From Gillette Children's Specialty Healthcare, St. Paul, MN (Dr. Laine and Dr. Novotny), the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN (Dr. Laine), the Division of Orthopaedic Surgery and Sports Medicine, Children's National Health System, Washington, DC (Dr. Martin), Campbell Clinic Orthopaedics, Memphis, TN (Dr. Kelly), the Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee, Memphis, TN (Dr. Kelly), and Le Bonheur Children's Hospital, Germantown, TN (Dr. Kelly).
J Am Acad Orthop Surg. 2018 Aug 1;26(15):526-536. doi: 10.5435/JAAOS-D-16-00856.
Since the first description of Legg-Calvé-Perthes disease a century ago, the diagnosis, staging, prognosis, and treatment decisions have been based on plain radiographs. The goal of treatment is prevention of femoral head deformity, yet radiographic prognostic classifications are applied in the fragmentation stage, often after deformity occurs. These classifications are assigned too late in the progression of the disease to maximize the effects of intervention. Thus, alternative mechanisms to determine femoral head involvement earlier in the disease course are warranted. Increasingly, MRI has been used in the study of the disease. Gadolinium-enhanced and diffusion-weighted MRI has shown promising results that correlate with radiographic classifications and the early radiographic outcome. Advanced imaging has improved the assessment of hinge abduction, yet the exact definition remains controversial. The role of imaging in the management of Legg-Calvé-Perthes disease is rapidly evolving. New or refined imaging techniques may eventually allow earlier prognosis and treatment.
自一个世纪前首次描述莱格-卡尔维-佩尔特斯病以来，其诊断、分期、预后和治疗决策一直基于 X 线平片。治疗的目标是预防股骨头畸形，但影像学预后分类适用于碎裂期，通常在畸形发生后。这些分类在疾病进展过程中应用得太晚，无法最大限度地发挥干预的效果。因此，有必要寻找其他机制在疾病早期确定股骨头受累。越来越多的研究开始使用 MRI。钆增强和弥散加权 MRI 显示出有前景的结果，与 X 线分类和早期 X 线结果相关。先进的影像学提高了对铰链外展的评估，但确切的定义仍存在争议。影像学在莱格-卡尔维-佩尔特斯病治疗中的作用正在迅速发展。新的或改进的成像技术最终可能允许更早地进行预后和治疗。
