Does transepiphyseal drilling and closure of the greater trochanter in early Legg-Calve-Perthes disease improve natural history?

Q1 Medicine

MUSCULOSKELETAL SURGERY Pub Date : 2023-09-01 DOI:10.1007/s12306-022-00750-1

M Eidelman, P Kotlarsky

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引用次数: 3

Abstract

Purpose: There is no consensus regarding treatment of Legg-Calve-Perthes disease (LCPD). The most common sequel of the disease is coxa breva and overgrowth of the greater trochanter (GT). Our purpose was to examine the effectiveness of transepiphyseal drilling combined with closure of the GT apophysis in patients with LCPD.

Methods: During 2013-2018, we treated 16 consecutive cases of LCPD. Average age was 7.5 (range 6-10) years; nine patients were in early fragmentation, five in late fragmentation and one in reossification stages. Treatment protocol included hip arthrography, percutaneous drilling of the femoral head epiphysis, percutaneous tenotomy of adductor longus and epiphysiodesis of the GT apophysis.

Results: Mean follow-up was 38 months. One patient was lost to follow-up. All patients had a limp prior to surgery. However, at latest follow-up, 10/15 patients had no limp, 11 patients had substantial improvement in hip range of motion. On radiographs, nine patients had Stulberg type 1-2, one type 3 and five type 4-5. There was no change in the epiphysio-trochanteric distance in any patient. Eight out of nine patients treated in the early fragmentation stage had good clinical and radiographic outcome. Most patients treated in late fragmentation stage had Stulberg 4-5 hip and required additional procedures.

Conclusions: Based on our preliminary experience, our protocol can be effective in the treatment of patients with LCPD in the initial or early fragmentation stages by improving the clinical and radiographic outcomes of the disease. This minimally invasive approach does not compromise any future treatment options.

Level of evidence: IV.

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早期legg - calf - perthes病经骨骺钻孔和大转子闭合是否能改善自然史?

目的:关于legg - calf - perthes病(LCPD)的治疗尚无共识。该疾病最常见的后遗症是髋裂和大转子过度生长。我们的目的是研究经骺端钻孔联合GT突突闭合治疗LCPD患者的有效性。方法:2013-2018年，我们连续治疗16例LCPD。平均年龄7.5岁(6-10岁);早期碎裂9例，晚期碎裂5例，再骨化1例。治疗方案包括髋关节造影术、经皮股骨头骨骺钻孔、经皮长内收肌肌腱切断术和GT突突骨骺成形术。结果:平均随访38个月。1例患者失访。所有的病人在手术前都有一瘸一拐的。然而，在最近的随访中，10/15例患者没有跛行，11例患者髋关节活动范围有明显改善。x线片上Stulberg 1-2型9例，3型1例，4-5型5例。所有患者的骨骺-粗隆距离均无变化。在骨折早期治疗的9例患者中有8例具有良好的临床和影像学结果。大多数在骨折晚期治疗的患者有Stulberg 4-5髋关节，需要额外的手术。结论:根据我们的初步经验，我们的方案可以通过改善疾病的临床和影像学结果，有效地治疗初期或早期碎片化阶段的LCPD患者。这种微创方法不影响任何未来的治疗选择。证据等级:四级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

MUSCULOSKELETAL SURGERY Medicine-Surgery

CiteScore

4.50

自引率

0.00%

发文量

期刊介绍： Musculoskeletal Surgery – Formerly La Chirurgia degli Organi di Movimento, founded in 1917 at the Istituto Ortopedico Rizzoli, is a peer-reviewed journal published three times a year. The journal provides up-to-date information to clinicians and scientists through the publication of original papers, reviews, case reports, and brief communications dealing with the pathogenesis and treatment of orthopaedic conditions.An electronic version is also available at http://www.springerlink.com.The journal is open for publication of supplements and for publishing abstracts of scientific meetings; conditions can be obtained from the Editors-in-Chief or the Publisher.