大转子骨骺阻滞术在儿童股骨头缺血性坏死中的疗效  

Therapeutic effect of greater trochanteric epiphysiodesis on the children with Legg-Calve-Perthes disease

作　　者：陈国强 王忠良[1] 覃佳强[1] 南国新[1] 宿玉玺[1] 蔡文全[1] 何波[1] 陈凯[1] 顾凯[1] 梁珣[1] 严格[1] Chen Guoqiang;Wang Zhongliang;Qin Jiaqiang;Nan Guoxin;Su Yuxi;Cai Wenquan;He Bo;Chen Kai;Gu Kai;Liang Xun;Yan Ge(Second Department of Orthopedics,Children’s Hospital of Chongqing Medical University,National Research Center for Clinical Medicine of Children’s Health and Diseases,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Pediatrics)

机构地区：[1]重庆医科大学附属儿童医院骨二科、国家儿童健康与疾病临床医学研究中心、儿童发育疾病研究教育部重点实验室、儿科学重庆市重点实验室,重庆400014

出　　处：《重庆医科大学学报》2022年第4期433-438,共6页Journal of Chongqing Medical University

摘　　要：目的:评价大转子骨骺阻滞术(greater trochanteric epiphysiodesis,GTE)治疗儿童股骨头缺血性坏死(Legg-Calve-Perthes disease,LCPD)的效果。方法:选择2013年1月至2019年6月在重庆医科大学附属儿童医院采取手术治疗的78例儿童股骨头缺血性坏死患者作为研究对象,根据术前X线是否存在大转子上移(overgrowth of the greater trochanter,OGGT)危象分为危象组与无危象组,危象组中根据术式不同分为阻滞组与未阻滞组。阻滞组给予包容手术联合大转子骨骺阻滞术治疗,共14例16髋,未阻滞组仅给予包容手术治疗,共33例33髋。无危象组共31例31髋。对以上病例进行术后随访,通过调查临床症状和影像学资料,评价手术疗效。结果:患者术后随访时间12~89个月,平均30.6个月。有危象未阻滞组大转子上移率(75.8%)较无危象组(6.5%)明显增加(P<0.001);阻滞组患儿大转子上移率(21.4%)较有危象未阻滞组(75.8%)明显降低(P=0.001)。阻滞组患、健侧大转子发育对比分析,阻滞侧平均每年大转子生长值较健侧减少约1.32 mm,差异有统计学意义(P<0.05),其中空心钉阻滞可达约1.77 mm/年。临床疗效方面,阻滞组术后优良率也高于未阻滞组。结论:大转子上移早期X线危象对大转子上移具有确切的预判意义,可作为实施大转子骨骺阻滞术的手术指征;选择性大转子骨骺阻滞术可有效抑制大转子生长,避免大转子上移的发生,联合传统包容手术,可有效提高患儿的治疗效果。Objective:To evaluate the therapeutic effect of greater trochanteric epiphysiodesis(GTE)on Legg-Calve-Perthes disease(LCPD)in children.Methods:A total of 78 patients with LCPD treated by surgery in Children’s Hospital of Chongqing Medical University from January 2013 to June 2019 were included in the study.They were divided into crisis group and no-crisis group according to that if there were radiographic crisis of overgrowth of the greater trochanter(OGGT)based on X-ray films before the surgery,and the patients in crisis group were divided into the GTE group and the non-GTE group according to different surgical procedures.The GTE group were treated with inclusive surgery combined with GTE including 14 cases(16 hips),and the non-GTE group were only treated with inclusive surgery including 33 cases(33 hips).There were 31 cases and 31 hips in the no-crisis group.The above cases were followed up and the therapeutic effect was evaluated by the clinical symptoms and radiographic data.Results:The patients were followed up for 12 to 89 months(mean,30.6 months).The rate of OGGT in the non-GTE group(75.8%)was significantly higher than that in the no-crisis group(6.5%)(P<0.001),and the rate of OGGT in the GTE group(21.4%)was significantly lower than that in the non-GTE group(75.8%)(P=0.001).According to the comparative analysis of the development of the greater trochanter between the affected side and the healthy side in the GTE group,the growth of the greater trochanter that underwent GTE was inhibited by 1.32 mm/year,while greater inhibition(1.77 mm/year)was noted in children who underwent the hollow nail epiphysiodesis.The clinical effect in the GTE group was also better than that in the non-GTE group.Conclusion:Radiographic crisis of OGGT has definite predictive significance and can be the indication for GTE,and selective GTE can effectively inhibit the growth of greater trochanter and avoid OGGT.Combined with traditional inclusive surgery,the therapeutic effect can be improved.

关 键 词：股骨头缺血性坏死 大转子骨骺阻滞术 大转子上移 儿童 

分 类 号：R726.8[医药卫生—儿科]