Wenger D R
J Pediatr Orthop. 1981;1(2):153-60. doi: 10.1097/01241398-198110000-00005.
Surgical containment is often selected for older children with "at risk" Legg-Perthes disease because healing time is long and abduction bracing is poorly tolerated. This review of 19 older children (mean age, 9.6 years) treated by surgical containment, selected from a total of 167 patients with Legg-Perthes disease, demonstrates the frequency of complications when only older children with severe involvement are surgically contained. The radiographic results (37% good, 26% fair, 37% poor) are mediocre when compared with reported series in which patients were not selected critically for "at risk" factors or in which the means age was lower. Although surgically contained, the femoral head in certain older children with "at risk" Legg-Perthes disease is unable to tolerate full activity. The avascular head responds in much the same manner as the adult femoral head with avascular necrosis (slow repair, marked collapse): therefore, older children treated surgically must be followed closely. Failure of containment, with head collapse, following surgical containment is heralded by a loss of hip motion and must be treated vigorously by reinstituting the usual nonsurgical protocol (hospitalization, traction, muscle release, arthrogram. Petrie casts, abduction bracing). Obviously, prior to surgical containment, the family should be advised of the possible later need for rehospitalization and a return to abduction casts or braces.
对于患有“高危”型Legg-Perthes病的大龄儿童，常选择手术包容疗法，因为愈合时间长且外展支具耐受性差。本研究回顾了从167例Legg-Perthes病患者中选取的19例接受手术包容治疗的大龄儿童（平均年龄9.6岁），结果表明，仅对严重受累的大龄儿童进行手术包容时并发症的发生率情况。与未因“高危”因素进行严格筛选患者或平均年龄较低的报道系列相比，其影像学结果（37%为良好，26%为中等，37%为较差）较为一般。某些患有“高危”型Legg-Perthes病的大龄儿童，尽管采用了手术包容疗法，但其股骨头仍无法耐受完全活动。缺血性股骨头的反应与成人缺血性坏死的股骨头非常相似（修复缓慢，明显塌陷）：因此，接受手术治疗的大龄儿童必须密切随访。手术包容后出现包容失败且股骨头塌陷，会表现为髋关节活动度丧失，必须通过重新采用常规非手术方案（住院、牵引、肌肉松解、关节造影、Petrie石膏、外展支具）进行积极治疗。显然，在进行手术包容之前，应告知家属后期可能需要再次住院以及重新使用外展石膏或支具的情况。
