Koksa Plana Cerrahi Tedavisinde Çift Osteotomi Operasyonu

Year 1983, Volume: 36 Issue: 2, 263 - 288, 30.06.1983

Güngör Sami Çakırgil

Abstract

1975 - 1982 yılları arasında Pelvik Osteotomi ile subtrokanterik varus, ekstansiyon ve derotasyon osteotomisinin bir kombinasyonu olan Çift Osteotomi olarak adlandırdığımız işlem, İrom coxa plana (Perthes-Calve Legg) hastası 26 olguya uygulandı ve ortalama 3 yıl 5 aylık postoperatif takip süresi Ankara Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı'nda gerçekleştirildi. Olguların sonuçları Histopatolojik, sintingrafik, radyografik ve klinik açıdan değerlendirildi ve bunlar ışığında aşağıdaki noktalar açıklığa kavuşturuldu.

Keywords

cerrahi tedavi , koksa plana , çift osteotomi

Double Osteotomy Operation in the Surgical Treatment of Coxa-Plana

Abstract

During the years 1975 - 1982 what we have named as Double Osteotomy, which is a combination of Pelvic Osteotomy together with subtrochanteric varus, extension and derotation osteotomy, was &pplied to 26 cases suffering İrom coxa plana (Perthes-Calve Legg) and post-operative follow-up of an average period of 3 years 5 months was undertaken at the Department of Orthopaedics and Traumatology of the Faculty of Medicine, University of Ankara. The results of the cases were evaluated from the Histo-Pathological, scintingraphic, radiographic and clinical point of view and the following points were clarified in the light of these.

findings : 1. No treatment is recommended for case classified under Catteralls group 1. N >. For case under the age ol four showine protrusion in arihrographic examination, cheliectomy together with derotational varisation östeotomy has been recommended by outhors (4,27). The clinical, radiographic and scintigraphic results of our own clinical cases have confirmed this viewpoint. 3. D.O. operation to be undertaken during the necrotic phase which is the early stage) of the disease (Cases with Catterall has classified as group 11, and 111), the biological and biomechanical effects have been found to be fevourable.4, In cases which fall within category IV by Catterall it has been decided to stick to the conservative method of treatment, because the prognosis isin a bad state. 5. Im accordance with our radiological (Anatomic) and clinical (functional) evaluation which constitute a combination of the evaluations by Mose, Catterall, Heyman, Weiber£, Siöval ,success at the rate of 84.61 W failure, as a result of D.O. surgery carried out in our series of 26 cases. The early results of the D.O. operation in connection with the surgical treatment of the Perthes disease have been heartning and promising and research in this direction will be kept up. The examination of case operated upon when they have attained the ages of 18-20 will shed light on our final evaluations.

Keywords

Osteotomy , Surgical Treatment , Coxa-Plana

References

• 1. Azer, A. : Subtvochenteric Östeotomy in the trestment of Perthes disease, J. Bene Joint Surg. 47B : 489, 1965.
• 2. Axer, A. and Schiller, M.G. : The pathogenesis of the early deformity of the capital femoral epiphysis in Leg-Calve-Perthes syndrome (L.C.P.S.) An arirographic study, Clin. Orthop. 84 : 108, 1972.
• 3. Axer, A. Schiller, MG, Segal, D., Rzentelny, V. and Gershuni Gordon D.EL Subtrochanteric osteotomy in the treatment of Legg-Calve-Porthos Syndrome (L.C.P.S.) Acta Orthop. Scand. 44:31, 1973.
• 4. Bohr, H. : Densiometry and 18-F scintigraphy in the study of the revascularisation of the femoral head in coxa plana (C-P), Acta Orthop. Scand. 44 : 417, 1973.
• 5. Brotherton, B.J., and MeKibbin, B. : Perthes disease treated by prolonged regumbency and femoral head containment ; A long term appraisal, J. Bone Joint Surg. 59B : 8, 1977.
• 6. Catterall, A. : The natural history of Perthes disease, J. Bone Joint Surg. 53 : 37, 1971.
• 7. Shung, 5.M.K., and Moe, J.H. : Legg-Calve-Perthes disease, Clinical radiographic - correlations, Clin. Ortop. 41 : 116, 1965,
• 8. Cotler, J.M. : The surgical approach to LCPS, Proceedings of the first Internetional Symposium on Legg-Calve-Perthes Syndrome, 162, 1977. Danielson, L.G. : Late results of Perthes disease, Acta Orthop. Scand. 346 : 70. 1965.
• 9. Daniglis, J.A. : Pinhole imaging in Lege-Perthes disease : Further observations, Semin. Nucl. Med. 8 : 69, 1978,
• 10. Dickens, D.R.V., and Menalauş, M.B. : The assesment of prognosis in Perthes disease, J. Bone Joint Surg. 60B : 189, 1978.
• 11. Dreyer, J., and Schafer, S. : Actual problems int the treatment of Perthes disease, 2. Kinderchir. 15 : 108, 1974.
• 12. Glimcher, L., Ninomiya, S., Shapiro, F. and Glimcher, MJ. : Nutrition of the secondary centre of ossification by synovial fluid, Trans. Orthop. Res. Soc. 3 : TA, 1978.
• 13. Gower, W.E., and Johnson, R.C. : Legg-Perthes disease, Long term follow-up of thiriy-six patients, J. Bone Joint Surg. 53A : 759, 1971.
• 14. Harrison, M.H.M,, Turner, M.H. and Nicholson, F.J. : Coxa plana-Results of a new form of spilinting, J. Bone Joint Surg. 51A : 1057, 1069,
• 15. Heikkinen, E., Puranen, J., and Suramo, 1 : The offect of interirochanteric osteotomy on the venous dranage of the femoral neck in Perthes disease, Acta Arthop. Scand. 47 : 80, 1978.
• 16. Kamhi, E., and MacEwen, D. : Treatment of Legg-Calve Perthes disease, J. Bone Joint Surg. 57A : 851, 1975, Katz, J.F. : Conservative treatment of Legg-Calve-Perthes disease, J. Bone Joint Surg. 49A : 1043, 1967.
• 17. Loyd-Roberts, G.C., Catterall, A., and Salamon, P.B. : A controlled study of ihe indications for the results of femoral osteotomy in Perthes disease, J. Bone Joint Surg. 58B :31, 1978.
• 18. arklund, T., and Tiliberg, B.: Coxa plana : A redinlogical comparrison of the rate of healing with conservative meAsure$ and after osteotomy J. Bone Joint Surg, 588 : 25, 1976.
• 19. Meyer, J. : Legg-Calve-Perthes disease, Radiological resulis of ireatmenti and their late conseguences, Acta Orthop. Scand. (Suppl) 167 : 1, 1977.
• 20. Mirowski, Y. : Shortening of the legin Legg-Calve-Perthes syndrome and the influence of femoral osteotomy on its shortening, Thesis, University of Tel Aviv, 1978.
• 21. Mose, K. : Lege-Calve-Perthes disease. Thesis Cophenhagen Universitetsforlaget, Aarhus, 1964.
• 22. Nevelos, A.B, Calton, CL. Burch, P.J.R., and Woodward, P.M. : Perthes disease, A study of radiological features, Acta Orthop. Scand. 48 : 411, 1977.
• 23. O'Garra, J.A, ; The radiographic changes in Perthes disease, J. Bone Joint Surg. 41B : 465, 1959.
• 24. Petris, J.B, and Bitene, 1. : The abduction weight-hearing treatment in LeggPerthes disease, J. Bone Joint Surg. 53B : 54, 1971,
• 25. Puranen, J., and Heikkinen, E. : İwtertrochanteric osteotorıy witlı tregtmeni of Perthes diseasse, Acta Orthop. Scand. 47 : 79, 1976.
• 26. Ralston. EL. : Legge-Calve-Perthes dişsase-Factors in. healing, J. Bone Joint Surg. 43A : 249, 1961.
• 27. Salter, R.B., and Beli, M. : The pathogenesis of detormity in Legg-Perihes disease, J. Bone Joint Surg. 50B : 498, 1968.
• 28. Shim, 5. Day, B., Leing, G. : Circulalion and vascular changes int the hip fok lowing innominate osteotomy. And experimental study, Clin. Orthop. 160 : 258, 1981.
• 29. Snyder, C.R. : Legg-Perthes disease in the young hip-Does it necessafily do well. J. Bone Joint Surg. 57A : 751, 1970.
• 30. Sommerville, E.W. : Perthes disease of the hip, J. Bone Joint Surg. 53B : 639, 1971.
• 31. Suramo, I., Puranen, J., Heikkinen, E., and Vuorinen, P, : Disturbed patterns of venous drainage of the femoral neck in Perthes disease, J. Bone Joint Surg. 56B : 44B, 1874.
• 32. Trueta, J. : The normal vascular anatomy of the human femoral head during growth, J. Bone Joint Surg, 39B : 358, 1857.