骨软骨成形术和相对颈延长治疗 Legg-Calvé-Perthes 病愈合后患者的结果：接受骨软骨成形术和相对颈延长治疗髋关节畸形患者的回顾性队列研究。
Outcome after osteochondroplasty and relative neck lengthening for patients with healed Legg-Calvé-Perthes disease: a retrospective cohort study of patients with hip-deformities treated with osteochondroplasty and relative neck lengthening.
机构信息
Department of Orthopaedics, County Hospital Ryhov, Jönköping, Sweden.
Medical Faculty, Linköping University, Linköping, Sweden.
出版信息
Hip Int. 2021 May;31(3):417-423. doi: 10.1177/1120700019896767. Epub 2019 Dec 26.
AIMS
Our main objectives were to evaluate the effect of surgery using self-assessed health scores. Secondary objectives were to correlate outcome with grade of deformity (Stulberg classification I-V) or age at surgery and whether additional periacetabular osteotomy (PAO) is beneficial for patients with concurrent acetabular dysplasia.
METHODS
This was a retrospective cohort and in part a cross sectional study using a planned clinical and radiological follow-up of patients. All patients with healed Legg-Calvé-Perthes disease (LCPD) treated with osteochondroplasty and relative neck lengthening using surgical hip dislocation, with or without periacetabular osteotomy (PAO) were included. A total of 39 patients were identified and invited to participate (29 males and 10 females) of which 32 accepted.Radiographic assessment and Stulberg classification were obtained. The Nonarthritic Hip Score (NAHS), modified Harris Hip Score (mHHS) and the VAS scale of EQ-5D-5L were used.
RESULTS
The majority of the patients experienced improvement (74%, 27) and 21 patients (78%, 27) found the surgery worthwhile. Preoperative Stulberg II and III patients (83% improvement) showed better results than Stulberg IV and V patients (56% improvement) ( 27, 0.121). There was significantly better patient-satisfaction for those younger than 29 years of age (⩽18 years old (92%), 19-28 years old (89%), ⩾29 years old (67%), x(2) = 8512, 27, 0.022) and a negative correlation for age at onset of LCPD and mHHS ( = -0.420, 0.046, 23). Patients with concurrent acetabular dysplasia ( 19), 82% (9 of 11) improved after additional PAO compared to 63% (5 of 8) who were not operated on with PAO.
CONCLUSION
This procedure is worthwhile in selected cases except for severe deformity (Stulberg IV and V) and patients >28 years of age.
目的
我们的主要目标是评估使用自我评估健康评分的手术效果。次要目标是将结果与畸形程度（Stulberg 分类 I-V）或手术时的年龄相关联，以及是否对合并髋臼发育不良的患者进行额外的髋臼周围截骨术（PAO）有益。
方法
这是一项回顾性队列研究，部分是一项横断面研究，对接受手术髋关节脱位的儿童进行了计划的临床和放射学随访。所有接受过骨软骨成形术和手术髋关节脱位的儿童均接受过相对颈延长术治疗的儿童，无论是否接受过髋臼周围截骨术（PAO），均被纳入研究。共确定并邀请了 39 名患者（29 名男性和 10 名女性）参加，其中 32 名患者接受了邀请。获得了影像学评估和 Stulberg 分类。使用非关节炎髋关节评分（NAHS）、改良 Harris 髋关节评分（mHHS）和 EQ-5D-5L 的 VAS 量表。
结果
大多数患者经历了改善（74%，27 例），21 例患者（78%，27 例）认为手术值得。术前 Stulberg II 和 III 期患者（改善 83%）的结果优于 Stulberg IV 和 V 期患者（改善 56%）（27 例，0.121）。年龄小于 29 岁的患者的患者满意度明显更高（≤18 岁（92%），19-28 岁（89%），≥29 岁（67%），x(2)=8512，27，0.022），而 LCPD 发病年龄与 mHHS 呈负相关（=−0.420，0.046，23）。合并髋臼发育不良的患者（19 例），在接受额外的 PAO 后，82%（9/11）得到改善，而未接受 PAO 治疗的患者为 63%（5/8）。
结论
除了严重畸形（Stulberg IV 和 V）和年龄大于 28 岁的患者外，该手术在特定情况下是值得的。
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