare the results of two surgical treatments for severe Perthes dis ease： combined Salter innominate osteotomy with femoral varus osteotomy and triple pelvic osteotomy and to identify risk factors for prognosis. Methods Patients with Perthes disease in Beijing Jishuitan Hospital were retrospectively reviewed and divided into two groups. Stulberg classification was used for assessment. Age （6-8 years, 〉8 years old）, Catterall group and the lateral pillar group were taken into regression analysis to identify related prognostic factors. Results Totally 43 patients （40 male and 3 female） with severe Perthes disease were treated. In the follow up term, there was no difference between the 2 groups in radiographic outcome. The Catterall group and the age group were the factors related with the Stulberg classification. Conclusions Both Salter plus varus osteotomy and triple pelvic osteotomy are effective in severe Perthes disease. Catterall classification system and age of patients are prognostic factors.