改良Chiari术治疗Perthes病术后随访研究

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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。Herring分类及患儿发病年龄对本病具有确切的预后价值 Objective To evaluate the long-term efficacy of modified Chiari pelvic osteotomy and partial synovectomy in the treatment of Perthes disease. Methods Forty-seven children undergoing the surgical treatment for more than 5 years were followed up regularly. Their symptoms and changes of hip joint were analyzed by asking medical history, physical examination and radiography. Results Among the 47 cases, 6 cases showed epiphyseal plate early closure, 11 cases had a large trochanter and 3 cases had hip pain. The epiphyseal height increased from 6.436% preoperatively to 74.85%. The acetabulum was deepened, widened and the inclination decreased. The acetabulum was satisfied with the femoral head. The load moment of the affected femoral head was increased compared with that of the contralateral side. At last follow-up, Stulberg classification of hip Ⅰ and Ⅱ grade accounted for 73.9%, grade Ⅲ and Ⅳ accounted for 2 4.0% and grade Ⅴ accounted for 2.1%. Herring classification and epiphyseal high recovery, age of onset and Stulberg classification were significantly correlated. Conclusion This procedure is effective in treating long-term Perthes disease. Herring classification and age of onset of the disease has the exact prognosis of the disease
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