A combined treatment strategy of Legg-Calve-Perthes disease with BEST quartet

Abstract

Purpose: The main pathology of Legg-Calvé-Perthes Disease (LCPD) is the disruption of blood flow of the femoral head resulting ischemic necrosis which leads hip joint incongruency. The most frequent methods in the treatment are the methods improving the containment of the femoral head. There are limited studies in the literature addressing the treatment of necrosis using methods such as epiphyseal drilling or distraction osteogenesis. Our study aimed to investigate the mid-long-term outcomes of LCPD patients treated with the BEST method, which aims to improve congruency and containment simultaneously. Materials and methods: LCPD patients (23 male, 1 female) who were treated with (B)leeding the epiphysis by drilling, (E)vacuation of the joint synovitis, contained with (S)alter’s Osteotomy, and distracted with skin (T)raction investigated retrospectively. Only patients who reached skeletal maturity at latest follow-up were included in the study. Patients’ final radiographs were classified according to the Stulberg classification, Mose classification, and Tönnis osteoarthritis classification. Results: The mean follow-up of the patients was 10.44±1.35 (8.5-13) years, and the mean age at the last followup was 17.71±1.73 (15.25-20.83) years. According to the Stulberg classification, 11 (45.8%) of the patients had a Class-I hip; 6 (25%) a Class-II hips; 3 (12.5%) a class-III hips, 4 (16.7%) a class-IV hips. According to the Mose classification, 12 (50%) of the patients had good results; 5 (20.8%) had fair results; 7 (29.1%) had poor results. Conclusion: BEST treatment method for LCPD is a combined procedure which addresses to all pathologies of disease at the same time. This combined treatment protocol may be preferred for severely affected LCPD cases who with subluxation especially in higher lateral pillar class that are prone to nonspherical incongruency

Keywords

• Legg-Calve-Perthes disease
• Salter’s osteotomy
• femoral head osteonecrosis

Legg-Calve-Perthes hastalığının BEST dörtlüsü ile bir kombine tedavi stratejisi

Abstract

Amaç: Legg-Calvé-Perthes hastalığının (LCPH) temel patolojisi, femur başındaki kan akışının bozulması sonucunda kalça ekleminde uyumsuzluğa yol açan iskemik doku nekrozudur. Tedavide sık uygulanan yöntemler femur başının kapsamasını artıran yöntemlerdir. Epifizin delinmesi veya distraksiyon osteogenezi gibi nekroz tedavisine değinen nadir yayın vardır. Çalışmamızın amacı, uyum ve kapsamayı aynı anda geliştirmeyi amaçlayan BEST yöntemiyle tedavi ettiğimiz LCPH hastalarının orta-uzun dönem sonuçlarını araştırmaktı. Gereç ve yöntem: LCPH tanısı ile 24 (23 erkek, 1 kadın) hastaya uygulanan epifizi delme yoluyla kanlandırma (B), eklem ponksiyonu ile fazla eklem sıvısının boşaltılması (E), Salter Osteotomisi (S) ile femur başı kapsamasının artırılması ve cilt (T)raksiyonu ile eklemdeki basıncın azaltılması yöntemlerinin birlikte kullanıldığı kombine yöntem araştırıldı. Çalışmaya sadece iskelet olgunluğuna ulaşan hastalar dahil edildi. Hastaların son radyografileri Stulberg sınıflaması, Mose sınıflaması ve Tönnis osteoartrit sınıflamasına göre sınıflandırıldı. Bulgular: Hastaların ortalama takip süresi 10,44±1,35 (8,5-13) yıl, son takip yaş ortalaması ise 17,71±1,73 (15,25-20,83) yıldı. Stulberg sınıflamasına göre hastaların 11'inde (%45,8) sınıf I kalça, 6 hastada (%25) sınıf II kalça, 3 hastada (%12,5) sınıf III kalça, 4 hastada (%16,7) sınıf IV kalça görüldü. Mose sınıflamasına göre hastaların 12'sinde (%50) iyi sonuç, 5'inde (%20,8) orta sonuç, 7'sinde (%29,1) kötü sonuç elde edildi. Sonuç: LCPH için BEST tedavi yöntemi, hastalığın tüm patolojilerine aynı anda hitap eden kombine bir prosedürdür. Bu kombine tedavi protokolü, özellikle asferik uyumsuzluğa eğilimli, yüksek lateral pillar sınıfında, subluksasyonlu ve ciddi şekilde etkilenmiş LCPH vakalarında tercih edilebilir.

Keywords

• Legg-Calve-Perthes hastalığı
• Salter osteotomisi
• femur başı osteonekrozu

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