目的 评价骨盆三联截骨手术对儿童股骨头缺血性坏死的中远期疗效。方法 回顾性分析2005年至2012年在我科采取骨盆三联截骨术治疗的儿童股骨头缺血性坏死(Legg-Calve-Perthes Disease,LCPD)患者临床资料,共39例,男29例,女10例。年龄6～12岁,平均8.2岁。术前进行Herring分型,术后3年进行Stulberg分型以及测量CE角、Sharp角、AI值、股骨头挤压指数、双下肢长度差值来评价手术疗效。结果 患者手术后随访3～10年,平均5.3年。术前Herring分型:B型18例,B/C型13例,C型8例。术后38例CE角、Sharp角、AI值、股骨头挤压指数显示股骨头获得了良好的包容。Herring分型为 B型、B/C型、C型的患者术后Stulberg分型优良率分别为94.44%、76.92%、50%,各Herring型患者术后Stulberg分型差异有统计学意义(P<0.05)。术后双下肢长度差值:Herring B型(6.94±2.69)mm,B/C型(10.46±3.45)mm,C型(14.87±4.94)mm,各型(包括2例C型术后长度差>20 mm)术后双下肢长度差值有统计学意义(P<0.05)。结论 骨盆三联截骨术治疗Herring B、B/C与C型LCPD患者,可使股骨头获得良好包容,有利于髋关节功能的恢复,并能减少术后跛行的发生,是改善儿童股骨头缺血性坏死的中远期功能以及减少残留畸形的有效治疗方式。
Objective To evaluate the therapeutic effect of triple pelvic osteotomy for LCPD in children. Methods We retrospectively reviewed the records of 39 patients(29 male and 10 female)with LCPD who were treated with triple pelvic osteotomy between with 2005 to 2012 in our hospital.All hips were classified with the modified lateral pillar classification(18 patients in lateral pillar group B,13 patients in lateral pillar group B/C,8 patients in lateral pillar group C).CE angle,Sharp's angle,Acetabular index,Femoral head extrusion index were measured to analysis femoral head containment.Leg length discrepancy and the Stulberg classification were used for evaluate progonosis. Results In the follow-up term,patients ranged 3 to 10 years(mean,5.3 years).38 patients exhibited femoral head containment at last followup.The lateral pillar B group or B/C group have a better stulberg classification with triple pelvic osteotomy.The lateral pillar classification is the factor related with Stulberg classification.Only two patients after treatment the LLD(Leg Length Discrepancy)is over 20 mm. Conclusion Triple pelvic osteotomy could achieve good containment effect in LCPD.To keep sphericity of the femoral head and congruity with acetabulum of the hip.This method could effectively prevent the complication of limp.It should be an effective procedure for treating LCPD in children.
