Kang Michael Seungcheol, Zimmerhanzel David, Haider Shamrez, Kwang-Woo Kim Harry
Scottish Rite for Children, Dallas, Texas.
Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
J Bone Joint Surg Am. 2025 Jan 1;107(1):36-45. doi: 10.2106/JBJS.23.01429. Epub 2024 Oct 29.
Perfusion MRI (pMRI) can quantify femoral head hypoperfusion in early-stage Legg-Calvé-Perthes disease. We investigated whether the severity of hypoperfusion measured at the early stage correlates with femoral head deformity at intermediate-term follow-up.
Sixty-three patients who were 5 to 11 years of age at the diagnosis of Legg-Calvé-Perthes disease and who had pMRI performed at an early stage (Waldenström Stage 1 to 2a) were retrospectively reviewed. Twenty-eight patients were treated nonoperatively and 35 were treated with proximal femoral varus osteotomy (PFVO). The sphericity deviation score (SDS) was used as the primary outcome. Femoral head perfusion and SDS were measured by 2 observers. Models assessing the relationship between hypoperfusion and SDS were fitted without and with stratifications by age at diagnosis and treatment method.
All 63 patients had a minimum of 4 years of follow-up (mean follow-up, 7.5 ± 2.6 years). All had reached the healed stage (Stage 4), and their mean age was 15.6 ± 2.8 years. The SDS outcome showed a significant positive correlation with the hypoperfusion % (p < 0.001). In the <50% hypoperfusion range, the SDS indicated no-to-low deformity, with narrow variability of outcome. However, the SDS became exponentially worse and had a wider variability of outcome at the ≥50% hypoperfusion range. Multivariable analyses revealed age at diagnosis, hypoperfusion %, and treatment method as significant prognostic factors for SDS (p = 0.007, <0.001, and 0.042, respectively). When treatment outcomes were stratified by age at diagnosis and hypoperfusion %, PFVO showed significantly better SDS outcome than nonoperative treatment in patients with an age at diagnosis of ≥8 years and low (<50%) and intermediate (50% to 80%) hypoperfusion ranges (p = 0.036 and 0.021, respectively).
Our study found a significant relationship between femoral head hypoperfusion measured in early-stage Legg-Calvé-Perthes disease and femoral head deformity at intermediate-term follow-up. This study provides new insight into the relationship between early-stage femoral head hypoperfusion and deformity.
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
灌注磁共振成像（pMRI）可量化早期莱-卡-佩病（Legg-Calvé-Perthes disease）股骨头的灌注不足情况。我们研究了早期测量的灌注不足严重程度与中期随访时股骨头畸形是否相关。
回顾性分析63例诊断为莱-卡-佩病时年龄为5至11岁且在早期（瓦尔登斯特伦1至2a期）进行了pMRI检查的患者。28例患者接受非手术治疗，35例接受股骨近端内翻截骨术（PFVO）。球形度偏差评分（SDS）用作主要结局指标。由2名观察者测量股骨头灌注情况和SDS。建立评估灌注不足与SDS之间关系的模型，未分层以及按诊断时年龄和治疗方法进行分层。
所有63例患者至少随访4年（平均随访7.5±2.6年）。所有患者均已达到愈合阶段（4期），平均年龄为15.6±2.8岁。SDS结局与灌注不足百分比呈显著正相关（p<0.001）。在灌注不足<50%的范围内，SDS显示无至轻度畸形，结局变异性较小。然而，在灌注不足≥50%的范围内，SDS呈指数级恶化，结局变异性更大。多变量分析显示诊断时年龄、灌注不足百分比和治疗方法是SDS的显著预后因素（分别为p=0.007,<0.001和0.042）。当按诊断时年龄和灌注不足百分比对治疗结局进行分层时，对于诊断时年龄≥8岁且灌注不足程度低（<50%）和中度（50%至80%）的患者，PFVO的SDS结局显著优于非手术治疗（分别为p=0.036和0.021）。
我们的研究发现早期莱-卡-佩病中测量的股骨头灌注不足与中期随访时的股骨头畸形之间存在显著关系。本研究为早期股骨头灌注不足与畸形之间的关系提供了新的见解。
预后III级。有关证据水平的完整描述，请参阅作者指南。
