影像学对Legg-Calve-Perthes病预后判断的价值

目的:探讨影像学检查对儿童Legg-Calve-Perthes病(LCPD)预后判断的价值。方法:49例LCPD,其中X线平片49例,CT 15例,MRI 8例,99mTc-MDP骨显像2例,DSA和动脉内药物灌注5例,X线平片采用Catterall分级方法。结果:49例53髋LCPD,初诊I级6髋,Ⅱ级6髋,Ⅲ级13髋,Ⅳ级20髋,修复后扁平髋和巨髋、大转子高位8髋。治疗后32例38髋LCPD得到随访,随访时间4~39(17.7±10.5)月,其中I级5髋变差,1髋痊愈;Ⅱ级2髋变差,2髋好转;Ⅲ级5髋变差,5髋好转;Ⅳ级3髋变差,15髋好转。结论:影像学检查对LCPD预后判断起重要作用,其中X线平片分期对本病的诊治有重要的指导意义,患者避免负重预后好。

The value of imaging in evaluating the prognosis of Legg-Calve-Perthes Disease

Objective:Study the image findings of Legg-Calve-Perthes Disease(LCPD) for evaluating the prognosis.Methods:Forty-nine cases of LCPD were selected,among them 49 cases had plain radiographs,15 CT scans,8 MRI scans,2 bone scans with99mTc-MDP,5 cases received DSA and intra-artery perfusion.The staging methods of radiographs adopted the Catterall's classification.Results:Forty-nine cases had 53 LCPD initially diagnosed with radiographs and other imaging methods,among them 6 LCPD were Catterall I group,6 Ⅱ,13 Ⅲ,20 Ⅳ,8 LCPD presented with coxa plana or coxa magna with greater trochanteric prominence after recovery.38 LCPD of 32 cases had been followed up after treatment with mean time of 4 to 39(17.7±10.5)months.Among them,alteration in the final result rating in Catterall I group5 fair to poor and 1 poor to heal;Catterall Ⅱ group2 fair to poor and 2 poor to fair;Catterall Ⅲ group5 fair to poor and 5 poor to fair;Catterall Ⅳ group3 fair to poor and 15 poor to good.Conclusion:Evaluating the prognosis of LCPD depends largely on the image findings,among them the stages based on X-ray plain film demonstrates a significant role.If the patients persists in relieve weight bearing that they could get the better result.