三种不同方法治疗Perthes病的疗效比较研究  

Comparison of the curative effect of three different therapies in the treatment of Perthes' disease in children

作　　者：甘先民[1,2] 倪江东[1] 

机构地区：[1]中南大学湘雅二医院创伤骨科,湖南长沙410011 [2]中南大学湘雅医学院附属海口医院骨科中心,海南海口570208

出　　处：《海南医学》2013年第12期1740-1744,共5页Hainan Medical Journal

摘　　要：目的比较三种不同方法治疗儿童Perthes病的疗效,进一步探讨适合儿童Perthes病的治疗手段。方法回顾性收集我院1999年12月至2012年10月收治的99例(99髋)儿童Perthes病,将其分为4组进行疗效观察,A组(保守治疗1组,年龄<5岁,Herring A.B型)33髋;B组(保守治疗2组,年龄>5岁,Herring B/C.C型)21髋;C组(股骨粗隆间或粗隆下内翻截骨组,不论年龄,Herring B/C.C型)24髋;D组(Salter骨盆截骨组,不论年龄,Herring B/C.C型)21髋。采用临床和X线片动态随访,按Stulberg标准进行疗效评价。结果经2～10年随访,4组的优良率分别为:A组66.7%,B组38.1%,C组62.5%,D组61.9%;A组、C组和D组的疗效均优于B组,差异均有统计学意义(P<0.05);同样为保守治疗,A组的疗效明显优于B组,差异有统计学意义(P<0.05);A组、C组和D组的优良率虽以A组最高,但三组间比较差异无统计学意义(P>0.05);B组、C组和D组同为Herring B/C.C型,优良率以B组最差,差异有统计学意义(P<0.05)。结论增加股骨头的包容是治疗Perthes病的有效方法,病情轻、发病年龄小的Herring A.B型患儿宜保守包容治疗,病情重、发病年龄大的Herring B/C.C型患儿宜手术包容治疗。Objective To compare the clinical efficacy of three different therapies in the treatment of Perthes＇ disease in children. Methods The clinical data of 99 patients （99 hips） of Perthes＇ disease in our hospital from December 1999 to October 2012 were retrospectively analyzed. The patients were divided into four groups： group A （conservative therapy group 1, patients with classification of Herring A or B, 5 years old）, group B （conser-vative therapy group 2, patients with classification of Herring B/C or C, 5 years old, group C （Femur osteotomy group, patients with classification of Herring B/C.C, regardless of the age, group D （Salter ilium osteotomy group, patients with classification of Herring B/C.C, regardless of the age）. The outcomes were analyzed with Stulberg criteria. Results After following up for 2～10 years, the excellent and good rate was 66.7% in group A, 38.1% in group B, 62.5% in group C, 61.9% in group D. The curative effect of group A, C, D was significantly better than that of group B （P0.05）. As for conservative therapy, the curative effect of group A was significantly better than that of group B （P0. 05）. The excellent and good rate of group A was higher than that of group C, D, but there are no statistically sig-nificant difference between the three groups （P0.05）. As for Herring B/C or C, the curative effect of group C, D was significantly better than that of group B （P0.05）. Conclusion Increased containment of the head of femur is a good way to treat Perthes＇ disease. Younger patients with light illnesses of Herring A or B are suitable for conservative therapy. Older patients with severe illnesses of Herring B/C or C are suitable for operative therapy.

关 键 词：儿童 PERTHES病 保守治疗 截骨术 疗效 

分 类 号：R681[医药卫生—骨科学]