Department of Orthopaedics, Oslo University Hospital, Rikshospitalet, and University of Oslo, NO-0027 Oslo, Norway.
Clin Orthop Relat Res. 2012 Sep;470(9):2394-401. doi: 10.1007/s11999-011-2181-7.
In the Norwegian prospective study on Legg-Calvé-Perthes disease (LCPD), we found varus femoral osteotomy gave better femoral head sphericity at a mean of 5 years postoperative than physiotherapy in children older than 6.0 years at diagnosis with femoral head necrosis of more than 50%. That study did not include separate analyses for hips with 100% necrosis and those with a percentage of necrosis between 50% and 100%.
QUESTIONS/PURPOSES: We asked whether (1) femoral osteotomy improves femoral head sphericity at followup in all patients with more than 50% femoral head necrosis or in selected groups only and (2) there is a critical age between 6.0 and 10.0 years over which femoral osteotomy does not improve the prognosis.
We treated 70 patients with unilateral LCPD, age at diagnosis of more than 6.0 years, and femoral head necrosis of more than 50% with varus femoral osteotomy between 1996 and 2000. We classified necrosis using the Catterall classification. We established a control group of 51 similar children who received physiotherapy. At the 5-year followup visit, the hips were graded according to femoral head shape: spherical, ovoid, or flat.
At 5-year followup, there was no difference between the treatment groups in radiographic outcome in Catterall Group 3 hips. In Catterall Group 4 hips, femoral head sphericity was better in the osteotomy group, with flat femoral heads in 14% compared to 75% after physiotherapy. The same trend toward better head sphericity occurred when the lateral pillar classification was used.
In children aged 6.0 to 10.0 years, in whom the whole femoral head is affected, femoral head sphericity 5 years after femoral osteotomy was better than that after physiotherapy.
在挪威前瞻性研究莱格-卡尔韦-佩尔特斯病（LCPD）中，我们发现对于股骨颈干角大于 6.0 岁且股骨头坏死大于 50%的儿童，股骨旋转截骨术比物理治疗在术后 5 年时能获得更好的股骨头球形。该研究未对股骨头坏死 100%的髋关节和坏死程度在 50%-100%之间的髋关节进行单独分析。
问题/目的：我们想知道（1）在所有股骨头坏死大于 50%的患者中，或者仅在某些特定分组中，股骨旋转截骨术是否能改善股骨头球形度；（2）股骨旋转截骨术是否存在一个 6.0-10.0 岁的关键年龄，如果超过这个年龄，预后就不会得到改善。
我们治疗了 1996 年至 2000 年期间患有单侧莱格-卡尔韦-佩尔特斯病、年龄大于 6.0 岁、股骨头坏死大于 50%的 70 例患者。我们采用 Catterall 分类法对坏死进行分类。我们建立了一个对照组，包括 51 名接受物理治疗的类似儿童。在 5 年随访时，根据股骨头形状对髋关节进行分级：球形、卵圆形或扁平形。
在 Catterall 3 型髋关节中，两组治疗在影像学结果方面没有差异。在 Catterall 4 型髋关节中，截骨组的股骨头球形度较好，术后 5 年扁平股骨头比例为 14%，而物理治疗组为 75%。当使用外侧柱分类时，也出现了类似的改善股骨头球形度的趋势。
在 6.0-10.0 岁的儿童中，当整个股骨头受到影响时，股骨旋转截骨术后 5 年的股骨头球形度优于物理治疗。
