3歳以下発症のペルテス病の検討

Treatment of Perthes' Disease in a Patient under Four Years Old

　抄録：ペルテス病は，若年例の場合，予後良好とされている．3歳以下で発症したペルテス病5例5関節について予後を調査し検討した．2例は保存的治療，3例は無治療であった．5例中4例は成績良好であるが，無治療のCatterall分類Ⅳ型，lateral pillar分類C群の1例ではStulberg分類Ⅲ型と成績不良であった．3歳以下の低年齢発症でもすべて好成績とは限らず，壊死範囲が広範なものについては，治療を行うべきと思われる．当センターでは，病状や患児に応じて安静と外転装具で対応したいと考えている．

　Younger children with Perthes' disease generally have a good outcome. Five children with Perthes' disease who were under four years old at the onset of symptoms were followed, and their outcome was assessed. Two of the patients were treated, and the other three were not. The outcome was good in four of the cases and poor in the other case, which was classified as Stulberg type Ⅲ. The patient with the poor outcome had not been treated and had a severely involved hip that had a Catterall score of Ⅳ and was Herring lateral pillar group C. Although the long-term outcome of the femoral deformity may not be severe, containment with abduction bracing in recumbency should be used to treat very young children with Perthes' disease who have severe epiphyseal involvement, have a Catterall score of Ⅳ, and are diagnosed as Herring lateral pillar group C.