儿童Legg-Calvé-Perthes病预后相关因素的研究进展

Research progress on prognostic factors of Legg-Calve-Perthes disease in children

Legg-Calvé-Perthes病(Perthes病)是一种儿童时期的特发性股骨头缺血性坏死, 随病程进展会出现股骨头变形, 最终导致骨性关节炎, 其治疗包括手术和非手术治疗, 但治疗指征和时机目前仍不明确。深入理解Perthes病的预后因素有助于预判结局, 对临床具有重要的指导意义。对2000年以后的Perthes病预后相关文献进行综述, 将预后因素归纳分类, 包括一般因素、疾病因素和干预因素, 并依此对相关的研究进展进行总结。一般因素为临床第一时间能够获取的患者特征信息, 发病年龄是最明确的预后相关因素, 年龄越小, 预后越好, 6~8岁是一个重要的分水岭。疾病因素是指通过检查与评估获取的疾病特征信息。首先需要确认改良Waldenstrom分期, 早期治疗(碎裂早期前)更能保证预后。其次是疾病程度评估, 包括坏死受累程度、股骨头形态改变、股骨头突出程度, 病情越严重, 预后越差, 多数评估指标如Catterall分级、Herring外侧柱分型都是Perthes病晚期的指标。增强MRI或弥散加权成像(diffusion-weighted image, DWI)-MRI中评估股骨头灌注程度是Perthes病早期预测指标, 但还处于初步探索阶段。干预因素即不同的干预方式对预后的影响, 包括手术或非手术、不同非手术方式及不同手术方式的对比。选择手术或非手术治疗主要取决于发病年龄和疾病严重程度, 小龄、轻型病例倾向于非手术治疗, 但具体指征还存在争议。

Legg-Calve-Perthes disease(LCPD)is an idiopathic necrosis of the femoral head in childhood,the deformities of the femoral head occurring in the progress of disease could result in osteoarthritis.Treatment can be surgical or nonsurgical,but the timing and indications remain unclear.Understanding of the prognostic factors of LCPD is helpful to predict the outcome and guide the clinical management.This study reviewed the literatures about the prognosis of LCPD since 2000,the prognostic factors were summarized from three categoriesas general factors,disease factors and intervention factors.The general factors were the characteristic information of patient that can be obtained at the first time clinically.The age of onset is the most definite prognostic factor,the younger the age,the better the prognosis,and 6-8 years is an important watershed.Disease factors refer to the disease characteristic information obtained through evaluation.The modified Waldenström stage of the disease needs to be confirmed first,early treatment can ensure better prognosis.Then the severity was evaluated,including the involvement of necrosis,morphological changes and extrusion of the femoral head.The more severe the disease,the worse the prognosis.Most predicters,such as Catterall grading and Herring lateral column typing,have to be used in late-stage of LCPD.The degree of femoral head perfusion evaluated in enhanced MRI or DWI-MRI is an early predictor of LCPD,but it is still in the preliminary exploratory.Intervention factors are the effects of different methods of treatment on prognosis,including the comparison of surgery or non-surgery,different non-surgical and different surgical methods.The determination of surgical or non-surgical treatment mainly depends on the age of onset and severity of disease,and the younger and milder cases tend to be non-surgical treatment,but the specific indications are still controversial.