CAJ | 학술논문

目的探讨改良Chiari髂骨截骨治疗儿童Perthes病的手术时机与疗效评定标准.方法 1986年6月至2004年12月,采用改良Chiari髂骨截骨、髋关节滑膜切除、股骨颈钻孔减压、髂腰肌延长和股内收肌松解的组合式手术治疗Perthes病患儿234例,其中得到3年以上随访者108例,男61例,女47例;年龄3岁2个月～13岁6个月,平均7岁3个月.根据术前骨盆X线片按Catterall法分期,Ⅰ期10例,Ⅱ期3l例,Ⅲ期32例,Ⅳ期35例.采用邸建德等、Green等和Mose的Perthes病疗效评定标准为基础,自行制定五项十分法进行疗效评定,即临床症状、患肢长度、头骺覆盖率、头骺形状和关节转子间距等,满分为10分,总分≥9分为优,7～8分为良,5～6分为可,≤4分为差.结果 108例患儿随访时间3～12年,平均5年8个月.术后无一例发生血管及神经损伤、切口感染、骨不连等并发症.患儿术前存在的轻度髋内旋和外展活动障碍及关节疼痛均消失.根据五项十分法进行疗效评定,Ⅰ期优良率90.00%,Ⅱ期优良率90.32%,二者平均为90.24%;Ⅲ期优良率68.75%,Ⅳ期优良率68.57%,二者平均为68.66%.早期(Ⅰ、Ⅱ期)优良率明显好于晚期(Ⅲ、Ⅳ期).结论早期采用改良Chiari髂骨截骨治疗儿童Perthes病的效果明显好于晚期.五项十分法的疗效评定标准可较好地对患儿术后的远期效果作出前瞻性评估.
목적 탐토개량Chiari가골절골치료인동Perthes병적수술시궤여료효평정표준.방법 1986년6월지2004년12월,채용개량Chiari가골절골、관관절활막절제、고골경찬공감압、가요기연장화고내수기송해적조합식수술치료Perthes병환인234례,기중득도3년이상수방자108례,남61례,녀47례;년령3세2개월～13세6개월,평균7세3개월.근거술전골분X선편안Catterall법분기,Ⅰ기10례,Ⅱ기3l례,Ⅲ기32례,Ⅳ기35례.채용저건덕등、Green등화Mose적Perthes병료효평정표준위기출,자행제정오항십분법진행료효평정,즉림상증상、환지장도、두후복개솔、두후형상화관절전자간거등,만분위10분,총분≥9분위우,7～8분위량,5～6분위가,≤4분위차.결과 108례환인수방시간3～12년,평균5년8개월.술후무일례발생혈관급신경손상、절구감염、골불련등병발증.환인술전존재적경도관내선화외전활동장애급관절동통균소실.근거오항십분법진행료효평정,Ⅰ기우량솔90.00%,Ⅱ기우량솔90.32%,이자평균위90.24%;Ⅲ기우량솔68.75%,Ⅳ기우량솔68.57%,이자평균위68.66%.조기(Ⅰ、Ⅱ기)우량솔명현호우만기(Ⅲ、Ⅳ기).결론 조기채용개량Chiari가골절골치료인동Perthes병적효과명현호우만기.오항십분법적료효평정표준가교호지대환인술후적원기효과작출전첨성평고.
Objective To explore the surgical designing,optimal timing and assessment of post-operative results for modified Chiari ilium osteotomy in treatment of children Perthes disease.nethods From June 1986 to December 2004,234 children with Perthes disease were operated by the combining procedures of modified Chiari ilium osteotomy,partial synovectomy of hip joint,femur neck drilling decompress,iliopsoas muscle lengthening and detachment of adductor muscles of the femur.Among them 108 cases were regularly followed up more than 3 years.There were 61 males and 47 females,with the mean age of 7 years and 3 months(ranged from 3 years and 2 months to 13 years and 6 months).According to preoperative radiographs,there were 10 e&qe8 for Catterall Ⅰ,31 for Ⅱ,32 for Ⅲ,and 35 for Ⅳ.The long-term post-operative results of 108 children were evaluated according 5-items(clinical presentation,length of limb shortage,percentage of femur capital coverage,shape of femur capital epiphysis and articulo-troehanteric distance)and 10-score system.The score sum≥9 was evaluated as excellent,7-8 as good,5-6 as fair,and less than 4 as bad respectively.Results One hundred and eight patients were followed up 3 to 12 years(average 5 years and eight months).No complications were found such as neurovascular injury.infection,and bone union.The hip intorsion,abduction disturbance,and arthralgia disappeared after operation.The overall rate of good to exceIlent result in Catterall Ⅰ and Ⅱ groups was 90.24%,while that of Catterall Ⅲ and Ⅳ groups was 68.66%.Conclusion This combining procedures of modified Chiari ilium osteotomy can be an alternative appropriately to treat Perthes disease in children,especially good for the early patients.