Stanitski Carl L
Department of Orthopaedic Surgery, Medical University of South Carolina, 87 Surfscoter Lane, Kiawah Island, SC, 29455, USA,
J Child Orthop. 2007 Mar;1(1):33-5. doi: 10.1007/s11832-007-0009-5. Epub 2007 Mar 3.
Children with early Perthes' disease and clinical loss of motion are commonly noted to have normal or almost normal hip range of motion (ROM) when examined under anesthesia (EUA). Despite anecdotal comments about this observation, no series has documented these findings. The lack of such data led to this study.
Consecutive patients with unilateral Herring class B or C Perthes' disease in mid to late Waldenstrom's fragmentation stages who failed a non-operative course of hip motion restoration had hip range of motion (ROM) documented pre-operatively and intra-operatively by a single, experienced pediatric orthopedic surgeon. The opposite normal hip's ROM was used as the control. Joint congruity was assessed arthrographically.
Twenty-seven patients, 6-10 years old (average 7.9 years) with early Perthes' disease were reviewed. Twenty-one of 27 patients (77.7%) had full or almost full hip ROM of the involved side when examined under anesthesia (EUA). Six patients (22.3%) had limited abduction (<50 degrees) and underwent an adductor tenotomy that normalized hip ROM. Five of these six patients were older than 8 years. Intra-operative arthrography did not demonstrate lack of containment, hinge abduction or joint incongruity.
Loss of hip ROM in this series of patients with early Perthes' disease without intra-articular incongruity was due to pain and muscle spasm which were obviated by anesthesia, demonstrating essentially normal hip ROM in the majority of patients. Pre-operative bed rest and traction was not required to restore ROM in this group of patients.
患有早期佩特兹病且临床上活动丧失的儿童在麻醉下检查（EUA）时，通常被发现髋关节活动范围（ROM）正常或几乎正常。尽管对此观察结果有一些传闻，但尚无系列研究记录这些发现。缺乏此类数据促成了本研究。
连续纳入处于瓦尔登斯特伦碎裂中晚期、单侧Herring B级或C级佩特兹病且非手术髋关节活动恢复治疗失败的患者，由一位经验丰富的小儿骨科医生在术前和术中记录其髋关节活动范围（ROM）。对侧正常髋关节的ROM用作对照。通过关节造影评估关节匹配情况。
回顾了27例6 - 10岁（平均7.9岁）的早期佩特兹病患者。27例患者中有21例（77.7%）在麻醉下检查（EUA）时患侧髋关节活动范围完全或几乎完全正常。6例患者（22.3%）外展受限（<50度），并接受了内收肌切断术，术后髋关节活动范围恢复正常。这6例患者中有5例年龄超过8岁。术中关节造影未显示包容不足、铰链外展或关节不匹配。
在这组早期佩特兹病且关节内无不匹配的患者中，髋关节活动范围丧失是由疼痛和肌肉痉挛引起的，麻醉可消除这些因素，表明大多数患者的髋关节活动范围基本正常。该组患者恢复活动范围无需术前卧床休息和牵引。
