Bowen J R, Schreiber F C, Foster B K, Wein B K
Clin Orthop Relat Res. 1982 Nov-Dec(171):24-9.
One hundred premature femoral neck physeal closures in 430 hips with Perthes' disease have occurred in two patterns central and lateral. Abnormal physeal growth can be demonstrated early by a narrowed physeal plate with overlying avascular epiphysis and marked metaphyseal reaction below. Subsequently, a bony bridge forms between the metaphysis and epiphysis. If the physeal closure is central, the mature hip will have a short femoral neck, a relatively round femoral head, a trochanter that has overgrown the femoral head, a short leg, and a mildly deformed acetabulum. If the physeal closure is lateral, the mature hip will have a femoral head that is externally tilted as the medial neck lengthens and the lateral neck remains short, a trochanter that has overgrown the femoral head, an oval femoral head, a short leg, and a deformed acetabulum. A physeal arrest is a contraindication for a varus osteotomy because it accentuates the deformity, especially in the greater trochanter. The leg-length discrepancy may be treated by epiphysiodesis of the contralateral femur, when necessary, and the abductor muscle insufficiency may be treated by an exercise program or distal and lateral transfer of the greater trochanter.
430例患有佩特兹病的髋关节中出现了100例股骨颈骺板过早闭合，其呈现两种模式：中央型和外侧型。早期可通过骺板变窄、上方无血管的骨骺以及下方明显的干骺端反应来证明骺生长异常。随后，干骺端与骨骺之间形成骨桥。如果骺板闭合是中央型的，成熟髋关节将出现股骨颈短、股骨头相对圆、大转子超过股骨头生长、腿短以及髋臼轻度变形。如果骺板闭合是外侧型的，成熟髋关节将出现随着内侧颈延长和外侧颈保持短而股骨头向外倾斜、大转子超过股骨头生长、股骨头呈椭圆形、腿短以及髋臼变形。骺板停滞是内翻截骨术的禁忌证，因为它会加重畸形，尤其是在大转子处。必要时，腿长差异可通过对侧股骨骨骺阻滞术治疗，外展肌无力可通过锻炼计划或大转子远端和外侧转移术治疗。
