Czubak Jarosław, Pietrzak Szymon, Kraiz Sulaiman, Płończak Maciej
Klinika Ortopedii Centrum Medycznego Kształcenia Podyplomowego, Warszawa; Samodzielny Publiczny Szpital Kliniczny im. Prof. Adama Grucy, Otwock.
Ortop Traumatol Rehabil. 2004 Nov-Dec;6(6):758-63.
Background. In Perthes' disease femoral head deformities can be accompanied by high location of the greater trochanter and diminished shaft-neck angle, causing decreased joint stability and diminished hip function. The aim of our study was to compare head-trochanter relationships in hips treated for Perthes' disease using surgical and non-surgical methods. Material and methods. The clinical material consisted of 61 children (68 hips) treated in our hospital from 1990 to 1994; 32 hips were treated conservatively, while 36 hips were operated. The mean observation time was 7.7 years. We re-examined X-rays done at onset, after 3-6 months of treatment, and at final follow-up. The projected shaft-neck angle, ATD (Edgren), and degree of head involvement (Catteral and Herring) were evaluated, while the Stulberg classification was used for outcome evaluation. In clinical examination we looked for Trendelenburg sign, limping, and leg length discrepancy. Results. The value of shaft-neck angle and ATD were correlated with age, sex, degree of head containment, and method of treatment. In boys, comparatively low ATD values were found in both treatment groups. In girls the ATD values were considerably lower in operated hips. High trochanter location and diminished shaft-neck angle had no statistical effect on clinical outcome. Conclusion. The natural course of Perthes' disease causes decreased ATD, regardless of treatment type. In our operative technique, containment may be achieved more by extension (anteflexion) osteotomy of the femur than by pure varisation osteotomy. We found no indication for epiphysiodesis of the greater trochanter combined with anteflexion osteotomy of the femur.
背景。在佩特兹病中，股骨头畸形可能伴有大转子高位和股骨干颈角减小，导致关节稳定性下降和髋关节功能减退。我们研究的目的是比较采用手术和非手术方法治疗佩特兹病的髋关节中股骨头与转子的关系。材料与方法。临床资料包括1990年至1994年在我院接受治疗的61例儿童（68个髋关节）；32个髋关节采用保守治疗，36个髋关节接受了手术治疗。平均观察时间为7.7年。我们重新检查了发病时、治疗3 - 6个月后以及最终随访时拍摄的X线片。评估了预计的股骨干颈角、ATD（埃德格伦）以及股骨头受累程度（卡特拉尔和赫林），同时采用斯图尔伯格分类法评估治疗结果。在临床检查中，我们检查了臀中肌步态试验阳性、跛行和腿长差异。结果。股骨干颈角和ATD的值与年龄、性别、股骨头包容程度和治疗方法相关。在男孩中，两个治疗组的ATD值相对较低。在女孩中，接受手术治疗的髋关节的ATD值明显更低。大转子高位和股骨干颈角减小对临床结果无统计学影响。结论。无论治疗类型如何，佩特兹病的自然病程都会导致ATD降低。在我们的手术技术中，通过股骨延长（前屈）截骨术比单纯内翻截骨术更能实现股骨头包容。我们未发现大转子骨骺阻滞联合股骨前屈截骨术的指征。
