16例Meyer发育不良患儿的临床特点及疗效的回顾性研究  

A retrospective study of clinical characteristics and curative results of 16 children with Meyer dysplasia

作　　者：傅刚[1] 王玉琨[1] 张建立[1] 朱振华[1] 郭源[1] 

机构地区：[1]北京积水潭医院小儿骨科,100035

出　　处：《中国骨与关节杂志》2017年第6期462-464,共3页Chinese Journal of Bone and Joint

摘　　要：目的回顾性分析本院16例Meyer发育不良患儿的临床特点和治疗效果。方法回顾分析我科2008年至2014年,诊断为Meyer发育不良的16例患儿(共计22髋)的临床资料。16例患儿中,男∶女=15∶1。双侧发病的为6例(38%)。就诊时平均年龄3.1(1.5~5)岁,随访时间平均2.8(2~6)年。诊断标准为:(1)年龄<5岁;(2)就诊时症状以轻微跛行或者髋关节轻微疼痛不适为主,经休息均自行缓解,症状消失;(3)活动不受限,查体无阳性体征;(4)X线检查见到股骨头骺小,骨性骺核出现延迟或分成数个,呈桑椹状或者表面不规则。但是没有软骨下骨折,没有骺核密度增高,没有髋关节半脱位;(5)如有MRI,未见骺内异常信号;(6)无其它骨骺发育异常;(7)无内分泌异常。初次就诊后处理:观察,先免负重3个月再复查,复查时如果症状解除,X线片上未出现软骨下骨折,骺核碎裂,密度增高及半脱位,可负重,定期复查。结果所有患儿在最终复查时均无症状,活动不受限。X线表现为骺核逐渐增大、融合,股骨头骺表现为球形或接近球形的轮廓(Stulberg I型和II型)。结论 Meyer发育不良发生率低,但是容易和Perthes病(Legg-Calve-Perthes Disease,股骨头骨骺的缺血性坏死)混淆。对于<5岁、股骨头骺核出现延迟而小的病例,应考虑Meyer发育不良的可能。其最终预后良好,早期正确诊断,可避免不必要的治疗。Objective To retrospectively analyze the clinical characteristics and curative results of 16 children with Meyer dysplasia. Methods From 2008 to 2014, 16 children （ 22 hips ） with Meyer dysplasia were treated in our hospital, whose clinical data were retrospectively analyzed. There was 1 female and 15 male patients in the study, including 6 patients （ 38% ） with both sides affected. Their mean age was 3.1 years old （ range： 1.5 - 5 years ） at the first hospital visit. They were followed up for a mean period of 2.8 years （ range： 2 - 6 years ）. The diagnosis criteria were： （ 1 ） Younger than 5 years; （ 2 ） The clinical symptoms were mild pain and limping at the first hospital visit, and the symptoms got resolved after rest; （ 3 ） There was no or only mild limitation in hip motion, and the physical examination showed positive signs; （ 4 ） The X-ray showed smaller or delayed ossification centers in the proximal femoral epiphysis, or a small epiphyseal nucleus composed of multiple independent bony foci, but no subchondral fracture, epiphysis condensation or subluxation of hip; （ 5 ） No abnormal finding in MRI; （ 6 ） The other skeleton dysplasia was excluded; （ 7 ） No congenital metabolic abnormality. After the first hospital visit, the treatment of all children was observation only with no weight-bearing for 3 months. During the follow-up after 3 months, if the clinical symptoms got resolved, and the X-ray did not show subchondral fracture, epiphysis fragmentation or condensation, or subluxation, the children were allowed to weight-bearing, and had regular follow-up. Results All children had no symptom and no motion limitation at the latest follow-up. The X-ray showed proximal femoral epiphysis became enlarged and gradual recovery to a normal or nearly normal contour of the femoral head （ class I and II in Stulberg classification ）. Conclusions Meyer dysplasia is a rare condition, but could be easily mistaken with Legg-Calve-Perthes disease （ LCPD ）, leading t

关 键 词：Meyer发育不良 股骨头缺血坏死 儿童 学龄前(2-5) 回顾性研究 

分 类 号：R726.8[医药卫生—儿科]