Gordon J Eric, Schoenecker Perry L, Osland John D, Dobbs Matthew B, Szymanski Deborah A, Luhmann Scott J
Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
J Pediatr Orthop B. 2004 Nov;13(6):367-70. doi: 10.1097/01202412-200411000-00003.
The etiology of Legg-Calvé-Perthes disease is poorly understood. An association has been found in the past between Legg-Calvé-Perthes disease and smoking as well as low socio-economic status.
A prospective study was carried out in which families with a child diagnosed with Legg-Calvé-Perthes' disease were interviewed about the presence and duration of household second-hand smoke exposure to children. A control group of randomly selected families seen at our institution were interviewed with identical questions. The radiographs of children with Legg-Calvé-Perthes disease were reviewed and classified according to the Herring lateral pillar classification system.
Thirty-eight of the 60 patients (63.3%) with Legg-Calvé-Perthes disease were noted to have at least one smoker living in the child's household with a mean of 1.03 smoker-years per year of life exposure to smoke. The median income of the patients with Legg-Calvé-Perthes disease was USD 20,300. The median income of the patients in the control group was USD 17,000. Thirty-eight of the 96 control patients (39.6%) were noted to have at least one smoker living in the child's household with a mean of 0.48 smoker-years per year of life. A significant association was noted between living with a smoker and Legg-Calvé-Perthes disease as well as between increasing smoke exposure and increased risk of developing Legg-Calvé-Perthes disease. No significant association was noted between lower income and Legg-Calvé-Perthes disease. There was no association between increased smoke exposure and increased severity of Legg-Calvé-Perthes disease as measured by the lateral pillar classification.
The presence of second-hand smoke seems to be a significant risk factor in the development of Legg-Calvé-Perthes disease. The presence of second-hand smoke may represent the 'unknown industrial factor' that has been discussed.
股骨头缺血性坏死的病因尚不清楚。过去曾发现股骨头缺血性坏死与吸烟以及社会经济地位低下之间存在关联。
进行了一项前瞻性研究，对有被诊断为股骨头缺血性坏死患儿的家庭就家庭中儿童二手烟暴露的存在情况和持续时间进行访谈。对在我们机构随机选取的对照组家庭也提出相同问题进行访谈。对股骨头缺血性坏死患儿的X线片根据赫林外侧柱分类系统进行复查和分类。
60例股骨头缺血性坏死患者中有38例（63.3%）其家中至少有一名吸烟者，平均每人每年有1.03吸烟人年的烟雾暴露。股骨头缺血性坏死患者的收入中位数为20,300美元。对照组患者的收入中位数为17,000美元。96例对照患者中有38例（39.6%）其家中至少有一名吸烟者，平均每人每年有0.48吸烟人年的烟雾暴露。发现与吸烟者同住和股骨头缺血性坏死之间以及烟雾暴露增加与患股骨头缺血性坏死风险增加之间存在显著关联。未发现低收入与股骨头缺血性坏死之间存在显著关联。根据外侧柱分类法，烟雾暴露增加与股骨头缺血性坏死病情严重程度增加之间无关联。
二手烟的存在似乎是股骨头缺血性坏死发病的一个重要危险因素。二手烟的存在可能代表了已被讨论过的“未知工业因素”。
