佩特兹氏病：6岁以下儿童的预后情况。

Perthes' disease: prognosis in children under six years of age.

作者信息

Canavese F, Dimeglio A

机构信息

Service de Chirurgie Orthopédique Pédiatrique, Hôpital Lapeyronie, 391, Avenue du Doyen G. Giraud, 34295 Montpellier, France.

出版信息

J Bone Joint Surg Br. 2008 Jul;90(7):940-5. doi: 10.1302/0301-620X.90B7.20691.

DOI:10.1302/0301-620X.90B7.20691

PMID:18591607

Abstract

Children presenting with Perthes' disease before their sixth birthday are considered to have a good prognosis. We describe 166 hips in children in this age group. The mean age at onset of the disease was 44 months (22 to 72). Mild forms (Catterall I and II) were treated conservatively and severe forms (Catterall III and IV) either conservatively or operatively. The aim of the former treatment was to restrict weight-bearing. Operative treatment consisted of innominate osteotomy and was indicated by a Conway type-B appearance on the bone scan. All the patients were followed to skeletal maturity with a mean follow-up of 11 years (8 to 15). The end results were evaluated radiologically using the classifications of Stulberg and Mose. A total of 50 hips were Catterall grade-I or grade-II, 65 Catterall grade-III and 51 Catterall grade-IV. All hips with mild disease had a good result at skeletal maturity. Of the hips with severe disease 78 (67.3%) had good (Stulberg I and II), 26 (22.4%) fair (Stulberg III) and 12 (10.3%) poor results (Stulberg IV and V). Of the Catterall grade-III hips 38 were treated conservatively of which 31 (81.6%) had a good result, six (15.8%) a fair and one (2.6%) a poor result. Operative treatment was carried out on 27 Catterall grade-III hips, of which 21 (77.8%) had a good, four (14.8%) a fair and two (7.4%) a poor result. By comparison conservative treatment of 19 Catterall grade-IV hips led to ten (52.7%) good, seven (36.8%) fair and two (10.5%) poor results. Operative treatment was carried out on 32 Catterall grade-IV hips, of which 16 (50.0%) had a good, nine (28.1%) a fair and seven (21.9%) a poor result. We confirm that the prognosis in Perthes' disease is generally good when the age at onset is less than six years. In severe disease there is no significant difference in outcome after conservative or operative treatment (p > 0.05). Catterall grade-III hips had a better outcome according to the Stulberg and Mose criteria than Catterall grade-IV hips, regardless of the method of treatment.

摘要

6岁前出现佩特兹病的儿童被认为预后良好。我们描述了该年龄组儿童的166个髋关节。疾病发病的平均年龄为44个月（22至72个月）。轻度形式（卡特拉尔I级和II级）采用保守治疗，重度形式（卡特拉尔III级和IV级）采用保守或手术治疗。前一种治疗的目的是限制负重。手术治疗包括无名骨截骨术，骨扫描显示康威B型表现时进行手术。所有患者均随访至骨骼成熟，平均随访11年（8至15年）。使用斯图尔伯格和莫斯分类法对最终结果进行放射学评估。共有50个髋关节为卡特拉尔I级或II级，65个为卡特拉尔III级，51个为卡特拉尔IV级。所有轻度疾病的髋关节在骨骼成熟时均有良好结果。重度疾病的髋关节中，78个（67.3%）结果良好（斯图尔伯格I级和II级），26个（22.4%）结果尚可（斯图尔伯格III级），12个（10.3%）结果较差（斯图尔伯格IV级和V级）。卡特拉尔III级髋关节中，38个采用保守治疗，其中31个（81.6%）结果良好，6个（15.8%）结果尚可，1个（2.6%）结果较差。27个卡特拉尔III级髋关节进行了手术治疗，其中21个（77.8%）结果良好，4个（14.8%）结果尚可，2个（7.4%）结果较差。相比之下，19个卡特拉尔IV级髋关节采用保守治疗，10个（52.7%）结果良好，7个（36.8%）结果尚可，2个（10.5%）结果较差。32个卡特拉尔IV级髋关节进行了手术治疗，其中16个（50.0%）结果良好，9个（28.1%）结果尚可，7个（21.9%）结果较差。我们证实，发病年龄小于6岁时，佩特兹病的预后总体良好。在重度疾病中，保守或手术治疗后的结果无显著差异（p>0.05）。根据斯图尔伯格和莫斯标准，无论治疗方法如何，卡特拉尔III级髋关节的结果都比卡特拉尔IV级髋关节好。