Department of Paediatric Orthopaedics, Kasturba Hospital, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
Musculoskelet Surg. 2022 Sep;106(3):325-335. doi: 10.1007/s12306-021-00709-8. Epub 2021 Apr 18.
Little literature exists regarding aggressive treatment of the extrusion in the early stage of the disease and the outcome at skeletal maturity. The purpose of the study was to evaluate the outcome of the disease with onset younger than 7 years, treated in the early stage of the disease, with aggressive management of significant extrusion (immediate containment with fixed abduction brace in children less than 5 years and varus derotation osteotomy in older children), and reached skeletal maturity.
All children with the age of onset younger than 7 years of disease during active Perthes disease were prospectively followed. Children with early stages of the disease (modified Elizabethtown classification) and reached skeletal maturity were included (68 children). The extrusion of the femur head was calculated by Reimer's migration index on both sides. A migration difference 12 % or above was considered as "significant extrusion". Children without significant extrusion were treated non-operatively; children with significant extrusion were treated with varus derotation osteotomy. The final radiological outcome was assessed by the Stulberg classification and sphericity deviation score (SDS). The independent "t" test and Chi-square test were done to compare the difference between the two groups.
The mean age at the onset and the final follow-up was 5.7 years and 15.3 years. The frequency of significant extrusion was 57%. At the final follow-up, an excellent clinical outcome and radiological outcomes (in 88% hips) were noted. There was no significant difference in the Stulberg groups and SDS (sphericity deviation score) in both groups.
The outcome of the children who had the age of onset of the disease less than 7 years was good with early and aggressive management of the extrusion. The reversal of extrusion is associated with a similar result of non-operative children in this age group.
III.
关于在疾病早期积极治疗骨突挤出以及在骨骼成熟时的结果，相关文献较少。本研究的目的是评估在疾病发病年龄小于 7 岁的情况下，通过对明显挤出（5 岁以下儿童采用固定外展支具立即固定，大龄儿童采用内翻旋转移位截骨术）进行早期积极治疗，并在骨骼成熟时，对疾病的结果进行评估。
所有在活跃性佩特氏病发病年龄小于 7 岁的儿童均进行前瞻性随访。纳入患有早期疾病（改良的伊丽莎白镇分类）且达到骨骼成熟的儿童（68 例）。通过双侧 Reimer 迁移指数计算股骨头的挤出程度。迁移差异 12%或以上被认为是“明显挤出”。无明显挤出的儿童采用非手术治疗；有明显挤出的儿童采用内翻旋转移位截骨术。最终的放射学结果通过 Stulberg 分类和球度偏差评分（SDS）进行评估。采用独立“t”检验和卡方检验比较两组之间的差异。
发病时的平均年龄和最终随访年龄分别为 5.7 岁和 15.3 岁。明显挤出的发生率为 57%。最终随访时，88%的髋关节临床和放射学结果均良好。两组间 Stulberg 分组和 SDS（球度偏差评分）无显著差异。
对于发病年龄小于 7 岁的儿童，通过早期积极治疗挤出，其结果良好。挤出的逆转与该年龄组非手术儿童的结果相似。
III 级。
