Koman L A, Meyer L C, Warren F H
Clin Orthop Relat Res. 1982 Jan-Feb(162):135-43.
The leg-length discrepancy in patients with proximal femoral focal deficiency is difficult to treat and is often unmanageable except by amputation. To identify candidates for ablative and nonablative surgery and to outline a rational treatment program, 91 patients (120 femurs) were retrospectively analyzed to determine the relationship of absolute femoral length, relative femoral length, and pelvofemoral stability to the functional effects at maturity of various operative and nonoperative management. The direct relationship of function to Aitken classification was documented and correlated with percent femoral inhibition (p less than 0.01), and pelvofemoral stability as determined by the acetabular index (p less than 0.05), shelf index (p less than 0.001), and acetabular dysplasia (p less than 0.001). In unilateral cases, two therapeutic subgroups were identified: Class I (patients with less than 17 cm of projected extremity shortening, and evidence of pelvofemoral stability), and Class II (patients with greater than 17 cm of predicted extremity shortening). Class I patients are potential candidates for height equalization by ipsilateral lengthening and/or contralateral shortening. Class II patients should have early ablative procedures and conversion to an above-knee or below-knee amputee. In bilateral PFFD, function at maturity was primarily dependent upon leg-length differential, foot position, and associated anomalies.
股骨近端局灶性缺损患者的腿长差异难以治疗，除截肢外通常难以处理。为了确定切除性手术和非切除性手术的候选者，并概述合理的治疗方案，我们对91例患者（120个股骨）进行了回顾性分析，以确定绝对股骨长度、相对股骨长度以及骨盆股骨稳定性与各种手术和非手术治疗成熟时功能效果之间的关系。记录了功能与艾特肯分类的直接关系，并与股骨抑制百分比（p<0.01）以及由髋臼指数（p<0.05）、髋臼壁指数（p<0.001）和髋臼发育不良（p<0.001）确定的骨盆股骨稳定性相关。在单侧病例中，确定了两个治疗亚组：I类（预计肢体缩短小于17 cm且有骨盆股骨稳定性证据的患者）和II类（预计肢体缩短大于17 cm的患者）。I类患者是通过同侧延长和/或对侧缩短实现身高均衡的潜在候选者。II类患者应尽早进行切除性手术并转为膝上或膝下截肢者。在双侧股骨近端局灶性缺损中，成熟时的功能主要取决于腿长差异、足部位置和相关异常情况。
