改良Chiari术治疗Perthes病术后随访研究

Long follow up of children with Perthes' disease after modified Chiari osteotomy

目的 评估改良Chiari骨盆截骨 +滑膜部分切除术治疗Perthes病的远期疗效。方法对接受该术式治疗 5年以上的 47个患儿进行定期随访 ,通过询问病史、查体和摄片 ,了解其症状及髋关节变化。结果 47例患儿中 6例出现骺板早闭 ,11例发生大转子上移 ,3例患髋疼痛。骺高由术前 6 4.36 %增至 74.85 % ,髋臼明显加深 ,加宽 ,倾斜度减小 ,髋臼对股骨头包容满意 ,患侧股骨头的负重力矩较健侧增大。最后随访时髋关节Stulberg分级Ⅰ、Ⅱ级占73.9% ,Ⅲ、Ⅳ级占 2 4.0 % ,Ⅴ级占2 .1%。Herring分类与骺高恢复、发病年龄与Stulberg分级分别显著相关。 结论 本术式治疗Perthes病远期效果满意。

Objective To evaluate the effect of synovectomy with modified Chiari medial displacement osteotomy of pelvis in the treatment of Perthes disease in children. Methods 47 patients who undernent the operated more than 5 years before were followed up on regular basis for symptom and hip changes by history taking,physical examinating taking and ray X filmstaking. Results In the 47patients, growth plate arrested in 6, greater trochanter overgrew in 11, and 3 had pain in hip. Epiphyseal height recovered from pre opration 64.36% to 74. 85% ; acetabular deepened and widened, sharp angular deceased,acetabular covered the femoral head satisfactorily; and moment of force in the involved side was longer than the normal side. According to Stulberg Classification, classes Ⅰ,Ⅱ amounted to 73.9% ,classes Ⅲ,Ⅳ classes made up 24.0% , class Ⅴ constituted 2.1% . Herring classification had close relevance with the epiphyseal height recovery, so did the age onset with Stulberg classification. Conclusions The surgery yielded a satisfactory results with Perthes disease. Herring classification and onset age were two important prognostic factors.