Perthes病外侧柱C型股骨头软骨形态及外侧1/3软骨高度与预后的相关性  

Correlation of the cartilage morphology of femoral head of Perthes disease with Herring classification C and the height of lateral one third cartilage with prognosis

作　　者：张华东 杨建平[1] 付喆[1] 张中礼[1] Zhang Huadong;Yang Jianping;Fu Zhe;Zhang Zhongli(Department of Pediatric Orthopedics,Tianjin Hospital,Tianjin 300202,China)

机构地区：[1]天津市天津医院小儿骨科,天津300202

出　　处：《中华小儿外科杂志》2025年第2期158-162,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨Perthes病患儿外侧柱C型股骨头软骨形态及股骨头骺外侧1/3软骨高度与预后的相关性。方法回顾分析2002年1月至2018年12月天津市天津医院收治的Perthes病319例患儿的临床资料,按纳入及排除标准将44例纳入研究。根据患儿冠状位MRI影像中股骨头软骨形态分为非球形软骨组(非球形组)7例和球形软骨组(球形组)37例,测量比较两组股骨头突出指数、患侧与健侧股骨头外侧1/3软骨高度的比值。股骨头愈合后测量评估以下指标:改良Stulberg分级,患侧与健侧的干骺端宽度比值,患侧与健侧的股骨头骺高度比值,患侧与健侧的关节转子间距(articlo-trochanteric distance,ATD)比值。结果非球形组股骨头骺突出指数为(33.7%±5.3%),球形组股骨头骺突出指数为(28.1%±6.7%),两组差别无统计学意义(t=2.066,P=0.433)。改良Stulberg分类评估结果,非球形组Ⅰ类髋关节1例,Ⅱ类髋关节2例,Ⅲ类髋关节4例;球形组Ⅰ类髋关节31例,Ⅱ类髋关节5例,Ⅲ类髋关节1例,两组差别有统计学意义(P<0.001)。患侧与健侧的干骺端宽度比值非球形软骨组为(131.7%±9.5%),球形组为(115.4%±8.9%),差异有统计学意义(t=8.12,P=0.003);患侧与健侧股骨头骺高度比值非球形组为(43.1%±16.2%),球形组为(69.8%±11.9%),差别有统计学意义(t=-4.151,P=0.004)。患侧与健侧的ATD比值非球形软骨组为(68.1%±86.0%),球形软骨组为(64.0%±41.9%),差别无统计学意义(t=0.124,P=0.905)。患侧与健侧股骨头外侧1/3软骨高度比值为(63.0%±16.0%),对股骨头愈合后的预测能力的ROC曲线截断值为69%,敏感度和特异度分别为0.607、0.875,曲线下面积为0.754。结论股骨头软骨形态与股骨头愈合后球形度有相关性;股骨头软骨形态与干骺端宽度和股骨头骺高度有相关性;股骨头软骨形态与ATD无相关性。股骨头外侧1/3软骨高度在Perthes病外侧柱C型患儿中对股骨头球形度具有预测意义,股骨头软骨�ObjectiveTo investigate the correlation of the cartilage morphology of femoral head of Perthes disease with Herring classification C of Perthes disease femoral head cartilage morphology and the height of lateral one-third cartilage with prognosis.MethodsA retrospective analysis was conducted on 319 children with Perthes disease treated at Tianjin Hospital from January 2002 to December 2018.According to the inclusion and exclusion criteria,44 cases were included in the study.Based on the morphology of the femoral head epiphyseal cartilage on the coronal Magnetic resonance imaging(MRI)images,patients were divided into the non-spherical cartilage group(7 cases)and spherical cartilage group(37 cases).The differences in the femoral head protrusion index and the ratio of the lateral one-third of the epiphyseal cartilage height on the affected side to that on the unaffected side were measured.After the healing of femoral head,modified Stulberg grade,the ratio of the width of the epiphyseal line on the affected side to that on the unaffected side,the ratio of the epiphyseal height on the affected side to that on the unaffected side,and the ratio of the ATD(articulo-trochanteric distance)on the affected side to that on the unaffected side were calculated.ResultsThere was no significant difference in the femoral head epiphyseal bulging index between the non-spherical group and spherical group(33.7%±5.3%vs 28.1%±6.7%,t=2.066,P=0.433).The modified Stulberg classification evaluation results showed that the non-spherical group had 1 case of ClassⅠhip joint,2 cases of ClassⅡhip joint,and 4 cases of ClassⅢhip joint.The spherical group had 31 cases of ClassⅠhip joint,5 cases of ClassⅡhip joint,and 1 case of ClassⅢhip joint.There was a significant difference in the modified Stulberg classification between the two groups(P<0.001).There was a significant difference in the ratio of the width of the epiphyseal end of the affected side to that of the healthy side between the non-spherical cartilage group and spherical car

关 键 词：累-卡-佩三氏病 股骨头坏死 干骺端 预后 

分 类 号：R68[医药卫生—骨科学]