结果：未接受任何治疗的髋关节、接受支具治疗的髋关节和接受运动范围治疗的髋关节的结果无差异。股骨内翻截骨术与微创截骨术治疗的髋关节之间也没有差异。对于发病年龄在8.0岁以下的儿童或骨骼年龄在6.0岁以下的儿童，治疗没有明显影响。在外侧柱分型B组和B/C边界组，发病年龄在8.0岁以上的儿童，手术治疗结果明显优于非手术治疗的结果（p <或= 0.05）。外侧柱分型B组发作时在8.0岁或以下患者的非手术和手术治疗方面均表现良好。在外侧柱分型C组的髋关节效果最差，手术组和非手术组之间没有差异。外侧柱分类（p <0.0001）和疾病发作年龄（p = 0.0001）都是很强的预后因素。如果女性患者在疾病发作时年龄超过8.0岁，则其病情明显比男性患者差（p = 0.004）。
文献出处：John A Herring, Hui Taek Kim, Richard Browne. Legg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome. J Bone Joint Surg Am. 2004 Oct;86(10):2121-34.
Legg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome
Background: The treatment of Legg-Calve-Perthes disease has been based on uncontrolled retrospective studies with relatively small numbers of patients. This large, controlled, prospective, multicenter study was designed to determine the effect of treatment and other risk factors on the outcome in patients with this disorder.
Methods: We enrolled 438 patients with 451 affected hips in a prospective multicenter study in which each investigator applied the same treatment method to each of his or her patients. The five treatment groups consisted of no treatment, brace treatment, range-of-motion exercises, femoral osteotomy, and innominate osteotomy. All patients were between 6.0 and 12.0 years of age at the onset of the disease, and none had had prior treatment. Three hundred and forty-five hips in 337 patients were available for follow-up at skeletal maturity. All hips were classified with the modified lateral pillar classification and the system of Stulberg et al.
Results: There were no differences in outcome among the hips with no treatment, those treated with bracing, and those treated with range-of-motion therapy. There were also no differences between the hips treated with a femoral varus osteotomy and those treated with an innominate osteotomy. Treatment did not have a significant effect on children who had a chronologic age of 8.0 years or less or a skeletal age of 6.0 years or less at the onset of the disease. In the lateral pillar B group and B/C border group, the outcomes of surgical treatment were significantly better than those of nonoperative treatment in children over the age of 8.0 years at the onset of the disease (p < or = 0.05). Patients who were 8.0 years old or less at the onset of the disease in lateral pillar group B did equally well with nonoperative and operative treatment. Hips in lateral pillar group C had the least favorable outcomes, with no differences between the operative and nonoperative groups. The lateral pillar classification (p < 0.0001) and the age at the onset of the disease (p = 0.0001) were both strong prognostic factors. Female patients did significantly worse than male patients if they were over the age of 8.0 years at the onset of the disease (p = 0.004).
Conclusions: The lateral pillar classification and age at the time of onset of the disease strongly correlate with outcome in patients with Legg-Calve-Perthes disease. Patients who are over the age of 8.0 years at the time of onset and have a hip in the lateral pillar B group or B/C border group have a better outcome with surgical treatment than they do with nonoperative treatment. Group-B hips in children who are less than 8.0 years of age at the time of onset have very favorable outcomes unrelated to treatment, whereas group-C hips in children of all ages frequently have poor outcomes, which also appear to be unrelated to treatment.
Fig. 1. Percentage of combined Stulberg class-I and II outcomes within the lateral pillar groups at different chronologic ages of disease onset.
图1. Stulberg I、II型预后与外侧柱分组、发病的不同年龄阶段之间的相关百分率。
Fig. 2. Percentage of combined Stulberg class-IV and V outcomes within the lateral pillar groups at different chronologic ages of disease onset.
图2. Stulberg IV、V型预后与外侧柱分组、发病的不同年龄阶段之间的相关百分率。