ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Synovitis is an important feature in Legg-Calvé-Perthes disease (LCPD) with a significant prognostically negative impact on clinical symptoms, cartilage biochemistry, mechanical properties of the cartilage, joint biomechanics, and prognosis toward healing with a congruent, spherical head of femur. Synovitis causes cartilage edema, deterioration of the cartilage's mechanical properties, cartilage hypermetabolism, and, subsequently, cartilage hypertrophy. This sequence of events could explain the clinical course, which consists of cartilage hypertrophy, lateral subluxation, anterolateral deformation of the head, and, subsequently, joint incongruence in prognostically poor cases of LCPD. A factor in the deformation of the hypertrophic cartilage of the epiphysis is decreased range of motion of the hip, because of pain caused by the increase in intracapsular pressure and the subsequent decrease in the “molding” ability of the acetabulum. Synovitis in LCPD causes an increased intracapsular pressure, the magnitude of which may, in some patients, intermittently compromise the blood supply to the proximal femoral epiphysis. Whether synovitis is the consequence of, or precedes, the loss of blood supply and epiphyseal necrosis is not yet established. Significant and persistent synovitis during the entire course of the disease emphasizes the importance of magnetic resonance imaging as the method of choice for the diagnosis and the prognosis, as well as the monitoring of therapy. The prognostically negative effects of synovitis suggest that more therapeutic efforts should be focused on the treatment of synovitis, from a palliative and prognostic point of view.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The usefulness of magnetic resonance imaging (MRI) for predicting prognosis was evaluated in 11 patients with unilateral early-stage Legg-Calvé-Perthes disease who were treated with a non-weight-bearing abduction brace. Six to 10 months after disease onset, severity of cartilage hypertrophy and physeal curvature of the femoral head were scored on MRI. Femoral head deformity was radiographically evaluated. Among five patients whose MRI score was 8 or greater, radiographic evaluation after the treatment was “poor” or “fair,” whereas evaluation for the other six patients whose MRI score was 7 or less was “good.” The MRI scores indicated possible occurrence of femoral head deformation. Treatment method should be considered carefully when the MRI score is high.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Twenty-five patients or 50 hips with bilateral Legg-Calvé-Perthes disease were reviewed at skeletal maturity in the orthopaedic departments of Leuven, Belgium, and Montpellier, France. The two groups were very similar as to age at onset of the disease, severity of involvement, and classification at skeletal maturity. The results seem to indicate that bilateral disease runs a more severe course as compared with unilateral Legg-Calvé-Perthes disease. Eighty percent presented with a Catterall group III and IV and Herring classification B and C. Forty-eight percent rated as Stulberg 4 and 5 at skeletal maturity.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

In the literature, long-term prognosis of Legg-Calve-Perthes disease (LCPD) means prognosis for secondary osteoarthritis of the hip joint or leg-length inequality and its consequences. Most studies show results after conservative treatment. The long-term natural history of LCPD is not known. In spite of deformity, most patients do well in early adulthood. Radiographic and clinical osteoarthritis is increased in 20-year to 40-year follow-ups and degenerative joint disease develops in the majority of patients by the sixth or seventh decade of life. The reported average shortening of the affected leg has usually been 1 to 1.5 cm. There are no thorough long-term reports on low back pain after LCPD. The only evidence-based factors that are of prognostic importance in the long-term are age of the patient at the onset of the disease and shape of the femoral head at skeletal maturity.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Changes in the acetabulum play an important role in the final results of Legg-Calve-Perthes disease (LCPD). To determine the relationship between the acetabulum and the final results, the acetabulum was measured in 108 children with unilateral LCPD. The acetabular radius, depth, width; iliac width and height; and medial joint distance were measured on the radiographs initially and on follow-up. The parameters between the affected and the unaffected sides were compared by usingttest. Herring's classification was employed to evaluate the extent of involved femoral head. The results showed that the radius of the acetabulum was the most sensitive measurement representing the pathologic changes in the acetabulum. The acetabular hypertrophy occurred very early in the avascular necrosis stage. It resulted in the lateral subluxation of the femoral head and in loss of containment. During the later stage of the disease, the femoral head overgrew and broke the growth limit of the acetabulum. Coxa magna made it difficult for a hypertrophic acetabulum to contain it.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Ultrasonography was used to establish the diagnosis of transient hip synovitis and the onset of Legg-Calve-Perthes disease. A total of 115 patients presenting with 119 painful hips and the preliminary diagnosis of transient hip synovitis were reviewed. Hip effusion, resulting in capsular distension, was documented accurately with ultrasound. In nine patients, capsular distension persisted longer than 6 weeks and was associated with the onset of Legg-Calve-Perthes disease.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A subset of postoperative recurrent clubfeet was isolated in a group of patients 4 to 8 years old. Twenty-seven consecutive patients who underwent redo surgery consisting of complete soft tissue clubfoot release combined with a calcaneocuboid fusion were reviewed for this study. Twenty-six feet of 27 feet in 20 patients had a long-term good result, suggesting that this procedure is the one of choice for this age group.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This study describes postoperative necrosis of the hallux and first ray in a child with clubfoot. Arteriography performed on this child's lower limbs demonstrated, in the operated leg, hypoplasia of both the anterior and posterior tibial arteries and failure of the dorsalis pedis artery to traverse the tarsus and complete the deep plantar arch. Previously, congenital vascular deficiency was suggested to predispose such operated limbs to necrosis. These findings confirm the association between vascular deficiency and necrosis. In this present study, the metabolic demands of wound healing were sufficient in a limb with vascular deficiency to cause localized distal hypoperfusion leading to cyanosis and necrosis of the hallux and medial foot.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The results of treatment of seven children with Sprengel deformity are reviewed. The patients were subjected to a modified Green procedure without dissection of the serratus anterior muscle and immediate postoperative mobilization. The results seem to indicate that the postoperative abduction gain (77°) compares favorably in regard to the current literature and that this modification of the classic technique offers a substantial advantage concerning functional outcome in these patients.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID