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学术前沿

儿童特发性股骨头坏死:Legg-Calvé-Perthes病第二部分:治疗对结果影响的前瞻性多中心研

发表者:陶可 人已读

Legg-Calvé-Perthes病第二部分:治疗对结果影响的前瞻性多中心研究

译者:陶可(北京大学人民医院骨关节科)

摘要:

背景:Legg-Calve-Perthes病的治疗基于对少数患者进行的非对照回顾性研究。本项大型、对照、前瞻性、多中心研究旨在确定Perthes病患者的治疗效果和对预后影响的其他危险因素。

方法:我们在一项前瞻性多中心研究中招募了438例共451髋关节患Perthes病的患者,其中每个研究者对他或她的每个患者采用相同的治疗方法。研究分为5个治疗组,包括无干预治疗组、支具治疗组、运动范围锻炼组、股骨截骨术组和微创截骨术组。所有患者发病年龄均在6.012.0岁之间,并且均未接受过治疗。最后,共对337例患者345例髋关节在骨骼成熟时进行了随访。所有髋关节均采用改良的外侧柱分类法和Stulberg等人的系统进行分类。

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 <= 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)。

结论:Legg-Calve-Perthes病患者的外侧柱分类和疾病发作时的年龄与预后密切相关。发病时年龄大于8.0岁且在外侧柱B组或B/C边界组的患者,与非手术治疗相比,手术治疗的效果更好。发病时年龄小于8.0岁的儿童中的B组髋关节具有与治疗无关的非常有利的结果,而所有年龄段的儿童中的C组髋关节常常具有较差的结果,这似乎也与治疗无关。

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

Abstract

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.

1.png

Fig. 1. Percentage of combined Stulberg class-I and II outcomes within the lateral pillar groups at different chronologic ages of disease onset.

1. Stulberg III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。

2.png

Fig. 2. Percentage of combined Stulberg class-IV and V outcomes within the lateral pillar groups at different chronologic ages of disease onset.

2. Stulberg IVV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。


本文是陶可版权所有,未经授权请勿转载。
本文仅供健康科普使用,不能做为诊断、治疗的依据,请谨慎参阅

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发表于:2020-11-21