Kim Harry K W, Burgess Jamie, Thoveson Alec, Gudmundsson Paul, Dempsey Molly, Jo Chan-Hee
Center of Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children, Dallas, Texas
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
J Bone Joint Surg Am. 2016 Nov 16;98(22):1897-1904. doi: 10.2106/JBJS.15.01477.
Legg-Calvé-Perthes disease is a juvenile form of osteonecrosis of the femoral head. The purpose of this study was to use serial perfusion magnetic resonance imaging (MRI) to determine the pattern and rate of revascularization of the femoral heads of patients with the active stage of Legg-Calvé-Perthes disease.
We performed a prospective study of 29 patients (30 hips) with a mean age (and standard deviation) of 8.4 ± 1.9 years who were diagnosed with Waldenström Stage-1 or 2 Legg-Calvé-Perthes disease. All patients had ≥2 perfusion MRIs, and 21 patients (22 hips) had ≥3. Perfusion percentages of the femoral epiphyses were measured by 2 independent observers. Statistical analyses included calculation of the intraclass correlation coefficient, the paired t test, the Mann-Whitney U test, and the Kruskal-Wallis test.
Initial perfusion MRIs showed the percent perfusion in the affected femoral heads to range from 5% to 70%. The average percent perfusion (and standard deviation) was 35% ± 16% on the first MRI, which increased to 77% ± 14% on the follow-up MRI acquired at an average of 10.5 ± 2.9 months later (p < 0.01). Serial assessment showed a general pattern of revascularization starting from the periphery of the posterior, lateral, and medial aspects of the femoral epiphysis and converging toward the anterocentral region. The average rate of revascularization was 4.9% ± 2.3% per month with a wide range among the patients (0.6% to 10.4% per month).
Revascularization of the necrotic femoral head increased over time in a horseshoe pattern, starting from the posterior, lateral, and medial aspects of the femoral epiphysis. The rate of revascularization was highly variable among patients.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Legg-Calvé-Perthes病是股骨头坏死的一种青少年型疾病。本研究的目的是使用连续灌注磁共振成像（MRI）来确定处于Legg-Calvé-Perthes病活动期患者股骨头的血管再生模式和速率。
我们对29例（30髋）平均年龄（及标准差）为8.4±1.9岁、被诊断为Waldenström 1期或2期Legg-Calvé-Perthes病的患者进行了一项前瞻性研究。所有患者均接受了≥2次灌注MRI检查，21例（22髋）患者接受了≥3次检查。由2名独立观察者测量股骨骨骺的灌注百分比。统计分析包括计算组内相关系数、配对t检验、Mann-Whitney U检验和Kruskal-Wallis检验。
初始灌注MRI显示，患侧股骨头的灌注百分比在5%至70%之间。首次MRI检查时的平均灌注百分比（及标准差）为35%±16%，在平均10.5±2.9个月后进行的随访MRI检查中增加到77%±14%（p<0.01）。连续评估显示，血管再生的总体模式是从股骨骨骺后、外侧和内侧周边开始，向中央前区域汇聚。血管再生的平均速率为每月4.9%±2.3%，患者之间差异较大（每月0.6%至10.4%）。
坏死股骨头的血管再生随时间呈马蹄形增加，始于股骨骨骺的后、外侧和内侧。患者之间的血管再生速率差异很大。
预后IV级。有关证据水平的完整描述，请参阅作者指南。
