Department of Orthopedic Surgery, Tamatsukuri Kosei-Nennkin Hospital, Yumachi 1-2 Tamayu-cho, Matsue, Shimane 699-0293, Japan.
Arch Orthop Trauma Surg. 2011 May;131(5):701-7. doi: 10.1007/s00402-011-1264-y. Epub 2011 Jan 22.
Although the prognosis of Perthes' disease at skeletal maturity is considered favorable, little is known about the long-term results after middle age.
We retrospectively analyzed the radiographic and functional outcomes of 67 patients (70 hips) who had been treated for Perthes' disease. Of these patients, 28 patients (29 hips) were evaluated using JOA (Japanese Orthopaedic Association) score and radiographs at follow-up (Group 1), 39 patients (41 hips) were evaluated by a postal questionnaire (Group 2). The mean follow-up period was 36.1 years. The mean age at follow-up was 43.1 years.
Group 1, good radiographic results (Stulberg class I or II) were achieved in 59% of hips. No osteoarthritis (Tönnis Grade 0) was observed in only 48% of hips. The clinical results were good (JOA score ≥ 70) in 79% of hips. Disturbance of walking ability and activities of daily living was little. The Tönnis grade and JOA score declined after 40 years of age. All patients older than 50 years showed severe osteoarthritis. The severity of osteoarthritis correlated significantly with age at follow-up. Group 2, the clinical results were good (JOA score ≥ 56) in 76% of hips. In both groups, no patient had undergone total hip arthroplasty. Younger age at diagnosis (<8 years) correlated significantly with a better result. The JOA score correlated significantly with age at follow-up.
Patients who were treated for Perthes' disease have a risk of osteoarthritis and a clinically poor outcome after the age of 40-50 years.
虽然佩特氏病在骨骼成熟时的预后被认为是良好的，但对于中年后长期的结果知之甚少。
我们回顾性分析了 67 例（70 髋）接受佩特氏病治疗的患者的影像学和功能结果。这些患者中，28 例（29 髋）通过 JOA（日本矫形协会）评分和随访时的影像学进行评估（组 1），39 例（41 髋）通过邮寄问卷进行评估（组 2）。平均随访时间为 36.1 年。平均随访年龄为 43.1 岁。
组 1，59%的髋关节影像学结果良好（Stulberg Ⅰ或Ⅱ级）。仅 48%的髋关节无骨关节炎（Tönnis 分级 0 级）。79%的髋关节临床结果良好（JOA 评分≥70）。行走能力和日常生活活动的障碍较小。40 岁后 Tönnis 分级和 JOA 评分下降。所有 50 岁以上的患者均出现严重骨关节炎。骨关节炎的严重程度与随访时的年龄显著相关。组 2，76%的髋关节临床结果良好（JOA 评分≥56）。在两组中，均无患者接受全髋关节置换术。诊断时年龄较小（<8 岁）与更好的结果显著相关。JOA 评分与随访时的年龄显著相关。
接受佩特氏病治疗的患者在 40-50 岁以后有发生骨关节炎和临床预后较差的风险。
