Arthrodiatasis for the treatment of Perthes' disease.

摘要

It is hypothesized that the interruption of the blood supply is an important factor causing femoral head osteonecrosis in the early stages of Legg-Calve-Perthes disease. Currently, treatment by containment is recommended to direct and guide remodeling of the softened femoral head as it evolves from fragmentation through ossification. The goal of this study was to show the results of arthrodiatasis to induce height recovery of the femoral head and to achieve true ambulatory nonweight-bearing containment. Forty-two patients younger than 8 years with a diagnosis of Perthes' disease were studied. Twenty-three patients (9 class B and 14 class C according to Herring's classification) were treated with an articulated distraction technique and 19 patients (11 class B and 8 class C) were treated conservatively as a control group. Arthrodiatasis or articulated distraction of the hip combines off-loading of muscles and body forces with distraction of the joint space by means of an external fixator that crosses the hip joint. Radiologically, 21 patients (91%) had satisfactory results and 2 (9%) had unsatisfactory results. Clinically, the results were good in 21 patients (92%), fair in 1 (4%), and poor in 1 (4%). In patients treated conservatively, 14 patients (72%) had satisfactory results and 5 (28%) had unsatisfactory results. Clinically, 71% had good results, 17% had fair, and 12% had poor. We conclude that hip joint containment by articulated arthrodiatasis (plus adductors and psoas minimal tenotomy surgery) is an effective method in the management of Perthes' disease in patients younger than 8 years, classified B and C, and associated with a highly reduced range of abduction. Restoration of clinical abnormalities and satisfactory radiological parameters are achieved in high percentages.