Wenger Dennis R, Pring Maya E, Hosalkar Harish S, Caltoum Christine B, Lalonde Francois D, Bastrom Tracey P
Department of Orthopedics and Scoliosis, Rady Children's Hospital-San Diego, CA, USA.
J Pediatr Orthop. 2010 Dec;30(8):749-57. doi: 10.1097/BPO.0b013e3181f5a0de.
Although surgical containment has become a mainstay for the treatment of Legg-Calvé-Perthes (LCP) disease; traditional operations (varus osteotomy of femur, Salter osteotomy) have certain limitations, sometimes resulting in a prolonged limp or inadequate containment. This paper presents the surgical method and results of triple pelvic osteotomy for containment treatment of LCP disease.
This retrospective review of 39 children (40 hips; age 5 to 13 y) with LCP disease treated with triple pelvic osteotomy (1995 to 2005) included preoperative lateral pillar assessment and other measurements. Final follow-up films (minimum 3 y, range 3 to 9 y) were assessed using the modified Stulberg classification. Clinical follow-up evaluation assessed limp, limb-length inequality, range of motion, and activity level.
Twenty-one (53%) hips were graded as lateral pillar B and 19 (48%) were lateral pillar C. Four patients required further treatment before the final follow-up. At final follow-up, 42% had a good outcome (Stulberg I/II), 47% had a fair outcome (Stulberg III), and 11% had a poor outcome. Thus, 89% of patients had satisfactory (good or fair) results. There was a significant difference in outcome based on the preoperative lateral pillar, with B hips more likely to have a good outcome (65%) compared with lateral pillar C hips (12.5%) (P=0.002). There were no lateral pillar B patients with a poor outcome. Seventeen percent of the lateral pillar C patients more than or equal to age 8 had a poor outcome compared with 50% being more than age 8 with a poor outcome. Four patients (3 lateral pillar C, 1 lateral pillar B) required further surgery.
Triple pelvic osteotomy resulted in maintenance of head shape in lateral pillar B patients of all ages and in younger lateral pillar C patients. Lateral pillar C patients over age 8 were more difficult to treat, however, we still advise containment for these cases because methods are now available to deal with containment failure. Triple pelvic osteotomy is an effective treatment method for LCP patients with lateral pillar B disease and younger patients with lateral pillar C disease. This method provides effective containment, which allows prolonged remodeling while avoiding the limitations of femoral varus osteotomy (limp, short limb) and Salter osteotomy (incomplete containment).
Level IV.
尽管手术包容疗法已成为治疗Legg-Calvé-Perthes（LCP）病的主要手段；但传统手术（股骨内翻截骨术、Salter截骨术）存在一定局限性，有时会导致跛行时间延长或包容不足。本文介绍了三联骨盆截骨术治疗LCP病的手术方法及结果。
本回顾性研究纳入了1995年至2005年接受三联骨盆截骨术治疗的39例LCP病患儿（40髋；年龄5至13岁），包括术前外侧柱评估及其他测量。使用改良的Stulberg分类法对最终随访X线片（最短3年，范围3至9年）进行评估。临床随访评估跛行、肢体长度不等、活动范围及活动水平。
21髋（53%）为外侧柱B型，19髋（48%）为外侧柱C型。4例患者在最终随访前需要进一步治疗。在最终随访时，42%的患者预后良好（Stulberg I/II级），47%的患者预后尚可（Stulberg III级），11%的患者预后较差。因此，89%的患者结果满意（良好或尚可）。根据术前外侧柱分型，预后存在显著差异，外侧柱B型髋预后良好的可能性（65%）高于外侧柱C型髋（12.5%）（P=0.002）。外侧柱B型患者无预后差的情况。外侧柱C型且年龄大于或等于8岁的患者中，17%预后较差，而年龄大于8岁且预后较差的患者占50%。4例患者（3例外侧柱C型，1例外侧柱B型）需要进一步手术。
三联骨盆截骨术可使各年龄段的外侧柱B型患者及较年轻的外侧柱C型患者维持股骨头形态。然而，8岁以上的外侧柱C型患者治疗难度较大，但我们仍建议对这些病例采用包容疗法，因为现在有方法可应对包容失败的情况。三联骨盆截骨术是治疗外侧柱B型LCP病患者及较年轻的外侧柱C型病患者的有效治疗方法。该方法提供了有效的包容，可使重塑过程延长，同时避免了股骨内翻截骨术（跛行、肢体短缩）和Salter截骨术（包容不完全）的局限性。
IV级。
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