Grzegorzewski Andrzej, Synder Marek, Kozłowski Piotr, Szymczak Wiesław, Bowen Richard James
Department of Orthopaedics, Medical University of ŁódY, Poland, and Department of Pediatric Orthopaedics, duPont Hospital for Children, Wilmington, DE, USA.
J Pediatr Orthop. 2006 May-Jun;26(3):316-21. doi: 10.1097/01.bpo.0000221926.10148.bf.
The purpose of this study is to evaluate the changes in the shape of acetabulum from the onset of the disease to the skeletal maturity in Legg-Calvé-Perthes disease. The study population consisted of 243 patients with unilateral involvement who had reached skeletal maturity at last follow-up. All hips were treated by containment methods (which included bed rest and traction in abduction, Petri cast, brace, varus osteotomy, Salter osteotomy, and shelf acetabuloplasty). Necrosis of the femoral head was estimated according to the lateral pillar classification and late results according to the Stulberg classification. Changes in the shape of the acetabulum were divided into 3 groups: type I-normal, concave lateral acetabulum margin; type II-flat, horizontal lateral acetabulum margin; and type III-convex, sloping acetabular margin. Roentgenograms performed during the fragmentation stage revealed type I changes in 78 (32.1%) hips, type II in 136 (55.7%), and type III in 29 (12.2%). At the last follow-up, there were type I changes in 124 (51.2%) hips, type II in 81 (33.5%), and type III in 38 (15.3%). The statistical analysis revealed no significant statistical difference between the age at the onset and gender with regard to acetabular changes. There was significant statistical correlation between the lateral pillar classification, subluxation of the femoral head, the range of hip abduction, and the Stulberg classification with regard to acetabular changes. A type III was statistically associated with lateral pillar classification group C, major subluxation of the femoral head, limited hip abduction, and in Stulberg group 3, 4, or 5. Only surgical methods of treatment improved the acetabular shape at the last follow-up (P<0.05). In our opinion, the lateral acetabulum shape plays a very important role during the remodeling of the deformed proximal femoral epiphysis.
本研究的目的是评估Legg-Calvé-Perthes病从发病到骨骼成熟阶段髋臼形状的变化。研究对象包括243例单侧患病且在最后一次随访时达到骨骼成熟的患者。所有髋关节均采用包容疗法进行治疗（包括卧床休息及外展牵引、Petri石膏、支具、内翻截骨术、Salter截骨术和髋臼造盖术）。根据外侧柱分类法评估股骨头坏死情况，根据Stulberg分类法评估远期疗效。髋臼形状的变化分为3组：I型——正常，髋臼外侧缘呈凹形；II型——平坦，髋臼外侧缘呈水平状；III型——凸起，髋臼缘呈倾斜状。在碎裂期拍摄的X线片显示，78例（32.1%）髋关节为I型改变，136例（55.7%）为II型改变，29例（12.2%）为III型改变。在最后一次随访时，124例（51.2%）髋关节为I型改变，81例（33.5%）为II型改变，38例（15.3%）为III型改变。统计分析显示，发病年龄和性别在髋臼变化方面无显著统计学差异。在髋臼变化方面，外侧柱分类、股骨头半脱位、髋关节外展范围与Stulberg分类之间存在显著的统计学相关性。III型在统计学上与外侧柱分类C组、股骨头严重半脱位、髋关节外展受限以及Stulberg 3、4或5组相关。仅手术治疗方法在最后一次随访时改善了髋臼形状（P<0.05）。我们认为，髋臼外侧形状在畸形的股骨近端骨骺重塑过程中起着非常重要的作用。
