股骨骨盆截骨治疗儿童重度Legg-Calvé-Perthes病  

Femoral osteotomy combined with pelvic osteotomy for severe Legg-Calvé-Perthes disease in children

作　　者：孔圳 孙永建 钟华 杨少铮 黄丰 纪悦伦 吴伟平 KKOONNG Zhen;SUN Yong-jian;ZHONG Hua;YANG Shao-zheng;HUANG Feng;JI Yue-lun;WU Wei-ping(Department of Orthopedics,The Fifth Affiliated Hospital,Southern Medical University,Guangzhou 510920,China;Department of Pediatric Orthopedics,The Third Affiliated Hospital,Southern Medical University,Guangzhou 510630,China)

机构地区：[1]南方医科大学第五附属医院创伤骨科,广东广州510920 [2]南方医科大学第三附属医院儿童骨科,广东广州510630

出　　处：《中国矫形外科杂志》2023年第23期2130-2135,共6页Orthopedic Journal of China

摘　　要：[目的]探讨股骨近端内翻截骨和联合Steel截骨治疗重度Legg-Calvé-Perthes病的疗效。[方法]回顾性分析南方医科大学第五及第三附属医院2013年1月—2021年6月收治的重度Legg-Calvé-Perthes病38例患者的临床资料。根据医患沟通结果,17例采用单纯股骨近端内翻截骨治疗(股骨组),21例采用股骨近端内翻截骨联合Steel截骨治疗(联合组)。比较两组围手术期、随访及影像资料。[结果]股骨组手术时间、切口长度、术中失血量、术后引流量、住院时间均显著少于联合组。随访时间平均(33.0±9.6)个月,股骨组患者下地行走时间[(73.5±3.5)d vs(79.9±5.1)d,P<0.05]和完全负重活动时间[(108.9±6.8)d vs(119.4±8.6)d,P<0.05]显著早于联合组。与术前相比,两组患者末次随访时,Harris评分、髋关节屈伸ROM、内外旋ROM均显著增加(P<0.05);相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。影像方面,与术前相比,末次随访时两组的AI、LCEA、FHEI、Sharp角均显著改善(P<0.05),术前两组间上述指标的差异均无统计学意义(P>0.05),末次随访时,联合组AI[(11.3±2.0)°vs(16.7±1.7)°,P<0.05]、LCEA[(33.4±2.1)°vs(25.2±2.8)°,P<0.05]、FHEI[(12.2±3.3)%vs(17.8±3.0)%,P<0.05]、Sharp角[(27.9±4.4)°vs(35.4±3.1)°,P<0.05]均显著优于股骨组,两组Stulberg分型差异无统计学意义(P>0.05)。[结论]联合组比股骨组能够更好地达到股骨头包容效果,促进股骨头恢复,但是手术创伤更大。[Objective]To investigate the clinical efficacy of proximal femoral osteotomy combined with Steel pelvic osteotomy in thetreatment of severe Legg-Calvé-Perthes disease(LCPD).[Methods]A retrospective study was conducted on 38 patients who received surgical treatments for severe LCPD in our hospitals from January 2013 to June 2021.According to doctor-patient communication,17 patientswere treated with simple proximal femoral varus osteotomy(the femoral group),while the other 21 patients were treated with proximal femoralvarus osteotomy combined with Steel pelvic osteotomy(the combined group).The perioperative period,follow-up and imaging data of the twogroups were compared.[Results]The femoral group proved significantly less than the combined group in terms of operation time,incisionlength,intraoperative blood loss,postoperative drainage volume and hospital stay(P<0.05).All patients in both groups were followed up for(33.0±9.6)months in a mean,and the femoral group resumed ambulation[(73.5±3.5)days vs(79.9±5.1)days,P<0.05]and the full weightbearing activity[(108.9±6.8)days vs(119.4±8.6)days,P<0.05]significantly earlier than the combined group.Compared with those preoperatively,the Harris score,hip flexion-extension range of motion(ROM)and internal-external rotation ROM significantly increased in bothgroups at the latest follow-up(P<0.05),which proved not statistically significant between the two groups at any time points accordingly(P>0.05).Radiographically,the acetabular index(AI),lateral center edge angle(LCEA),femoral head extrusion index(FHEI)and Sharp anglesignificantly improved at the last follow-up compared with those before surgery in both groups(P<0.05).Although there was no statistical significance in the above radiographic parameters between the two groups before surgery(P>0.05),the combined group was significantly superior to the femoral group in terms of AI[(11.3±2.0)°vs(16.7±1.7)°,P<0.05],LCEA[(33.4±2.1)°vs(25.2±2.8)°,P<0.05],FHEI[(12.2±3.3)%vs(17.8±3.0)%,P<0.05],Sharp angle[(27.9±4.4)

关 键 词：Legg-Calvé-Perthes病 手术治疗 股骨内翻截骨 骨盆Steel截骨 

分 类 号：R681.6[医药卫生—骨科学]