Legg-Calve-Perthes病非手术治疗效果及相关预后因素分析  

Outcomes evaluation and prognosis factors of conservative treatment in Legg-Calve-Perthes disease

作　　者：陈雷雷[1] 洪郭驹[2] 张庆文[1] 陈镇秋[1] 方斌[1] 何伟[1] 

机构地区：[1]广州中医药大学第一附属医院关节骨科,510405 [2]广州中医药大学第一临床医学院,510405

出　　处：《中华关节外科杂志（电子版）》2016年第3期46-50,共5页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：国家自然科学基金(81302990);广东省杰出青年科学基金(2015A030306037);广东省高等学校学科与专业建设专项资金项目(2013LYM 0010)

摘　　要：目的总结Legg-Calve-Perthes病的非手术疗效,分析相关预后因素。方法收集广州中医药大学第一附属医院关节骨科1996年12月至2012年10月非手术治疗Legg-Calve-Perthes 43例（48髋）,根据Waldenstrm分期,初诊时坏死期、碎裂期病例予以Petrie石膏固定,每次固定时间为3个月,拆除石膏后进行关节功能锻炼1~2 d,连续固定2次,之后更换为外展支具;进入修复期后拆除支具进行功能锻炼,治疗时长约12~18个月,定期门诊复查,直至骨骺完全成熟。分析比较病例的改良Stulberg结局,并将结局指标与发病年龄、Catterall分期、Herring分型和初诊时Waldenstrm病理分期进行Kruskal-Wallis秩和检验、Nemenyi检验分析。结果以改良Stulberg分型作为临床结局评价指标,总体显效率（I、Ⅱ型）为85.4%,优良率（I型）为56.3%。发病年龄≤8岁患者的优良率为80%,大于8岁为45.5%;CatterallⅠ＆Ⅱ组的优良率为77.8%,Ⅲ＆Ⅳ组为43.3%;Herring A型优良率为100%,B型为62.5%,C型为25%;初诊为Waldenstrm坏死期的优良率为56.5%,碎裂期为0%,修复期为77.8%。经秩和检验,各个分组差异均有统计学意义（P〈0.05）;其中,Herring分型A与C之间差异有统计学意义（P〈0.05）;Waldenstrm分期中坏死期与修复期比较,差异无统计学意义（P〉0.05）;但两组分别与碎裂期比较,差异有统计学意义（P〈0.05）。结论 Legg-CalvePerthes病非手术疗效可,发病年龄、Catterall分期、Herring分型及初诊时Waldenstrm分期均为影响预后的相关因素,并且Waldenstrm分期更适合疾病早期临床应用。Objective To evaluate the outcomes of the non-surgery treatment for Legg-CalvePerthes disease（ LCPD） and analyze the related prognosis factors. Methods Forty-three patients（ 48hips） from the first Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively reviewed,who had LCPD and accepted non-surgical treatment between December 1996 and October 2012.According to Waldenstrm classification,the children in osteonecrosis or fragmentation phase adopted Petrie plaster bandage fixation for three months each time（ total two times） and accepted regular exercises 1-2 d during the interval time between the fixations. When the plaster fixation finished,Scottish Rite abduction brace was applied. When the pathological process developed to the reossification phase,the functional exercises were performed. The total treatment time last for 12-18 months. The patients were required to come to the outpatient for reviews until the epiphysis was completely mature. The outcomes of the nonsurgery treatment were investigated; the relationship between the outcomes and onset age, Catterall grouping,Herring Lateral Pillar Sign,and Waldenstrm classification were analyzed by Kruskal-Wallis rank-sum test and Nemenyi test. Results The clinical effective rate in modified Stulberg classification（ typeⅠ Ⅱ） was 85. 4% and the excellent rate（ ER） was 56. 3%. The children younger than eight years old showed an ER of 80% compared to 45. 5% in the elder ones. The cases of Catterall typeⅠ Ⅱgroup presented an ER of 77. 8% which was higher than that of Ⅲ Ⅳ type group（ 43. 3%）. In Herring classification,ER of type A group was 100%,ER of type B group was 62. 5% and ER of type C group was25%. In osteonecrosis phase,the patients were proved to be better with an ER of 56. 5% than those patients in the fragmentation phase（ 0%） and reossification phase（ 77. 8%）（ P〈0. 05）. Among them,the differences between type A and C were statistically significant in Haring classification（ P�

关 键 词：Legg-Calve-Perthes病 预后 分期 

分 类 号：R726.8[医药卫生—儿科]