Wichłacz Wojciech, Sotirow Bogolub, Sionek Andrzej, Czop Andrzej
I Oddział Urazowo-Ortopedyczny Dzieci, Klinika Ortopedii, Otwock.
Ortop Traumatol Rehabil. 2004 Nov-Dec;6(6):718-27.
Background. The purpose of this article is to present the history of the authors' own technique for the surgical treatment of children with Perthes' disease by means of inter- and subtrochanteric osteotomy, and to describe the outcomes achieved. Material and methods. We analyzed 208 hip joints treated during the period 1976-1998 (162 boys and 46 girls, m/f ratio 78/22). The average age at surgery was 7.8 years, and at final check-up, 13 years; the average observation period was 11 years (range 5-25). After surgery the children were immobilized in a plaster cast for 8 weeks, and then for 8 more weeks in an exercise cast. Results. We analyzed the results, assessed according to the Stulberg and Mose systems, in 3 age groups with differing outcome. In the 3-5 years age bracket there were 81% good outcomes, 22% satisfactory, and 5% poor. In the 6-8 age bracket, there were 77% good outcomes, 18% satisfactory, and 5% poor. In the 9-14 age bracket we found 50% good outcomes, 40% satisfactory, and 10% poor. Conclusions. In 60% of the children operated in the early phase of the disease we observed cessation of the disease process and accelerated healing of the necrosis in the femoral head. These joints either did not pass through a fragmentation phase or only entered it. The outcomes we achieved and the short period of immobilization in plaster cast are good reasons to recommend this type of treatment.
背景。本文旨在介绍作者采用转子间和转子下截骨术治疗儿童 Perthes 病的技术发展历程，并描述所取得的治疗效果。材料与方法。我们分析了 1976 年至 1998 年期间治疗的 208 个髋关节（162 名男孩和 46 名女孩，男女比例为 78/22）。手术时的平均年龄为 7.8 岁，最后一次检查时为 13 岁；平均观察期为 11 年（范围 5 - 25 年）。术后患儿用石膏固定 8 周，然后再用功能锻炼石膏固定 8 周。结果。我们根据 Stulberg 和 Mose 系统评估结果，分析了 3 个不同预后年龄组的情况。在 3 - 5 岁年龄组中，良好预后占 81%，满意占 22%，差占 5%。在 6 - 8 岁年龄组中，良好预后占 77%，满意占 18%，差占 5%。在 9 - 14 岁年龄组中，良好预后占 50%，满意占 40%，差占 10%。结论。在疾病早期接受手术的患儿中，60%观察到疾病进程停止，股骨头坏死加速愈合。这些关节要么未经历碎裂期，要么仅进入该阶段。我们所取得的治疗效果以及短时间的石膏固定是推荐这种治疗方法的充分理由。
