Research Article
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İleri Evre Perthes Hastalığında Cerrahi Tedavi Sonuçlarının Radyolojik Olarak Karşılaştırılması

Year 2016, Volume: 13 Issue: 2, 154 - 161, 29.08.2016

Abstract

Amaç: Bu çalışmada menteşeli abdüksiyon ile seyreden Herring grup C Perthes hastalığının tedavisinde
uyguladığımız proksimal femoral valgus osteotomisi ile tektoplasti kombinasyonunda, hastaların son
kontrol kalça grafileri ile kalça tomografilerini radyolojik sonuç açısından karşılaştırmayı amaçladık.
Materyal ve metod: Bu çalışmada kliniğimizde aynı seansta proksimal femoral valgus ekstansiyon
osteotomisi ve tektoplasti uygulanan, 11 Herring grup C Perthes hastanın son kontrol kalça grafileri ile kalça
tomografileri karşılaştırıldı. Ayrıca opere kalça ile sağlam kalça son kontrolde femur başı örtünmesi
yönünden tomografik olarak karşılaştırıldı. Hastaların ortalama takip süreleri 5.5 (2.2-9.3) yıldı. Her iki
grupta da femur başı subluksasyon oranı, femur başı örtünme oranı, femur başı genişlik oranı, Sharp açısı,
merkez-kenar (CE) açısı, femur boyun-cisim açısı, asetabulum derinlik indeksi ve kaput indeksi ayrı ayrı
ölçülerek karşılaştırıldı.
Bulgular: Hastaların son kontrol kalça grafileri ve son kontrol tomografileri üzerinde yapılan ölçümlerde
sadece kaput indeks ölçüm sonuçları için iki grup arasında anlamlı fark ortaya çıkmıştır (p=0.031).
Hastaların opere kalçaları ile normal kalçalarının son kontrol üç boyutlu tomografileri karşılaştırıldığında
femur başı örtünme oranı yönünden normal kalça ile opere kalça arasında istatistiksel olarak anlamlı bir fark
bulunmamıştır (p=0.494).
Sonuç:Herring grup C Perthes hastalığının tedavisinde uygulanan proksimal femoral valgus osteotomisi ve
tektoplasti kombinasyonu,femur başı örtünmesi yönünden normal anatomiyle uyumlu sonuçlar vermiştir.
Perthes hastalığının cerrahi sonuçlarının değerlendirilmesinde kullanılan caput indeksin ölçümünde BT'nin
yararlı olduğu düşünülmektedir. 

References

  • 1-Roy DR. Current concepts in Legg-CalvéPerthesdisease.Pediatr Ann 1999; 28:748-752.
  • 2-Stulberg SD, Cooperman DR, Wallensten R.Thenaturalhistory of Legg-Calvé-Perthes disease. J Bone JointSurgAm 1981; 63:1095-1108.
  • 3-Herring JA, Kim HT, Browne R.Legg-CalvePerthesdisease. Part II: Prospective multicenter study of the effect of treatment on outcome. J Bone JointSurgAm 2004; 86:2121-2134.
  • 4-Myers GJ, Mathur K, O'Hara J.Valgusosteotomy: a solution for late presentation of hinge abduction in Legg-Calvé-Perthesdisease. J Pediatr Orthop. 2008; 28:169-172.
  • 5-Grzegorzewski A, Bowen JR, Guille JT, Glutting J.Treatment of the collapsed femoral head by containment in Legg-Calve-Perthes disease. J Pediatr Orthop. 2003; 23:15-19.
  • 6-Bankes MJ, Catterall A, Hashemi-Nejad A.Valgus extension osteotomy for 'hinge abduction' in Perthes' disease. Results at maturity and factors influencing the radiological outcome. J Bone Joint Surg Br. 2000; 82:548-554.
  • 7-Saito S, Takaoka K, Ono K.Tectoplasty for painful dislocation or subluxation of the hip. Long-term evaluation of a new acetabuloplasty. J Bone JointSurgBr 1986; 68:55-60.
  • 8-Reddy RR, Morin C.Chiariosteotomy in Legg-CalvePerthes disease.J Pediatr Orthop B 2005; 14:1-9.
  • 9-Aksoy MC, Cankus MC, Alanay A, Yazici M, Caglar O, Alpaslan AM. Radiological outcome of proximal femoral varus osteotomy for the treatment of lateral pillargroup-C Legg-Calvé-Perthes disease. J Pediatr Orthop B 2005; 14:88-91.
  • 10-Ghanem I, Haddad E, Haidar R, Haddad-Zebouni S, Aoun N, Dagher F, Kharrat K. Latera shelf acetabuloplasty in the treatment of Legg-Calvé-Perthes disease: improving mid-term outcome in severely deformed hips. J Child Orthop 2010; 4:13-20.
  • 11-Willett K, Hudson I, Catterall A.Lateralshelf acetabuloplasty: an operation for older children with Perthes' disease. J Pediatr Orthop 1992; 12:563-568.
  • 12-Ishida A, Kuwajima SS, LaredoFilho J, Milani C. Salterinnominateosteotomy in the treatment of severe Legg-Calvé-Perthes disease: clinical and radiographic results in 32 patients (37 hips) at skeletal maturity. J Pediatr Orthop 2004; 24:257-264.
  • 13-Crutcher JP, Staheli LT.Combined osteotomy as a salvage procedure for severe Legg-Calvé-Perthes disease. J Pediatr Orthop 1992; 12:151-156.
  • 14-Carsi B, Judd J, Clarke NM.Shelfacetabuloplasty for containment in the early stages of Legg-CalvePerthesdisease. J Pediatr Orthop 2015; 35:151-156.
  • 15-Lim KS, Shim JS.Outcomes of Combined Shelf Acetabuloplasty with Femoral Varus Osteotomy in Severe Legg-Calve-Perthes (LCP) Disease: Advanced Containment Method for Severe LCP Disease. ClinOrthopSurg 2015; 7:497-504.
  • 16-Chang JH, Kuo KN, Huang SC.Outcomes in advancedLegg-Calvé-Perthes disease treated with the Staheli procedure. J SurgRes. 2011; 168:237-242.
  • 17-Podeszwa DA, DeLaRocha A. Clinical and radiographic analysis of Perthes deformity in the adolescent and young adult. J Pediatr Orthop 2013; 33:S56-61.
  • 18-Farsetti P, Benedetti-Valentini M, Potenza V, Ippolito E. Valgus extension femoral osteotomy to treat "hinge abduction" in Perthes' disease. J Child Orthop 2012; 6:463- 469.
  • 19-Yazici M, Aydingöz U, Aksoy MC, Akgün RC.Bipositional MR imaging vs arthrography for the evaluation of femoral head sphericity and containment in Legg-Calvé-Perthes disease. ClinImaging 2002; 26:342- 346.
  • 20-Jaramillo D, Galen TA, Winalski CS, DiCanzio J, Zurakowski D, Mulkern RV, McDougall PA, VillegasMedina OL, Jolesz FA, Kasser JR.Legg-CalvéPerthesdisease: MR imaging evaluation during manual positioning of the hip—comparison with conventional arthrography. Radiology 1999; 212:519-525.
  • 21- Hochbergs P, Eckerwall G, Egund N, Jonsson K, Wingstrand H. Femoral head shape in Legg-CalvéPerthes disease. Correlation between conventional radiography, arthrograph yand MR imaging. ActaRadiol 1994; 35:545-548.

Radiological Comparision of The Surgical Treatment Results in Severe Perthes Disease

Year 2016, Volume: 13 Issue: 2, 154 - 161, 29.08.2016

Abstract

Background: In this study we aimed to compare the final follow-up pelvic radiographic views and computed
tomographic views of combined proximal femoral valgus osteotomy and tectoplasty in the treatment of
Herring group C Perthes disease with hinge abduction.
Methods:This study was carried out in 11 male patients who underwent combined proximal femoral valgus
osteotomy and tectoplasty related to Herring group C Perthes disease. The mean follow-up was 5.5 (2.2-9.3) years. The final follow-up pelvic radiographic views and computed tomographic views were compared in
terms of femoral head subluxation ratio, femoral head coverage ratio, femoral head size ratio, Sharp angle,
center-edge angle, neck-shaft angle, caput index and acetabular depth index.
Results: In the comparison of datas obtained from pelvic radiographic views and computed tomographic
views, only the caput index values showed significance with a p=0.031. The three diamentional tomographic
comparison of the operated hip and non-operated hip in terms of femoral head coverage showed no
significance with a p=0.494.
Conclusions: The combination of proximal femoral valgus osteotomy and tectoplasty in the treatment of
Herring group C Perthes disease provided consistent results with normal anatomy in terms of femoral head
coverage. Computed tomography is a useful method in the measurement of caput index which is an important
parameter in the assesment of surgical results in Perthes disease.

References

  • 1-Roy DR. Current concepts in Legg-CalvéPerthesdisease.Pediatr Ann 1999; 28:748-752.
  • 2-Stulberg SD, Cooperman DR, Wallensten R.Thenaturalhistory of Legg-Calvé-Perthes disease. J Bone JointSurgAm 1981; 63:1095-1108.
  • 3-Herring JA, Kim HT, Browne R.Legg-CalvePerthesdisease. Part II: Prospective multicenter study of the effect of treatment on outcome. J Bone JointSurgAm 2004; 86:2121-2134.
  • 4-Myers GJ, Mathur K, O'Hara J.Valgusosteotomy: a solution for late presentation of hinge abduction in Legg-Calvé-Perthesdisease. J Pediatr Orthop. 2008; 28:169-172.
  • 5-Grzegorzewski A, Bowen JR, Guille JT, Glutting J.Treatment of the collapsed femoral head by containment in Legg-Calve-Perthes disease. J Pediatr Orthop. 2003; 23:15-19.
  • 6-Bankes MJ, Catterall A, Hashemi-Nejad A.Valgus extension osteotomy for 'hinge abduction' in Perthes' disease. Results at maturity and factors influencing the radiological outcome. J Bone Joint Surg Br. 2000; 82:548-554.
  • 7-Saito S, Takaoka K, Ono K.Tectoplasty for painful dislocation or subluxation of the hip. Long-term evaluation of a new acetabuloplasty. J Bone JointSurgBr 1986; 68:55-60.
  • 8-Reddy RR, Morin C.Chiariosteotomy in Legg-CalvePerthes disease.J Pediatr Orthop B 2005; 14:1-9.
  • 9-Aksoy MC, Cankus MC, Alanay A, Yazici M, Caglar O, Alpaslan AM. Radiological outcome of proximal femoral varus osteotomy for the treatment of lateral pillargroup-C Legg-Calvé-Perthes disease. J Pediatr Orthop B 2005; 14:88-91.
  • 10-Ghanem I, Haddad E, Haidar R, Haddad-Zebouni S, Aoun N, Dagher F, Kharrat K. Latera shelf acetabuloplasty in the treatment of Legg-Calvé-Perthes disease: improving mid-term outcome in severely deformed hips. J Child Orthop 2010; 4:13-20.
  • 11-Willett K, Hudson I, Catterall A.Lateralshelf acetabuloplasty: an operation for older children with Perthes' disease. J Pediatr Orthop 1992; 12:563-568.
  • 12-Ishida A, Kuwajima SS, LaredoFilho J, Milani C. Salterinnominateosteotomy in the treatment of severe Legg-Calvé-Perthes disease: clinical and radiographic results in 32 patients (37 hips) at skeletal maturity. J Pediatr Orthop 2004; 24:257-264.
  • 13-Crutcher JP, Staheli LT.Combined osteotomy as a salvage procedure for severe Legg-Calvé-Perthes disease. J Pediatr Orthop 1992; 12:151-156.
  • 14-Carsi B, Judd J, Clarke NM.Shelfacetabuloplasty for containment in the early stages of Legg-CalvePerthesdisease. J Pediatr Orthop 2015; 35:151-156.
  • 15-Lim KS, Shim JS.Outcomes of Combined Shelf Acetabuloplasty with Femoral Varus Osteotomy in Severe Legg-Calve-Perthes (LCP) Disease: Advanced Containment Method for Severe LCP Disease. ClinOrthopSurg 2015; 7:497-504.
  • 16-Chang JH, Kuo KN, Huang SC.Outcomes in advancedLegg-Calvé-Perthes disease treated with the Staheli procedure. J SurgRes. 2011; 168:237-242.
  • 17-Podeszwa DA, DeLaRocha A. Clinical and radiographic analysis of Perthes deformity in the adolescent and young adult. J Pediatr Orthop 2013; 33:S56-61.
  • 18-Farsetti P, Benedetti-Valentini M, Potenza V, Ippolito E. Valgus extension femoral osteotomy to treat "hinge abduction" in Perthes' disease. J Child Orthop 2012; 6:463- 469.
  • 19-Yazici M, Aydingöz U, Aksoy MC, Akgün RC.Bipositional MR imaging vs arthrography for the evaluation of femoral head sphericity and containment in Legg-Calvé-Perthes disease. ClinImaging 2002; 26:342- 346.
  • 20-Jaramillo D, Galen TA, Winalski CS, DiCanzio J, Zurakowski D, Mulkern RV, McDougall PA, VillegasMedina OL, Jolesz FA, Kasser JR.Legg-CalvéPerthesdisease: MR imaging evaluation during manual positioning of the hip—comparison with conventional arthrography. Radiology 1999; 212:519-525.
  • 21- Hochbergs P, Eckerwall G, Egund N, Jonsson K, Wingstrand H. Femoral head shape in Legg-CalvéPerthes disease. Correlation between conventional radiography, arthrograph yand MR imaging. ActaRadiol 1994; 35:545-548.
There are 21 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Mehmet Emre Baki

Publication Date August 29, 2016
Submission Date February 24, 2016
Acceptance Date March 9, 2016
Published in Issue Year 2016 Volume: 13 Issue: 2

Cite

Vancouver Baki ME. İleri Evre Perthes Hastalığında Cerrahi Tedavi Sonuçlarının Radyolojik Olarak Karşılaştırılması. Harran Üniversitesi Tıp Fakültesi Dergisi. 2016;13(2):154-61.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty