Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.
Department of Pediatric Surgery, Dr. Von Hauner Children's Hospital, Ludwig-Maximilians-Universität, München, Munich, Germany.
Sci Rep. 2023 Nov 23;13(1):20538. doi: 10.1038/s41598-023-45749-1.
Legg-Calvé-Perthes disease (LCPD) requires individualized treatment in order to regain a functional hip joint. In severe cases, in which a congruent joint cannot be achieved, other options are necessary in order to improve functionality and prevent early osteoarthritis. Therefore, we analysed the clinical and radiologic outcome of 28 patients after valgus osteotomy of the proximal femur (VOF). We examined the range of hip motion, functionality and health-related quality of life (HRQoL) via modified Harris Hip Score (mHHS) and Kidscreen-10. Radiographic analysis contained quantitative and qualitative measurements of hip morphology. In particular, we correlated the results with the change of the pelvic-femoral angle (PFA). PFA was defined as the angle between the anatomical diaphyseal line of the femur and a vertical line through the pelvis. The mean follow-up was 5.5 years. Patients showed high mHHS and good HRQoL postoperatively. An increase in ROM with an improvement of 30.5° abduction and 10.3° internal rotation was evident. PFA correlated with adduction contracture and improved significantly after surgery. In consideration of careful patient selection, VOF showed a positive effect on ROM, pain, HRQoL, radiographic congruence and outcome. We identified the age at surgery and an increasing adduction contracture-objectified by a decreased PFA-as a prognostic factor.
Legg-Calvé-Perthes 病（LCPD）需要个体化治疗，以恢复髋关节的功能。在严重的情况下，如果不能获得一致的关节，则需要其他选择来改善功能并预防早期骨关节炎。因此，我们分析了 28 例股骨近端内翻截骨术（VOF）治疗后患者的临床和影像学结果。我们通过改良 Harris 髋关节评分（mHHS）和 Kidscreen-10 评估了髋关节运动范围、功能和健康相关生活质量（HRQoL）。影像学分析包括髋关节形态的定量和定性测量。特别是，我们将结果与骨盆股骨角（PFA）的变化进行了相关性分析。PFA 定义为股骨解剖骨干线与通过骨盆的垂直线之间的夹角。平均随访时间为 5.5 年。患者术后 mHHS 高，HRQoL 良好。ROM 增加，外展增加 30.5°，内旋增加 10.3°。PFA 与内收挛缩有关，术后明显改善。考虑到患者的选择，VOF 对 ROM、疼痛、HRQoL、影像学一致性和结果有积极影响。我们确定了手术年龄和内收挛缩（以 PFA 降低为指标）是一个预后因素。
