EXPERIENCE OF SURGICAL TREATMENT OF LEGG-CALVE-PERTES DISEASE IN CHILDREN
Introduction. The article presents the result of treatment of a patient with Perthes ' disease. The main goal is to share the experience of using a rod external fixation device (EFD) for osteochondropathy of the femoral head in children, which allows significantly reducing the treatment time with the maximum possible restoration of the structure and shape of the femoral head.
Aim. Improve the results of surgical treatment of Perthes ' disease in children.
Materials and methods. The design of the study is to describe a single case. We studied the immediate and long-term results of treatment of a patient with Perthes ' disease in the fragmentation stage who was in the Department of pediatric orthopedics and rehabilitation, city children's hospital N2, Nur-Sultan. The age of the patient during the operation is 11 years 4 months, male. The surgical intervention included the installation of a rod external fixation device using the technology developed by us, a correct dosed system of distarction, using telescopic rods. The semi-rings of the Ilizarov apparatus were used as support elements.
Results. The follow-up period was 15 months. Full recovery of mobility in the joint was achieved in 2.5 months. There was no pain syndrome. Partial restoration of the shape and structure of the head was observed during the first 6 months after the operation. At the time of the last examination, the epiphyseal index was 0.4. The continuity of the Shenton line was maintained. X-ray results were evaluated according to Herring criteria: group B. the Joint corresponds to class II according to Stulberg.
Conclusions. This device will create favorable conditions for painless unloading of the hip joint, thereby improving blood circulation, which provides nutrition to soft tissues, the head of the hip and will reduce the recovery time of the head of the hip.
Nazym A. Tuktiyeva1, https://orcid.org/0000-0002-4024-6705
Bolatbek A. Dossanov2, https://orcid.org/0000-0001-9816-7404
Yersin T. Zhunussov1, https://orcid.org/0000-0002-1182-5257
1 NPJSC " Medical University of Semey ", Department of children's surgery and orthopedics,
Semey, Republic of Kazakhstan.
2 NPJSC " Medical University of Astana ", Department of children's surgery,
Nur-Sultan, Republic of Kazakhstan.
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8. Amer A., Khanfour A., Arthrodiastasis for late onset Perthes’ disease using a simple frame and limited soft tissue release: early results. Acta Orthop Belg. 2011. 77 (4). pp.472–479
9. Arruda V., Belangero W., Ozelo M. et al. Inherited risk factors for thrombophilia among childrenwith Legg-Calvé-Perthes disease. J Pediatr Orthop. 1999. 19. pp. 84-87.
10. Catterall A. Thoughts on the etiology of Perthes'disease. Iowa Orthop. J. 1984. 4: pp.34–36.
11. Catterall A. Perthes' disease. J. Bone Joint Surg. [Br]. 1971. N53. P.37 –53
12. Ferguson A., Jr. Segmental vascular changes in the femoral head in children and adults. Clin Orthop Relat Res. 1985. 200. 291-298.
13. Gregosiewicz A., Okonski M., Stolecka D. et al. Ischemia of the femoral head in Perthes' disease: is thecause intra- or extravascular? J Pediatr Orthop. 1989. 9. 160-162.
14. Glueck C., Freiberg R., Crawford A. et al. Secondhand smoke, hypofibrinolysis, and Legg-Perthesdisease. Clin Orthop Relat Res. 1998. 352. 159-167.
15. Hosny G., El-Deeb K., Fadel M., Laklouk M. Arthrodiastasis of the hip. J. Pediatr. Orthop. 2011. Vol. 31, Suppl. 2. P. 229-234. doi: 10.1097/ BPO.0b013e318223b45a.
16. Herring J. [et al.] Perthes'disease. J. Pediatr. Orthop. 1992. N12. P.143 –150.
17. Herring J. [et al.] Perthes'disease. J. Pediatr. Orthop. 1993. N13. P.41 –45.
18. Herring J. Legg-Calve-PerthesDisease. In Tachdjians Pediatric Orthopaedics. 2001. P. 675-679.
19. Hall A., Barker D. The age distribution of Legg-Perthes disease.An analysis using Sartwell'sincubation period model. Am J Epidemiol. 1984. 120. Р. 531-536.
20. Harper P., Brotherton B., Cochin D. Genetic risks in Perthes' disease. Clin Genet. 1976. 10. 178-182.
21. Ilizarov G. The tension-stress effect on the genesis and growth of tissues.Transosseousosteosynthesis. Berlin: Springer-Verlag; 1992. p. 137–255
22. Ibrahim Y., Mohamed Ahmed A., Kersh and Hesham Fahmy. Arthrodiastasis in the management of Perthes disease: a systematic review. Journal of Pediatric Orthopaedics B 2019, Vol XXX No XXX, р 5-11.
23. Krutikov N., Vinogradov A. Legg-Calve-Perthes disease // Questions of modern pediatrics. 2015. 14. 5. Р. 548-552.
24. Karagyaur M., Makarevich P., Shevchenko E.K., Stambolsky D., Kalinina N., Parfyonova Ye. Modern approaches to peripheral nerve regeneration after injury: the prospects of gene and cell therapy. Genes and Cells. 2017. 12(1). Р. 172-177.
25. Maxwell S., Lappin K., Kealey W., McDowell B., Cosgrove A. Arthrodiastasis in Perthes' disease. Preliminary results. J. Bone Joint Surg. Br. 2004. Vol. 86-B. No 2. P. 244-250.
26. Mehta J., Conybeare M., Hinves B. et al. Protein C levels in patients with Legg-Calvé-Perthesdisease: is it a true deficiency? J Pediatr Orthop. 2006. 26. 200-203.
27. Perthes G. The classic: On juvenile arthritis deformans. 1910. Clin. Orthop. Relat. Res. 2012. 470 (9). 2349–2368.
28. Perry D., Skellorn P., Bruce C. The lognormal age of onset distribution in Perthes’ disease: an analysis from a large well-defined cohort. J Bone Joint Surg Br. 2016. 98(5). pp. 110–114.
29. Perry D., Machin D., Pope D. et al. Racial and geographic factors in the incidence of Legg-CalvéPerthes' disease: a systematic review. Am J Epidemiol. 2012. 175. Р. 159-166.
30. Reimers J. The stability of the hip in children.Acta Orthop. Scand. 1980. Suppl. No 184. P. 1-100.
31. Stulberg S., Cooperman D., Wallensten R. The natural history of Legg-Calvé-Perthes disease. J.Bone Joint Surg Am. 1981. Sep. 63(7). 1095-1108.
32. Trueta J. The normal vascular anatomy of the femoral head in adult man. 1953. Clin Orthop Relat Res.1997. 334. 6-14.
33. Volpon J., Lima R., Shimano A. Tratamento da forma ativa da doenc¸a de Legg-Calvé-Perthes pelaartodiástase. Rev Bras Ortop. 1998. 33(1). Р. 8–14
34. Wynne-Davies R., Gormley J. The aetiology of Perthes' disease. Genetic, epidemiological and growthfactors in 310 Edinburgh and Glasgow patients. J Bone Joint Surg Br. 1978. 60. 6-14.
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Tuktieva N.A., Dosanov B.A., Zhunussov Ye.T. Experience of surgical treatment of Legg-Calve-Pertes disease in children // Nauka i Zdravookhranenie [Science & Healthcare]. 2020, (Vol.22) 4, pp. 126-132. doi10.34689/SH.2020.22.4.013Related publications:
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