Comparison of surgical and nonsurgical containment methods for patients with Legg-Calve-Perthes disease of the onset ages between 6.0 and 8.0 years: Salter osteotomy versus a non-weight-bearing hip flexion-abduction brace

被引：6

作者：

Kaneko, Hiroshi ^{[1
]}

Kitoh, Hiroshi ^{[2
]}

Mishima, Kenichi ^{[2
]}

Matsushita, Masaki ^{[2
]}

Hattori, Tadashi ^{[1
]}

Noritake, Koji ^{[3
]}

Ishiguro, Naoki ^{[2
]}

Yoshihashi, Yuji ^{[3
]}

机构：

[1] Aichi Childrens Hlth & Med Ctr, Dept Orthopaed Surg, 7-426 Moriokacho, Obu, Aichi 4748710, Japan

[2] Nagoya Univ, Grad Sch Med, Dept Orthopaed Surg, Nagoya, Aichi, Japan

[3] Aichi Prefectural Mikawa Aoitori Med & Rehabil Ct, Dept Orthopaed Surg, Okazaki, Aichi, Japan

来源：

JOURNAL OF PEDIATRIC ORTHOPAEDICS-PART B | 2020年 / 29卷 / 06期

基金：

日本学术振兴会;

关键词：

acetabular coverage; femoral head lateralization; Legg-Calve-Perthes disease; non-weight-bearing hip brace; Salter osteotomy; FEMORAL-HEAD; INNOMINATE OSTEOTOMIES; PROGNOSTIC-FACTORS; FOLLOW-UP; ACETABULUM; CHILDREN; CLASSIFICATION; RELIABILITY;

D O I：

10.1097/BPB.0000000000000710

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

Since bone healing potential decreases with age, patients with Legg-Calve-Perthes disease should receive treatment appropriate to their age group. Nonsurgical treatment is commonly applied to patients under 6.0 years of age at the onset and surgical treatment is recommended for those over 8.0 years of age, but it remains unclear which is better for those between 6.0 and 8.0 years. The aim of this retrospective study was to compare outcomes of Salter osteotomy and a non-weight-bearing brace in this age group. Inclusion criteria were unilateral Legg-Calve-Perthes disease patients who were 6.0-8.0 years of age at the onset, who had more than 50% femoral head involvement without hinge abduction, and who underwent either Salter osteotomy (n = 35) or a non-weight-bearing hip flexion-abduction brace (n = 18). Radiological and clinical outcomes at skeletal maturity were compared between the two groups. The mean follow-up durations were 9.4 years in the Salter osteotomy group and 10.0 years in the brace group. There was no significant difference in the modified Waldenstrom classification at the beginning of treatment and the Catterall and modified lateral pillar classifications evaluated at the fragmentation stage between the groups. At skeletal maturity, the Stulberg classification, the sphericity deviation score, femoral head overgrowth, and the articulo-trochanteric distance were similar between the groups, but the Salter osteotomy group showed significantly smaller lateralization of the femoral head and better acetabular shape and coverage than the brace group: femoral head lateralization (P< 0.001), acetabular depth-to-width ratio (P= 0.002), Sharp angle (P< 0.001), lateral acetabular shape (P= 0.027), acetabular head index (P< 0.001). There was no significant difference in hip pain and motion between the groups. In this age group, Salter osteotomy provides better femoral head position and acetabular shape and coverage than a non-weight-bearing brace.

引用

页码：542 / 549

页数：8