Hoseini-Zare Nima, Mirghaderi Peyman, Ilharreborde Brice, Roustai-Geraylow Kiarash, Moharrami Alireza, Baghdadi Taghi, Kalantar Seyed Hadi, Nabian Mohammad Hossein
Surgical research society (SRS), Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran; Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Surgical research society (SRS), Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran; Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Orthop Traumatol Surg Res. 2024 May 22:103909. doi: 10.1016/j.otsr.2024.103909.
Proximal femoral varus osteotomy (FVO) is one of the most used treatment methods with acceptable outcomes for Legg-Calvé-Perthes disease (LCPD). We aimed to investigate the influence of age at disease onset and the Lateral Pillar classification on clinical and radiological outcomes of FVO surgery LCPD patients between 6-12years of age.
Proximal FVO surgery in the early fragmentation phase of LCPD patients led to acceptable clinical and radiographic outcomes in a 3-year follow-up, regardless of preoperative age and Herring type.
Fifty patients with LCPD (Herring groups B, B/C, and C) who underwent FVO were retrospectively reviewed. We evaluated radiological [center-edge angle, extrusion index, epiphyseal index, acetabular index, articulo-trochanteric distance (ATD)] and clinical [hip abduction range of motion (ROM), Trendelenburg sign, pain, and Harris hip score (HHS)] outcomes with a follow-up of 37.3±10.5months (range: 24-180months). Finally, the overall treatment outcome was assessed using the Stulberg classification.
The ROC curve analysis did not reveal any significant relationship between age and clinical or radiological outcomes, and there was no predictable age cut-off for surgical outcomes (p=0.13). No significant difference was found in Stulberg classification at the follow-up between patients with type B, B/C, and C of the lateral pillar (p>0.05).
Our results demonstrated that open-wedge proximal FVO surgery in the early fragmentation phase of LCPD patients led to acceptable clinical and radiographic outcomes in a 3-year follow-up. Each sample of our study was very small and a lot of variables were measured, making this result not adequately strong enough to draw a robust conclusion. However, FVO surgery remains a possible suggestion for patients in the early fragmentation phase, and age and lateral pillar type may not be limiting factors.
IV; therapeutic retrospective cohort.
股骨近端内翻截骨术（FVO）是治疗Legg-Calvé-Perthes病（LCPD）最常用的治疗方法之一，疗效尚可。我们旨在研究发病年龄和外侧柱分型对6至12岁LCPD患者FVO手术临床及影像学疗效的影响。
LCPD患者早期碎裂期行近端FVO手术，在3年随访中可获得可接受的临床及影像学疗效，与术前年龄及Herring分型无关。
回顾性分析50例行FVO的LCPD患者（Herring B、B/C和C组）。随访37.3±10.5个月（范围：24至180个月），评估影像学指标[中心边缘角、挤压指数、骨骺指数、髋臼指数、关节转子间距（ATD）]及临床指标[髋关节外展活动度（ROM）、Trendelenburg征、疼痛及Harris髋关节评分（HHS）]。最后，采用Stulberg分型评估总体治疗效果。
ROC曲线分析未显示年龄与临床或影像学疗效之间存在显著关系，手术疗效也无可预测的年龄临界值（p = 0.13）。外侧柱B型、B/C型和C型患者随访时Stulberg分型无显著差异（p>0.05）。
我们的结果表明，LCPD患者早期碎裂期行开放性楔形近端FVO手术，在3年随访中可获得可接受的临床及影像学疗效。我们研究的每个样本量都很小，且测量了很多变量，使得该结果不够有力，无法得出确凿结论。然而，FVO手术仍是早期碎裂期患者的一个可行建议，年龄和外侧柱类型可能不是限制因素。
IV级；治疗性回顾性队列研究。
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