骨盆三联截骨联合股骨近端截骨术治疗Legg-Calvé-Perthes病的疗效

Efficacy of triple pelvic osteotomy combined with proximal femoral osteotomy for Legg-Calvé-Perthes disease

目的评价骨盆三联截骨联合股骨近端截骨术治疗Legg-Calvé-Perthes病的短期疗效。方法回顾性分析2010年5月至2012年12月采用包容治疗的40例（40髋）Legg-Calvé-Perthes病患者资料，其中男29例，女11例；年龄6岁～10岁4个月，平均8．3岁。根据包容治疗方法将患者分为2组：A组，20例，采用骨盆三联截骨联合股骨近端截骨术；B组：20例，采用其他包容治疗（股骨近端截骨术、Salter骨盆截骨联合股骨近端截骨术）。比较两组手术前后影像学数据变化和Harris髋关节评分。结果所有患者均获得术后18～48个月（平均32个月）的随访。术后A、B组CE角分别增加18．45°±4．25°和13．18°±3．07°，股骨头外移比值分别降低0．53±0．25和0．35±0．19，Sharp角分别降低14．64°±3．25°和10．87°±6．42°，股骨头覆盖率分别增加22．42％±2．19%和18．57％±6．42%，差异均有统计学意义（P〈0．05）。A组术后Harris髋关节评分4分及以上19例，B组18例，差异无统计学意K（P〉O．05）。结论骨盆三联截骨联合股骨近端截骨术治疗Legg-Calvé-Perthes病髋关节局部解剖结构改变较小，能达到很好的包容效果，可有效防止单一术式局部矫正过大引发的并发症，适用于严重Legg-Calvé-Perthes病。

Objective To evaluate the clinical efficacy of triple pelvic osteotomy combined with proximal femoral osteotomy for Legg-Calvé-Perthes disease.Methods Date of 40 patients with Legg-Calvé-Perthes disease who were treated with triple pelvic osteotomy combined with proximal femoral osteotomy between May 2010 and December 2012 were retrospectively analyzed.There were 29 males and11 females,with an average age of 8.3 yerars(range,6-10.4 years).All patients were separated into two groups.There were 20 patients treated with triple pelvic osteotomy combined with proximal femoral osteotomy in group A and 20 patients treated with the other containment surgery(proximal femoral osteotomy,Slater pelvic osteotomy combined with proximal femoral osteotomy)in group B.Radiography analyzes in pre-operation and post-operation between two groups and Harris hip score in the last follow-up were performed.Results The follow-up for the patients ranged 18 to 48 months(mean,32 months).The increasing CE angles were 18.45°±4.25°and 13.18°±3.07°in group A and group B at post-operation,respectively.The decreasing subluxation femoral radio(SFR)were 0.53±0.25 and 0.35±0.19 in group A and group B at post-operation,respectively.The decreasing Sharp angle were 14.64°±3.25°and 10.87°±6.42°in group A and group B at post-operation,respectively.The increasing femoral head coverage rate were 22.42% ±2.19% and 18.57%±6.42%in group A and group B at post-operation,respectively.There were significant differences between two groups in CE angle,SFR,Sharp angle and femoral head coverage rate(P<0.05).There were 19 patients of four scores or more of Harris hip score in grouop A.There were 18 patients of four scores or more of Harris hip score in grouop B.There was no significant difference between two groups in Harris hip score(P>0.05).Conclusion Triple pelvic osteotomy combined with proximal femoral osteotomy could achieve well containment effect in the Legg-Calvé-Perthes disease,even in some severe cases.Compare with other surgery,this method could effectively prevent the complications caused by single operation which may need more bigger correction in the local areas.