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Legg-Calve-Perthes Disease®É¡AY·Q¨ìºC©ÊÅè©Ê²ÓM¤]¥i¯à¤Þ°_¦p¦¹¯fÅܮɡA¨º
À³´N¸Ó¸Ô¬dµÊ¸~¤j§_¡H¦å²G¥Õ¦å²y¦p¦ó¡HÁ`¦Ó¨¥¤§¡A³o¯f¨Ò»¡©ú¡AY¤p«Ä¦³Legg-
Calve-Perthes¯f®É¡AÀ³¦h°µÅ²§O¶EÂ_¡A¦Ò¼{¨ä¥¦¦UºØ ¯f ªº¥i¯à¡AºC©ÊÅè©Ê²ÓM
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(¥|¡^¤åÄm
1) Salimi Z, Vas W, Sundaram M. Avascular bone necrosis in an untreated case of
chronic myelogenous leukemia. Skeletal Radiology 1988;17:353-355
2) Hanif I, Mahmoud H, Pui C-H. Avascular femoral head necrosis in pediatric cancer
patients. Med and Pediat Oncol 1993;21:655-660
3) Behrman RE, Kliegman RM , Arvin AM eds. Nelson Textbook of Pediatrics.15th ed.,
Philadelphia: WB Saunders Co. 1996:1949-51
4) Avery ME, First LR eds. Pediatric Medicine. 2nd ed. Baltimore: Williams & Wilkins.
1994:1425-6
5) Rudolph AM, Hoffman JIE, Rudolph CD eds. Rudolph’ s Pediatrics. 19th ed.
Norwalk, Connecticut: Appleton & Lange. 1991:1943-4
6) Oski FA, DeAngelis CD, Feigin RD, Warshaw JB eds. Principles and Practice of
Pediatrics. Philadelphia: Lippincott. 1990: 942-943
7) Weinstein SL, Buckwalter JA eds. Turek’ s Orthopedics, Principles and Their
Application. 5th ed. Philadelphia: Lippincott.1994: 495-509.
8) Morrissy, RT ed. Pediatric Orthopedics. 4th ed. Philadelphia: Lippincott. 1996:
951-991.
¡]ÂÔÁ±ç·ç¬Ã¤p©j¥´¦r¡^
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¤°»ò¬O¤£ª¾¹DªºªF¦è¡C³oºØ©Ó»{¤£ª¾¹D¤]¬O¤@ºØ»{ª¾¡A³o¸ò¡uª¾¤§¬°ª¾¡A¤£ª¾¬°¤£ª¾¬Oª¾
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¡@¡@¥t´XÂI§Ú©Òı¹î¦Ón«ü¥Xªº¬O¡A¦b¬ü°ê¶}·~Âå®v«D±`³Q´L«¡A©eûÌ¥H¤Î¥H«á§å¨Ñ§å
µûªº¦å²G¾ÇÂå®v¡A¤£¤Ö¬O¶}·~Á{§ÉÂå®v¡A¤£¥þ¬O¾Ç°|¬£ªº¾Ç³N¨ú¦Vªº¤j¾ÇÂå°|Âå®v¦Ó¤w¡C
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¡@¡@«ü°w¨Ã¤£¬O¡u¼Ð·Çµª®×¡v¡A§@ªÌ̤]¦b¤å¤¤´£¥X¡A¥H«á¦³·sªº¼Æ¾Ú¤]»ÝÄ~Äò§ó§ï¡C¦ý
µL½×¦p¦ó³o«ü°wªºµoªí¹ïITPªº¶Eªv¦³³\¦h²`ªº¼vÅT¡A¤]·|§ïÅܩΥ[²`¤@¨Ç¦å²G¾Ç®a¶Eªv
ITPªºÆ[©À¡C§Æ±æ¨ä¥L±M¬ì¤]¦h¦h¥hµo®i¬ã¨s§ó¦hªº«ü°wµ¹¤j®a·í¶Eªvªº°Ñ¦Ò¡A¤]¼W¶iÂåÀø
ªº«~½è¡A´£°ªÂåÀøªº¤ô·Ç¡C
°Ñ¦Ò¤åÄm
1.George JN, Woolf SH, Raskob GE, et al: Idiopathic thrombocytopenic purpura:
A practice guideline developed by explicit methods for the American Society of
Hematology Blood, 1996; 88: 3-40.
2.The American society of hematology ITP practice guideline panel clinical
guideline, diagnosis and treatment of idiopathic thrombocytopenic purpura:
Recommendations of American Society of Hematology.Ann Int Med:1997; 126:319-326.
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