Hailer Yasmin D, Perry Daniel C, Schaeffer Emily, Li Jacqueline, Mulpuri Kishore
Department of Surgical Sciences, Section of Pediatric Orthopedic Surgery, Uppsala University, Uppsala, Sweden.
Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
Bone Jt Open. 2025 Jun 4;6(6):635-643. doi: 10.1302/2633-1462.66.BJO-2024-0219.R1.
In the absence of clear and consistent clinical guidelines, this study aims to survey the current international consensus on recommendations for physiotherapy (PT), physical activity (PA), and weightbearing in patients with Perthes' disease. Additionally, the study seeks to identify factors influencing these recommendations, and to determine at which stage possible restrictions on physical activity are typically lifted.
An online international cross-sectional survey using a purpose-designed questionnaire with a general section, and three cases of Perthes' disease, was distributed to surgeons through paediatric orthopaedic societies and research groups.
A total of 160 paediatric orthopaedic surgeons from 43 different countries (seven continents) participated. There was general agreement that impaired range of motion (ROM) and pain were important when prescribing PT, while the child's sex was not important. There was disagreement on whether age and Waldenström or Lateral Pillar classification were important factors in determining the need for PT. There was widespread agreement that stretching in the early stages of Perthes' disease was important, although Western and Southern Europe and the British Isles differed. There was considerable disagreement about strengthening exercises. 'Weightbearing as tolerated' in the early and fragmentation stages was generally recommended in the British Isles and Scandinavia (both > 90%), whereas other regions showed large variation. Regarding PA, there was broad agreement in allowing swimming and cycling, and discouraging high-impact activities including school sports in all stages.
Maintaining ROM was crucial for most participants, with strong consensus to discourage high-impact activities during initial and fragmentation stages. Swimming and cycling were often allowed, but no clear consensus emerged on weightbearing restrictions or when to resume full activities. Consensus within the British Isles, Scandinavia, and Eastern Europe was high for both for PT and PA, but recommendations differed between countries. Recommendations from the British Isles and Scandinavia were less restrictive than their Eastern European counterparts.
在缺乏明确且一致的临床指南的情况下，本研究旨在调查目前关于佩特兹病患者物理治疗（PT）、体育活动（PA）和负重建议的国际共识。此外，该研究试图确定影响这些建议的因素，并确定通常在哪个阶段解除对体育活动的可能限制。
通过儿科骨科学会和研究小组向外科医生分发一份使用专门设计问卷的在线国际横断面调查，问卷包括一个一般部分和三个佩特兹病病例。
来自43个不同国家（七大洲）的160名儿科骨科外科医生参与了调查。普遍认为，在开物理治疗处方时，活动范围（ROM）受损和疼痛很重要，而孩子的性别并不重要。对于年龄以及瓦尔登斯特伦或外侧柱分类是否是决定是否需要物理治疗的重要因素存在分歧。普遍认为佩特兹病早期的伸展运动很重要，尽管西欧、南欧和不列颠群岛存在差异。对于强化锻炼存在相当大的分歧。在不列颠群岛和斯堪的纳维亚半岛（均超过90%），普遍建议在早期和碎裂阶段“根据耐受情况负重”，而其他地区则差异很大。关于体育活动，在所有阶段允许游泳和骑自行车以及不鼓励包括学校体育在内的高冲击活动方面存在广泛共识。
对于大多数参与者来说，维持活动范围至关重要，在初始和碎裂阶段强烈共识是不鼓励高冲击活动。通常允许游泳和骑自行车，但在负重限制或何时恢复全面活动方面没有明确的共识。不列颠群岛、斯堪的纳维亚半岛和东欧在物理治疗和体育活动方面的共识都很高，但各国的建议有所不同。不列颠群岛和斯堪的纳维亚半岛的建议比东欧国家的限制更少。
