Maxwell S L, Lappin K J, Kealey W D, McDowell B C, Cosgrove A P
Musculoskeletal Education and Research Unit, Department of Orthopaedics, Musgrave Park Hospital, Belfast, Northern Ireland, UK.
J Bone Joint Surg Br. 2004 Mar;86(2):244-50. doi: 10.1302/0301-620x.86b2.14284.
We have examined the effect of arthrodiastasis on the preservation of the femoral head in older children with Perthes' disease. We carried out a prospective trial in boys over the age of eight years and girls over seven years at the time of the onset of symptoms. The patients had minimal epiphyseal collapse and were compared with a conventionally treated, consecutive, historical control group. Arthrodiastasis was applied for approximately four months. The primary outcome measure was the extent of epiphyseal collapse at the end of the fragmentation phase. One of the 15 treated hips and nine of the 30 control hips showed a loss of height of 50% or more of the lateral epiphyseal column on the anteroposterior radiographs (Herring grade-C classification). On a Lauenstein view, one of the treated hips and 19 of the control hips showed at least a loss of height of 50% of the anterior epiphyseal column. The complications of arthrodiastasis included pin-site infection in most hips, transient joint stiffness in two, and breakage of a pin in two. The final outcome will be known when all the patients and the control group reach skeletal maturity.
我们研究了关节扩张术对大龄 Perthes 病患儿股骨头保留情况的影响。我们对症状出现时年龄在 8 岁以上的男孩和 7 岁以上的女孩进行了一项前瞻性试验。这些患者骨骺塌陷程度较轻，并与常规治疗的连续历史对照组进行比较。关节扩张术实施约四个月。主要结局指标是碎裂期结束时骨骺塌陷的程度。在前后位 X 光片上，15 个接受治疗的髋关节中有 1 个以及 30 个对照髋关节中有 9 个显示外侧骨骺柱高度丢失 50%或更多（Herring C 级分类）。在 Lauenstein 位片上，1 个接受治疗的髋关节和 19 个对照髋关节显示前骨骺柱高度至少丢失 50%。关节扩张术的并发症包括大多数髋关节的针道感染、2 例短暂性关节僵硬和 2 例钢针折断。当所有患者和对照组达到骨骼成熟时，最终结果才会明确。
