Segev Eitan, Ezra Eli, Wientroub Shlomo, Yaniv Moshe, Hayek Shlomo, Hemo Yoram
Department of Pediatric Orthopaedics, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, Tel-Aviv, 64239, Israel,
J Child Orthop. 2007 Oct;1(4):229-35. doi: 10.1007/s11832-007-0046-0. Epub 2007 Sep 27.
Late-onset Perthes' disease is diagnosed after 9 years of age. Conservative treatment and conventional surgical techniques have limited ability to reduce the pressure in the joint or change the shape of the femoral head. We used a combination of soft tissue release and joint distraction with a hinged mono-lateral external fixator for these patients. Ten of our patients reached skeletal maturity and were evaluated.
Clinical assessment included: Harris hip score, hip range-of-motion (ROM), limb length discrepancy, and the Oxford hip questionnaire for pain and function. Radiographic assessment included: Sharp transverse acetabular inclination, the uncoverage percentage, the epiphyseal index before surgery (modified Eyre-Brook), at frame removal, and, at last follow-up, the epiphyseal quotient (of Sjovall) and the Stulberg classification.
Our study included eight boys and two girls (mean age at surgery 12.3 years, range 9.4-15.1, mean age at last follow-up 18.1 years, range 15.2-22.8). The mean follow-up was 5.7 years (range 4.3-7.8). The mean Harris hip score was 86.3/100 (range 48.5-96); one patient had <85 points. The hip ROM was slightly limited in most patients, and seven patients had limb shortening between 1-4 cm. The mean Oxford hip questionnaire score was 17.4/60 (range 12-31). The mean Sharp transverse acetabular inclination of the affected side was 42 degrees (range 36-54) compared to 39 degrees for the unaffected side (P = 0.045). The mean uncoverage percentage was 37% (range 27-47) compared to 20% for the unaffected side (P = 0.017). The mean epiphyseal index was 0.71 (range 0.31-0.92) before surgery, 0.79 (range 0.50-0.93) at frame removal (P = 0.012), and 0.72 (range 0.51-0.89) at last follow-up (P = 0.646). The epiphyseal quotient for the eight unilateral cases was 0.72 (range 0.49-0.91), and the Stulberg classification was type III for three cases and type IV for seven.
Patient satisfaction for function and pain following the combined procedure was good. Radiographic parameters did not change significantly. This should be regarded as a salvage procedure.
晚发性佩特兹病在9岁以后被诊断出来。保守治疗和传统手术技术在降低关节压力或改变股骨头形状方面的能力有限。我们对这些患者采用了软组织松解和使用铰链式单侧外固定器进行关节牵张相结合的方法。我们的10名患者达到了骨骼成熟并接受了评估。
临床评估包括：Harris髋关节评分、髋关节活动范围（ROM）、肢体长度差异以及用于评估疼痛和功能的牛津髋关节问卷。影像学评估包括：髋臼锐利横倾角、覆盖不足百分比、术前（改良艾yre - Brook）、拆除外固定架时以及最后随访时的骨骺指数、（Sjovall）骨骺商以及Stulberg分类。
我们的研究包括8名男孩和2名女孩（手术时平均年龄12.3岁，范围9.4 - 15.1岁，最后随访时平均年龄18.1岁，范围15.2 - 22.8岁）。平均随访时间为5.7年（范围4.3 - 7.8年）。Harris髋关节平均评分为86.3/100（范围48.5 - 96）；1例患者评分低于85分。大多数患者的髋关节活动范围略有受限，7例患者肢体短缩1 - 4厘米。牛津髋关节问卷平均评分为17.4/60（范围12 - 31）。患侧髋臼锐利横倾角平均为42度（范围36 - 54），而未患侧为39度（P = 0.045）。覆盖不足平均百分比为37%（范围27 - 47），未患侧为20%（P = 0.017）。术前骨骺指数平均为0.71（范围0.31 - 0.92），拆除外固定架时为0.79（范围0.50 - 0.93）（P = 0.012），最后随访时为0.72（范围0.51 - 0.89）（P = 0.646）。8例单侧病例的骨骺商为0.72（范围0.49 - 0.91），Stulberg分类中3例为III型，7例为IV型。
联合手术后患者对功能和疼痛的满意度良好。影像学参数没有显著变化。这应被视为一种挽救性手术。
