莱格-卡尔维-佩特兹病的治疗：是否存在共识？：一项关于欧洲小儿骨科学会成员首选临床实践的研究。
The management of Legg-Calvé-Perthes' disease: is there a consensus? : A study of clinical practice preferred by the members of the European Paediatric Orthopaedic Society.
作者信息
Hefti Fritz, Clarke N M P
机构信息
Pediatric Orthopedic Department, Children's Hospital, University of Basle (UKBB), Postfach, 4005, Basle, Switzerland,
出版信息
J Child Orthop. 2007 Mar;1(1):19-25. doi: 10.1007/s11832-007-0010-z. Epub 2007 Mar 15.
PURPOSE
The aim of the study was to find out whether or not there is consensus among experienced pediatric orthopaedists about the management of certain clinical scenarios in Legg-Calvé-Perthes' disease.
METHODS
A questionnaire was sent to all 297 members of the European Paediatric Orthopaedic Society (EPOS) describing four cases of Legg-Calvé-Perthes' disease (LCPD) with two X-rays each and a short description of the clinical scenario. Two of the patients were younger and two were older than six years of age. From both age groups there was one with a good range of motion and an X-ray classified as Herring A or B, while the other patient had a poor range of motion and an X-ray classified as Herring C. EPO members were asked to choose from various treatment options or to describe any other therapy that they would advise in the clinical scenarios.
RESULTS
One-hundred and fifty members answered the questionnaire. The participants had an average of 20 years of experience in pediatric orthopaedics. There was a consensus that no surgery should be performed in a young patient with a good range of motion and that there should be no weight relief when older with a good range of motion. Conservative containment treatment (abduction splint, Petrie cast) and arthrodiastasis was suggested in only very few centres. There was a tendency to perform an operation when the patient is older with a poor range of motion and to perform operative treatment only when there were subluxation or head at risk signs. pelvic osteotomies or a combination of pelvic and femoral osteotomies rather than femoral osteotomies alone. Age did not determine the indication for treatment and there was no agreement on the indications for physiotherapy. There was also no consensus on the type of pelvic osteotomy to be used.
CONCLUSIONS
The study showed that indications for the treatment of LCPD is based more on the personal experience of the surgeon rather than on scientific data.
目的
本研究旨在查明经验丰富的儿科骨科医生在Legg-Calvé-Perthes病某些临床情况的处理上是否存在共识。
方法
向欧洲儿科骨科学会（EPOS）的所有297名成员发送了一份问卷，描述了4例Legg-Calvé-Perthes病（LCPD）病例，每个病例有两张X光片以及对临床情况的简短描述。其中两名患者年龄小于6岁，另外两名患者年龄大于6岁。在这两个年龄组中，各有一名患者活动范围良好且X光片分类为Herring A或B，而另一名患者活动范围较差且X光片分类为Herring C。要求EPOS成员从各种治疗选项中进行选择，或者描述他们在这些临床情况下会建议的任何其他治疗方法。
结果
150名成员回答了问卷。参与者在儿科骨科方面平均有20年的经验。存在的共识是，对于活动范围良好的年轻患者不应进行手术，对于活动范围良好的年长患者不应减轻负重。只有极少数中心建议采用保守包容治疗（外展夹板、Petrie石膏）和关节扩张术。当患者年龄较大且活动范围较差时倾向于进行手术，并且仅在存在半脱位或股骨头有风险迹象时才进行手术治疗。倾向于采用骨盆截骨术或骨盆与股骨截骨术联合，而不是仅采用股骨截骨术。年龄并不能决定治疗指征，对于物理治疗的指征也没有达成一致意见。对于所采用的骨盆截骨术类型也没有共识。
结论
该研究表明，LCPD的治疗指征更多地基于外科医生的个人经验而非科学数据。
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