Long-term follow-up results of Perthes disease in older children treated with surgical containment methods / 中华骨科杂志

ABSTRACT

Objective To evaluate the long-term results of Chiari osteotomy in the treatment of Legg-Calv?-Perthes disease for the patients of 8 years old or above and discuss the factors that influence the prognosis of this disease. Methods There were 116 hips of 103 patients of Perthes disease treated with Chiari osteotomy between June 1986 and December 2002. All patients were 8 years old or above. 72 hips of these cases acquired follow-up, the meaning follow-up duration was 97 months(range, 38-196 months). According to lateral pillar classification, 30 hips were classified as group B, 22 hips as B/C group, 20 hips as C group. There were 50 hips in male, 22 hips in female, 47 patients between 8 and 10 years old, 22 cases between 10 and 14 years old. X-ray showed 25 hips with subluxation of femoral head preoperatively. Results According to the revised Stulberg classification system (1)31 hips had Stulberg classⅠ,Ⅱ outcome, in which B group accounted for 19 of 30 hips, the hips in group C had the worst results: of 20 hips, only 3 had a Stulberg class Ⅰ or Ⅱ outcome, the results for the hips in lateral B/C border group were intermediate between those groups B and C. 33 hips had Stulberg class Ⅲ, in which B group had 10 hips, B/C group had 11 hips, C group had 12 hips. 8 hips had Stulberg class Ⅳ or Ⅴ, B group had 1 hip, B/C group had 2 hips, C group had 5 hips. (2)All cases had a satisfied containment, no one had subluxation after Chiari osteotomy. (3)48% of male patients had a Stulberg class Ⅰor Ⅱ outcome, in contrast, only 23% of female had the comparable outcome. (4)55% of the group of 8 to 10 years old patients had a Stulberg class Ⅰ or Ⅱ outcome, in comparison with 17% from the group of 10 to 14 years old cases. Conclusion The patients older than 8 years at the onset of disease and in the lateral pillar B or C group should be treated with surgical containment, Chiari osteotomy can fulfill such task. The gender, the age of onset, especially the lateral pillar classification strongly correlate with the outcome of Perthes disease, and the latter can help us to evaluate the severity degree of the disease and the prognosis.