Carsi Belen, Judd Julia, Clarke Nicholas M P
Department of Child Health, University Hospital Southampton, Southampton, Hampshire, UK.
J Pediatr Orthop. 2015 Mar;35(2):151-6. doi: 10.1097/BPO.0000000000000220.
To evaluate the effectiveness of shelf acetabuloplasty in the containment of extruded hips without hinge abduction in early stages of Legg-Calve-Perthes disease, we present a retrospective series of 44 patients (45 hips) treated between August 1999 and February 2010, which included 34 boys and 10 girls with a mean age at diagnosis of 7.4 years (range, 3.9 to 15.3).
All patients presented with sclerosis or early fragmentation stages. The average time from diagnosis to surgery was 2.1 months (range, 0 to 8.2) and the mean time to heal was 40.4 months (range, 20 to 82.2). The Reimer migration and the deformity indices were measured on initial, preoperative, postoperative, and healed x-rays. The average deformity index at 3 of those 4 timepoints was significantly related to their final Stulberg classification. CE angles increased and Sharp angles decreased significantly as a result of treatment.
At the healed stage and consistent with other published series, 84.4% of patients were Stulberg III or less, denying any pain, and with full range of movement, whereas 15.6% were classified as Stulberg IV.
We defend that shelf acetabuloplasty should be performed early in the disease and, uniquely, we propose that the indication for treatment should be guided by the deformity and the Reimer migration indices.
IV.
为评估髋臼加盖成形术在治疗早期Legg-Calve-Perthes病无铰链外展的髋关节半脱位中的有效性，我们回顾性分析了1999年8月至2010年2月期间治疗的44例患者（45髋），其中包括34例男孩和10例女孩，诊断时的平均年龄为7.4岁（范围为3.9至15.3岁）。
所有患者均处于硬化期或早期碎裂期。从诊断到手术的平均时间为2.1个月（范围为0至8.2个月），平均愈合时间为40.4个月（范围为20至82.2个月）。在初始、术前、术后及愈合后的X线片上测量Reimer移位和畸形指数。这4个时间点中3个时间点的平均畸形指数与最终的Stulberg分级显著相关。治疗后CE角增大，Sharp角显著减小。
在愈合阶段，与其他已发表的系列研究一致，84.4%的患者为Stulberg III级或更低，无疼痛，活动范围正常，而15.6%的患者被分类为Stulberg IV级。
我们认为髋臼加盖成形术应在疾病早期进行，并且我们独特地提出治疗指征应以畸形和Reimer移位指数为指导。
IV级。
