Rosenfeld Scott B, Herring John A, Chao John C
Department of Orthopedic Surgery, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8883, USA.
J Bone Joint Surg Am. 2007 Dec;89(12):2712-22. doi: 10.2106/JBJS.G.00191.
The prognosis for children in whom Legg-Calvé-Perthes disease develops before the age of six years was initially reported to be good, but later studies demonstrated a less favorable prognosis. To assess the natural history of this condition in this age group, we reviewed a large cohort of children who had received minimal treatment for the disease.
The medical records and radiographs of all children with Legg-Calvé-Perthes disease seen at our institution between 1944 and 2000 were reviewed. The cases of 172 patients with a total of 188 affected hips were studied. The course of the disease and the final clinical and radiographic outcomes were evaluated in all patients.
Typical Legg-Calvé-Perthes disease was noted in 164 hips of 160 patients. According to the lateral patellar classification, seven of these hips were in group A; 101, in group B; twenty-seven, in the B/C border group; and twenty-nine, in group C. According to the Stulberg classification, there were 131 Class-I or II (good) results, fourteen Class-III (fair) results, and nineteen Class-IV (poor) results. The lateral pillar classification was highly correlated with the outcome, whereas treatment did not correlate with the outcome. Only lateral pillar group-B/C border and C hips with an onset of the disease between the ages of four years and five years and eleven months had a poor prognosis. We unexpectedly encountered a group of twelve patients with bilateral, simultaneous development of apparent Legg-Calvé-Perthes disease. In that group, there were twenty-one Stulberg Class-I or II (good), three Stulberg Class-III (fair), and no Stulberg Class-IV (poor) results, although fourteen of the twenty-four hips were in lateral pillar group C. The outcome in the hips in lateral pillar group C was significantly better when the patient had bilateral simultaneous involvement than when the patient had typical Legg-Calvé-Perthes disease.
The prognosis for patients with the onset of Legg-Calvé-Perthes disease before the age of six years is favorable, with 80% having a good result. Only children between the ages of four years and five years and eleven months with a B/C or C lateral pillar classification of involvement have a less favorable prognosis. Treatment was not found to influence outcome. Simultaneous bilateral disease, which had a more favorable prognosis, may represent a unique disorder.
最初有报道称，6岁前罹患Legg-Calvé-Perthes病的儿童预后良好，但后来的研究表明预后没那么乐观。为了评估该年龄段这一疾病的自然病程，我们回顾了一大群接受过最少治疗的患儿。
我们查阅了1944年至2000年间在本机构就诊的所有Legg-Calvé-Perthes病患儿的病历和X光片。研究了172例患者共188个患髋的病例。评估了所有患者的疾病病程以及最终的临床和影像学结果。
160例患者的164个髋出现典型的Legg-Calvé-Perthes病。根据外侧柱分类，这些髋中7个属于A组；101个属于B组；27个属于B/C边界组；29个属于C组。根据Stulberg分类，有131个结果为I级或II级（良好），14个为III级（尚可），19个为IV级（差）。外侧柱分类与结果高度相关，而治疗与结果无关。只有外侧柱B/C边界组和C组、发病年龄在4岁至5岁11个月之间的患髋预后较差。我们意外地遇到了一组12例双侧同时出现明显Legg-Calvé-Perthes病的患者。在该组中，有21个Stulberg I级或II级（良好），3个Stulberg III级（尚可），没有Stulberg IV级（差）的结果，尽管24个髋中有14个属于外侧柱C组。当患者双侧同时受累时，外侧柱C组患髋的结果明显优于患典型Legg-Calvé-Perthes病的患者。
6岁前发病的Legg-Calvé-Perthes病患者预后良好，80%的患者结果良好。只有年龄在4岁至5岁11个月之间、受累为B/C或C外侧柱分类的儿童预后较差。未发现治疗会影响结果。双侧同时发病且预后较好，可能代表一种独特的疾病。
