Sucato Daniel J
Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX 75219, USA.
J Pediatr Orthop. 2013 Jul-Aug;33 Suppl 1:S70-5. doi: 10.1097/BPO.0b013e318295e86b.
Legg-Calve-Perthes disease (LCPD) nearly always results in femoral deformity at skeletal maturity that may lead to symptoms due principally to femoroacetabular impingement. Treatment for the skeletally mature patient with LCPD varies from observation with activity modifications to surgical procedures which range from isolated femoral or acetabular-sided surgery to the more common combined surgery. On the femoral side, the traditional procedures have been proximal varus and valgus osteotomies (with some component of flexion) to reorient the femoral head and allow better femoral head weight-bearing cartilage across the hip joint. Acetabular procedures have been used less frequently including reorientation or shelf procedures to provide improved femoral head coverage. The challenge in the skeletally mature hip patient is to determine which of these components require addressing at the time of surgical treatment. More recently, procedures to the femoral head itself have been developed to reshape the femoral head and assist in matching the size of the femoral head to the acetabulum, prevent impingement and restore more normal articular cartilage in the weightbearing zone. This review will focus on these surgical treatments specific to the femoral head in skeletally mature LCPD.
Legg-Calvé-Perthes病（LCPD）在骨骼成熟时几乎总会导致股骨畸形，这主要可能因股骨髋臼撞击而引发症状。对于骨骼成熟的LCPD患者，治疗方法各异，从通过调整活动进行观察到手术治疗，手术范围从单纯的股骨或髋臼侧手术到更常见的联合手术。在股骨侧，传统手术方法是近端内翻和外翻截骨术（伴有一定程度的屈曲），以重新定位股骨头，并使股骨头负重软骨在髋关节上获得更好的分布。髋臼手术使用频率较低，包括重新定位或髋臼加盖术，以改善股骨头的覆盖情况。对于骨骼成熟的髋关节患者，挑战在于确定在手术治疗时哪些部分需要处理。最近，已开发出针对股骨头本身的手术方法，以重塑股骨头，并帮助使股骨头大小与髋臼相匹配，防止撞击，并在负重区恢复更正常的关节软骨。本综述将聚焦于骨骼成熟的LCPD患者中针对股骨头的这些手术治疗方法。
