Ailabouni Ramez, Zomar Bryn O, Slobogean Bronwyn L, Schaeffer Emily K, Joseph Benjamin, Mulpuri Kishore
Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand.
Department of Orthopaedic Surgery, BC Children's Hospital, 1D66-4480 Oak Street, Vancouver, BC V6H 3V4 Canada.
Indian J Orthop. 2022 Jan 20;56(5):867-873. doi: 10.1007/s43465-021-00543-x. eCollection 2022 May.
The purpose of this study was to examine the evolution of Legg-Calvé-Perthes' disease (LCPD) among children from British Columbia (BC), Canada who were treated non-operatively and to compare the results to a previously conducted study in India.
This was a retrospective review of patients treated non-operatively for LCPD in BC between 1990 and 2006 compared with a cohort from India. Demographic and treatment information were collected from medical records. Radiographs were assigned modified Waldenstrom, Catterall, Salter-Thompson and Herring classifications and intra- and interobserver reliability were assessed. We evaluated epiphyseal extrusion (EE) and metaphyseal width (MW), and assessed radiographs using the Mose and modified Stulberg classifications.
102 hips (90 patients) had radiographs available for evaluation. 95% of the BC cohort presented as Waldenstrom stages I and II, whereas, 90% of the Indian cohort presented as IIIa. Final EE was similar for both groups (BC 26.8%, India 27.3%) and final MW was 119% in both groups. Modified Waldenstrom and Herring classifications had substantial intra- and interobserver reliability, while Salter-Thompson and Catterall classifications had moderate agreement at best. Most hips were Catterall IV (80%) and Herring C (89%) for the BC cohort compared to only 44% and 43% of Indian hips, respectively. Most hips were irregular according to the Mose classification (BC 43%, India 52%) and aspherical according to the Stulberg classification (BC 78%).
We found similar radiographic progression and final radiographic appearances of LCPD in India and BC though differences in the distribution of the classification systems warrant further study.
The online version contains supplementary material available at 10.1007/s43465-021-00543-x.
本研究旨在探讨加拿大不列颠哥伦比亚省（BC）非手术治疗的儿童Legg-Calvé-Perthes病（LCPD）的病情演变，并将结果与之前在印度进行的一项研究进行比较。
这是一项对1990年至2006年期间在BC非手术治疗LCPD的患者与印度队列进行的回顾性研究。从医疗记录中收集人口统计学和治疗信息。对X线片进行改良的瓦尔登斯特伦、卡特拉尔、索尔特-汤普森和赫林分类，并评估观察者内和观察者间的可靠性。我们评估了骨骺挤压（EE）和干骺端宽度（MW），并使用莫斯和改良的斯图尔伯格分类对X线片进行评估。
102个髋关节（90名患者）有可供评估的X线片。BC队列中95%表现为瓦尔登斯特伦I期和II期，而印度队列中90%表现为IIIa期。两组的最终EE相似（BC为26.8%，印度为27.3%），两组的最终MW均为119%。改良的瓦尔登斯特伦和赫林分类在观察者内和观察者间具有较高的可靠性，而索尔特-汤普森和卡特拉尔分类的一致性充其量为中等。BC队列中大多数髋关节为卡特拉尔IV级（80%）和赫林C级（89%），而印度髋关节分别仅为44%和43%。根据莫斯分类，大多数髋关节不规则（BC为43%，印度为52%），根据斯图尔伯格分类为非球形（BC为78%）。
我们发现印度和BC的LCPD在影像学进展和最终影像学表现上相似，尽管分类系统分布的差异值得进一步研究。
在线版本包含可在10.1007/s43465-021-00543-x获取的补充材料。
