BACKGROUND The treatment of late stages of Legg-Calvé-Perthes disease(LCPD)is controversial.Although the concept of femoral head containment is a well-established technique of treatment,its use remains debatable ...BACKGROUND The treatment of late stages of Legg-Calvé-Perthes disease(LCPD)is controversial.Although the concept of femoral head containment is a well-established technique of treatment,its use remains debatable in the late stages of the disease,as it does not improve symptoms in terms of limb length discrepancy and gait.AIM To assess the results of subtrochanteric valgus osteotomy in symptomatic patients with late-stage Perthes disease.METHODS From 2000 to 2007,36 symptomatic patients with late stage of Perthes disease were surgically treated with subtrochanteric valgus osteotomy and followed-up for 8 to 11 years using the IOWA score and range of motion(ROM)variables.The Mose classification was also assessed at the last follow-up to reflect possible remodeling.The patients were 8 years old or older at the time of surgery,in the post-fragmentation stage,and complaining of pain,limited ROM,Trendelenburg gait,and/or abductor weakness.RESULTS The preoperative IOWA score(average:53.3)markedly improved at the 1-year post follow-up period(average:85.41)and then slightly improved at the last follow-up(average:89.4)(P value<0.05).ROM improved,with internal rotation increased on average by 22°(from 10°preoperatively to 32°postoperatively)and abduction increased on average by 15.9°(from 25°preoperatively to 41°postoperatively).The mean Mose deviation of femoral heads was 4.1 mm at the end of the follow-up period.The tests used were the paired t-test and Pearson correlation test,where the level of significance was a P value less than 0.05.CONCLUSION Subtrochanteric valgus osteotomy can be a good option for symptomatic relief in patients with late-stage of LCPD.展开更多
Legg-Calvé-Perthes disease(LCPD),a historically-considered osteochondrosis,is now being diagnosed as an idiopathic avascularnecrosis of the femoral head in children.At present,the treatment for LCPD mainly focuse...Legg-Calvé-Perthes disease(LCPD),a historically-considered osteochondrosis,is now being diagnosed as an idiopathic avascularnecrosis of the femoral head in children.At present,the treatment for LCPD mainly focuses on the preservation orrecovery of the arthrogenic component of the femoral head.The currently-available surgical methods are various,most of which can obtain bettertherapeutic effects in LCPD.Nerveless,these surgeries are not universally acknowledged,and may have some limitations like increased articularand vascularinjury.In recent years,Traditional Chinese Medicine(TCM)has been shown a certain advantage in LCPD.This article primarily investigated the key points of common syndromes,TCM nursing methods and healthy guidance of LCPD,aiming at maintaining and developing the strengths of TCM,improving its efficacy and standardizing its behavior.展开更多
To investigate the role of cartilage alterations in the pathogenesis of the idiopathic femoral head necrosis, 3 components of glycosaminoglycans(GAG) in pathological and health cartilage, levels of hyaluronic acid(HA)...To investigate the role of cartilage alterations in the pathogenesis of the idiopathic femoral head necrosis, 3 components of glycosaminoglycans(GAG) in pathological and health cartilage, levels of hyaluronic acid(HA) in synovial fluid and serum were detected. The correlations among HA level in synovial fluid, serum and GAG content in cartilage were analyzed. The results showed that ①the three components of cartilage GAG in normal adults and children showed little difference; ②Compared with the normal autopsy specimens, steroid induced ANFH and Perthes disease specimens had significantly decreased GAG contents (P<0 025). In the former ones, sulfate radical content had no obvious reduction in Ficat Ⅱ (P>0 05), but it decreased significantly (P<0 05) in Ficat Ⅲ, while hexosamine decreased sharply in Ficat Ⅱ and had no marked alternation in Ficat Ⅲ. And hexuronic acid fell sharply during Ficat Ⅱ and Ficat Ⅲ (P<0 05). Serum level of HA did not have obvious changes until Ficat Ⅲ. HA level in synovial fluid decreased extremely in Ficat Ⅲ in contrast to Ficat Ⅱ and normal controls (P<0 05). Moreover, there was no correlation between levels of HA in serum and in synovial fluid (P>0 05); ③Children suffered from Perthes disease had a much higher level of HA in serum than the controls (P<0 01). HA level in serum led an inverse correlation with that in synovial fluid. (r=-0 663,P<0 05);④There was a positive correlation between HA level in synovial fluid and GAG content in both steroid induced ANFH and Perthes disease. GAG content was positive correlated with HA level in serum of Perthes disease, whereas, there was no correlation between them in steroid induced ANFH. The results suggest that:①GAG content in affected hip decreased significantly in the early stage. It provides clinical theory basis for auxiliary treatment to cartilage in early stage; ②Sulfate radical depletion is the most conspicuous one of GAG changes in middle and late stage. It suggests that the sulfate radical glycoaminoglycans should be replenished in these stages; ③Measurement of the serum HA level is of no value in early diagnosis of steroid induced ANFH. To some extent serum levels of HA reflect biochemical changes in cartilage in Perthes disease.展开更多
文摘BACKGROUND The treatment of late stages of Legg-Calvé-Perthes disease(LCPD)is controversial.Although the concept of femoral head containment is a well-established technique of treatment,its use remains debatable in the late stages of the disease,as it does not improve symptoms in terms of limb length discrepancy and gait.AIM To assess the results of subtrochanteric valgus osteotomy in symptomatic patients with late-stage Perthes disease.METHODS From 2000 to 2007,36 symptomatic patients with late stage of Perthes disease were surgically treated with subtrochanteric valgus osteotomy and followed-up for 8 to 11 years using the IOWA score and range of motion(ROM)variables.The Mose classification was also assessed at the last follow-up to reflect possible remodeling.The patients were 8 years old or older at the time of surgery,in the post-fragmentation stage,and complaining of pain,limited ROM,Trendelenburg gait,and/or abductor weakness.RESULTS The preoperative IOWA score(average:53.3)markedly improved at the 1-year post follow-up period(average:85.41)and then slightly improved at the last follow-up(average:89.4)(P value<0.05).ROM improved,with internal rotation increased on average by 22°(from 10°preoperatively to 32°postoperatively)and abduction increased on average by 15.9°(from 25°preoperatively to 41°postoperatively).The mean Mose deviation of femoral heads was 4.1 mm at the end of the follow-up period.The tests used were the paired t-test and Pearson correlation test,where the level of significance was a P value less than 0.05.CONCLUSION Subtrochanteric valgus osteotomy can be a good option for symptomatic relief in patients with late-stage of LCPD.
文摘Legg-Calvé-Perthes disease(LCPD),a historically-considered osteochondrosis,is now being diagnosed as an idiopathic avascularnecrosis of the femoral head in children.At present,the treatment for LCPD mainly focuses on the preservation orrecovery of the arthrogenic component of the femoral head.The currently-available surgical methods are various,most of which can obtain bettertherapeutic effects in LCPD.Nerveless,these surgeries are not universally acknowledged,and may have some limitations like increased articularand vascularinjury.In recent years,Traditional Chinese Medicine(TCM)has been shown a certain advantage in LCPD.This article primarily investigated the key points of common syndromes,TCM nursing methods and healthy guidance of LCPD,aiming at maintaining and developing the strengths of TCM,improving its efficacy and standardizing its behavior.
文摘To investigate the role of cartilage alterations in the pathogenesis of the idiopathic femoral head necrosis, 3 components of glycosaminoglycans(GAG) in pathological and health cartilage, levels of hyaluronic acid(HA) in synovial fluid and serum were detected. The correlations among HA level in synovial fluid, serum and GAG content in cartilage were analyzed. The results showed that ①the three components of cartilage GAG in normal adults and children showed little difference; ②Compared with the normal autopsy specimens, steroid induced ANFH and Perthes disease specimens had significantly decreased GAG contents (P<0 025). In the former ones, sulfate radical content had no obvious reduction in Ficat Ⅱ (P>0 05), but it decreased significantly (P<0 05) in Ficat Ⅲ, while hexosamine decreased sharply in Ficat Ⅱ and had no marked alternation in Ficat Ⅲ. And hexuronic acid fell sharply during Ficat Ⅱ and Ficat Ⅲ (P<0 05). Serum level of HA did not have obvious changes until Ficat Ⅲ. HA level in synovial fluid decreased extremely in Ficat Ⅲ in contrast to Ficat Ⅱ and normal controls (P<0 05). Moreover, there was no correlation between levels of HA in serum and in synovial fluid (P>0 05); ③Children suffered from Perthes disease had a much higher level of HA in serum than the controls (P<0 01). HA level in serum led an inverse correlation with that in synovial fluid. (r=-0 663,P<0 05);④There was a positive correlation between HA level in synovial fluid and GAG content in both steroid induced ANFH and Perthes disease. GAG content was positive correlated with HA level in serum of Perthes disease, whereas, there was no correlation between them in steroid induced ANFH. The results suggest that:①GAG content in affected hip decreased significantly in the early stage. It provides clinical theory basis for auxiliary treatment to cartilage in early stage; ②Sulfate radical depletion is the most conspicuous one of GAG changes in middle and late stage. It suggests that the sulfate radical glycoaminoglycans should be replenished in these stages; ③Measurement of the serum HA level is of no value in early diagnosis of steroid induced ANFH. To some extent serum levels of HA reflect biochemical changes in cartilage in Perthes disease.
