Segev Eitan, Ezra Elias, Wientroub Shlomo, Yaniv Moshe
Department of Pediatric Orthopaedics, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel-Aviv 64239, Israel.
J Pediatr Orthop B. 2004 May;13(3):158-65. doi: 10.1097/00009957-200405000-00004.
Sixteen children with late onset Perthes' disease were surgically treated at an average age of 12 years 1 month (9 years 4 months to 15 years) by soft tissue release and articulated hip distraction. Two patients had additional diagnosis of Down syndrome and one suffered from geleophysic epiphyseal dysplasia. Fifteen hips were graded Catterall IV and Herring C and one hip was graded Catterall III Herring B. On preoperative arthrograms, 14 patients had a saddle-shape subluxating femoral head with hinge abduction. The distraction discontinued when Shenton line was corrected. The fixation lasted 4-5 months. At a mean follow-up of 2 years 7 months (1-5 years), an improvement of hip range of motion was found in all patients. Hip joint arthrograms upon removal of the fixator showed disappearance of the saddle-shape femoral head in 10 of the 14 patients with this deformation. Shenton line breakage improved from 7.6 mm to 2.1 mm at last follow-up. The epiphyseal index improved by 14%. The average pain score on an analog scale dropped from a preoperative 7.0 to 1.6 at last follow-up (filled in by patients or parents in case of Down syndrome). Separate analysis of data from the group having only Perthes disease (13 children) showed better results. These preliminary data suggest that soft tissue release combined with unloading of the femoral head and restoration of joint space can improve the function and epiphyseal height.
16例晚发性佩特兹病患儿接受了手术治疗，平均年龄为12岁1个月（9岁4个月至15岁），采用软组织松解和髋关节牵张术。2例患者还被诊断为唐氏综合征，1例患有脂肪软骨骨骺发育异常。15个股关节被评为Catterall IV级和Herring C级，1个股关节被评为Catterall III级Herring B级。术前关节造影显示，14例患者的股骨头呈马鞍形半脱位伴铰链外展。当Shenton线恢复正常时停止牵张。固定持续4 - 5个月。平均随访2年7个月（1 - 5年），所有患者的髋关节活动范围均有改善。拆除固定器后的髋关节造影显示，14例有这种畸形的患者中，10例的马鞍形股骨头消失。最后随访时，Shenton线中断从7.6 mm改善至2.1 mm。骨骺指数提高了14%。最后随访时，模拟量表的平均疼痛评分从术前的7.0降至1.6（唐氏综合征患者由患者或家长填写）。对仅患有佩特兹病的组（13名儿童）的数据进行单独分析显示结果更好。这些初步数据表明，软组织松解联合股骨头减压和关节间隙恢复可改善功能和骨骺高度。
