PELVIC OSTEOTOMY IN THE COMPLEX TREATMENT OF CHILDREN WITH LEGG-CALVE-PERTHES DISEASE

Abstract

At the Scientific and Research Institute for Children’s Orthopedics n. a. G. I. Turner we analyzed survey data of 120 patients aged from 6 to 14 years old with Legg-Calve-Perthes disease with severe epiphysis deformation, in order to improve the outcomes. All patients underwent reconstructive (remodeling) surgery - a corrective hip osteotomy, a pelvic osteotomy by Salter, a combination of these techniques and a triple pelvic osteotomy. Postoperative follow-up period averaged 10 years. It is shown that pelvic osteotomy is an operation of choice for Legg-Calve- Perthes disease along with corrective hip osteotomy, and remodeling of the femoral head is only possible when the degree of bone coverage is equal to one or more. We highlighted radioanatomical structure of the affected hip joint, allowing to precise indications for surgical remodeling type of femoral head.

Keywords

Legg-Calve-Perthes disease / Duchenne-Trendelenburg syndrome / coxarthrosis / femoral head remodeling / pelvic osteotomy

References

[1] Барсуков Д. Б. Ортопедо-хирургическое лечение детей с болезнью Легга - Кальве - Пертеса: Дис.. канд. мед. наук; СПб; 2003.

[2] Веселовский Ю.А., Тихоненков Е.С., Садофьева В. И. Идиопатический асептический некроз головки бедренной кости у детей: Методические рекомендации. Л.; 1989.

[3] Schultz K., Dustmann H. Morbus Perthes. Berlin: Springer; 1992.

[4] Catterall A. Legg-Calve-Perthes syndrome. Clin. Orthop. Relat. Res. 1981; (158): 41-52.

[5] Catterall A. Natural history, classification and X-ray signs in Legg-Calve-Perthes’ disease. Acta Orthop. Belg. 1980; 46 (4): 346-51.

[6] Tannast M., Hanke M., Ecker T.M., Murphy S.B., Albers C.E., Puls M. LCPD: reduced range of motion resulting from extra- and intraarticular impingement. Clin. Orthop. Relat. Res. 2012; 470 (9): 2431-40.

[7] Ganz R., Leunig M., Leunig-Ganz K., Harris W. H. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin. Orthop. Relat. Res. 2008; 466 (20): 264-72.

[8] Shore B. J., Novais E.N., Millis M.B., Kim Y. J. Low early failure rates using a surgical dislocation approach in healed Legg-Calvé-Perthes disease. Clin. Orthop. Relat. Res. 2012; 470 (9): 2441-9.

[9] Salter R. B. Legg-Perthes disease: the scientific basis for the methods of treatment and their indications. Clin. Orthop. 1980; (150): 8-11.

[10] Кузнечихин Е.П., Моисеев С. Н. Остеохондропатия головки бедренной кости (диагностика и принципы лечения, предупреждающие развитие коксартроза и инвалидности у детей). Пособие для врачей. М.: РГМУ; 1997.

[11] Марков И. В. Прогнозирование течения болезни Легга - Кальве - Пертеса и выбор тактики лечения: Автореф. дис.. канд. мед. наук. Курган, 2012.

[12] Salter R. B., Thompson G. H. Legg-Calve-Perthes Disease. The prognostic significance of the subchondral fracture and a two-group classification of the femoral head involvement. J. Bone Jt. Surg. Am. 1984; 66 (4):479-89.

[13] Klisic P. J. Treatment of Perthes' disease in older children. J. Bone Jt Surg. Br. 1983; 65 (4): 419-27.

[14] Thompson G. H. Salter osteotomy in Legg-Calvé-Perthes disease. J. Pediatr. Orthop. 2011; 31 (2 Suppl): 192-7.

[15] Joseph B. Morphological changes in the acetabulum in Perthes' disease. J. Bone Jt Surg. Br. 1989; 71 (5): 756-63.

[16] Mose K. Methods of measuring in Legg-Calve-Perthes diasease with special regard to the prognosis. Clin. Orthop. 1980; (150):103-9.

[17] Thompson G.H., Salter R. B. Legg-Calve-Perthes disease. Clin. Symp. 1986; 38 (1): 2-31.

[18] Деменцов А. Б. Тройная остеотомия таза при неблагоприятном течении болезни Легга - Кальве - Пертеса: Автореф. дис. канд. мед. наук; Минск; 2011.

[19] Wenger D. R., Pring M.E., Hosalkar H.S., Caltoum C.B., Lalonde F.D., Bastrom T. P. Advanced containment methods for Legg-Calvé-Perthes disease: results of triple pelvic osteotomy. J. Pediatr. Orthop. 2010; 30 (8): 749-57.

RIGHTS & PERMISSIONS

Barsukov D.B., Kamosko M.M.