Palazón-Quevedo Ángel, Galán-Olleros María, Egea-Gámez Rosa M
Pediatric Orthopaedic and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Av. de Menéndez Pelayo 65, 28009, Madrid, Spain.
Orthopaedic Surgery and Traumatology Department, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n 28004, Madrid, Spain.
J Hip Preserv Surg. 2021 Jun 23;8(Suppl 1):i9-i15. doi: 10.1093/jhps/hnab021. eCollection 2021 Jun.
Residual hip deformity secondary to Perthes disease may lead to early symptomatic joint degeneration. The altered anatomy results in biomechanical and biological problems that can be surgically addressed in adolescents or young adults with hip preservation procedures. This case report aims to demonstrate a customized surgical treatment performed on a 15-year-old male who developed painful hips with significant intra- and extra-articular impingement, secondary to bilateral Leg-Calvé-Perthes disease residual deformity. Intra-articular procedures were executed through a safe surgical dislocation of the hip, with a mosaicplasty using osteochondral autografts from the exceeding peripheral ipsilateral femoral head, a femoral head-neck osteochondroplasty and a labrum repair. A relative lengthening of the femoral neck was also carried out with a trochanteric advancement to solve the extra-articular issues. On follow-up, he referred to a substantial improvement in pain and function, being his radiographic studies satisfactory. At 4 and 5 years from surgery, the patient was able to exercise regularly with minimal complaints, with a Harris Hip Score of 85.85% and a Hip Outcome Score of 94.1% for activities of daily life and 86.1% for sports. In patients with hip deformity after healed Perthes disease, treatment strategies that address both the morphological disturbance of coxa magna, plana and breva, as well as the biological concerns arising from osteochondral injuries or labral tears, and mechanical dysfunctions lead to improvements in symptomatology, function and medium-term prognosis. Further procedures to address residual adaptative acetabular dysplasia would favor outcomes of conservative hip surgery in the sequelae of LCPD.
佩特兹病继发的残留髋关节畸形可能导致早期症状性关节退变。解剖结构的改变会引发生物力学和生物学问题，对于青少年或年轻成人，可以通过保髋手术来解决这些问题。本病例报告旨在展示对一名15岁男性患者进行的定制化手术治疗，该患者因双侧Leg-Calvé-Perthes病残留畸形而出现疼痛性髋关节，伴有明显的关节内和关节外撞击。关节内手术通过髋关节的安全手术脱位进行，使用来自同侧股骨头多余外周的自体骨软骨移植进行镶嵌成形术、股骨头颈骨软骨成形术和盂唇修复。还通过转子推进进行了股骨颈的相对延长，以解决关节外问题。随访时，患者称疼痛和功能有显著改善，影像学检查结果令人满意。术后4年和5年，患者能够定期锻炼，仅有轻微不适，Harris髋关节评分为85.85%，髋关节功能结果评分在日常生活活动方面为94.1%，在运动方面为86.1%。对于佩特兹病愈合后出现髋关节畸形的患者，针对大、平、短髋臼形态紊乱以及骨软骨损伤或盂唇撕裂引起的生物学问题和机械功能障碍的治疗策略，可改善症状、功能和中期预后。解决残留适应性髋臼发育不良的进一步手术将有利于Legg-Calvé-Perthes病后遗症的保守性髋关节手术的结果。
