Logan Lindsey, Haider Seemab, Brauer Carmen, Miettunen Paivi Maria
Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
Diagnostic Radiology, Alberta Children's Hospital, Calgary, Alberta, Canada.
BMJ Case Rep. 2019 Sep 18;12(9):e229919. doi: 10.1136/bcr-2019-229919.
We describe an 11-year prospective clinical and radiologic course of a 6-year-old boy with bilateral Legg-Calvé-Perthes disease, who was treated with intravenous pamidronate (IV-PAM). His baseline radiographs showed grade IV avascular necrosis/Catterall stage IV, and at worst he progressed to lateral pillar/Herring stage C bilaterally. His disease initially was extremely functionally limiting with expected poor outcome with eventual joint replacement. Because IV-PAM stops bone breakdown and allows for ongoing bone formation while revascularisation of bone occurs, we hypothesised that IV-PAM could act as an adjunct to traditional treatment to help heal the femoral heads. Our patient received nine once monthly doses of IV-PAM (1 mg/kg/dose) over 13 months, along with Petrie/broomstick casts and physiotherapy. Remarkably, over time, his femoral heads healed. Now, at 11-year follow-up, he has excellent functional and radiologic outcome with congruence between femoral head and acetabulum, no residual osteonecrosis and minimal loss of femoral head sphericity.
我们描述了一名6岁双侧Legg-Calvé-Perthes病男孩11年的前瞻性临床和放射学病程，该男孩接受了静脉注射帕米膦酸盐（IV-PAM）治疗。其基线X线片显示IV级无血管性坏死/Catterall IV期，最严重时双侧进展为外侧柱/Herring C期。他的疾病最初在功能上极具限制，预期最终进行关节置换的预后较差。由于IV-PAM可阻止骨质破坏，并在骨血管再生时允许持续的骨形成，我们推测IV-PAM可作为传统治疗的辅助手段，帮助股骨头愈合。我们的患者在13个月内接受了9次每月一次的IV-PAM治疗（1毫克/千克/剂量），同时使用Petrie/扫帚柄石膏和物理治疗。值得注意的是，随着时间的推移，他的股骨头愈合了。现在，在11年的随访中，他的功能和放射学结果极佳，股骨头与髋臼匹配，无残留骨坏死，股骨头球形度仅有轻微损失。
