Perthes病17例治疗分析.docxVIP

Perthes病17例治疗分析 中国编辑。 作者：李军，马保安，胡运生，龙华，周本根 【摘要】 目的 回顾性分析Perthes病 治疗 的经验，结合系统 文献 复习，以确定治疗的指征和方法。方法 17例(平均6.岁)Perthes病中，CatterallⅠ型3例，Ⅱ型4例，Ⅲ型7例， Ⅳ型3例。分别采取支具或石膏固定，滑膜切除髓腔减压或植骨，Salter或Chairi截骨治疗。采用临床和X线片动态随访，按Stulberg标准进行疗效评价。结果 术后平均随访24(6～52)个月。4例采用石膏或支具外固定的CatterallⅠ和Ⅱ型病例均取得全优效果；采用滑膜切除髓腔减压或植骨的CatterallⅠ和Ⅱ型病例，2优，1中；采用Salter或Chairi截骨治疗Catterall Ⅲ和Ⅳ型的10个病例，5优，3良，2中。结论 严格应用Perthes病临床分型，选择合适的治疗方法是提高此疾患治愈效果的重要手段。  【关键词】 Perthes病；治疗； 儿童  Abstract： Objective To figure out an effective combined treatment system for Perthes disease. Methods A total of 1pediatric patients (with a mean age ) with Perthes disease with classification of Catterall I (cases), Ⅱ (cases), Ⅲ (cases), Ⅳ (cases) were treated with cast (cases), core decompression (cases), Salter and Chairi osteotomy (10 cases), respectively. The outcomes were analyzed with Stulberg Average followup time wasmonths (6-5months). All the four patients of Catterall I and II classification who were treated with cast had the best outcome, and the other three patients treated with core decompression had excellent outcome (in two patients) and good outcome (in one patient). All the ten patients classified as Catterall Ⅲ and Ⅳ were treated with Salter or Chairi osteotomy, got excellent outcome (in five patients), good outcome (in three patients) and fair outcome (in two patients). Conclusion Following the Catterall classification and combined treatment for Perthes disease is crucial for improvement in prognosis.  Key words： LeggCalvePerthes disease; treatment; children  Perthes 病 (LeggCalvePerthes Disease，儿童股骨头无菌性坏死)是一种儿童发育期常见的髋关节自限性疾病，其发病原因尚不明确，临床有诸多的治疗方法[1]。我科自XX年起采纳Catterall临床分型方法，应用石膏或支具固定、滑膜切除髓腔减压或植骨，Salter或Chairi骨盆截骨治疗，现将得到随访的17例进行分析，以探讨有效、适宜的治疗方法。  1 对象与方法  1．1 对象 本组17例。其中男11髋，女6髋。年龄4～13岁，平均6岁4个月。有轻微外伤史者4例，有应用激素史者2例，其他无明确诱因。患儿Catterall分期，Ⅰ型3例，Ⅱ型4例，Ⅲ型7例，Ⅳ型3例。  方法  石膏或支具固定 本组4例均为Catterall分期Ⅰ型，Ⅱ型。双下肢外展40～45°，内旋10～15°位置，单侧石膏固定，根据复查及患者耐受情况，4～12