The Efficacy Of Single And Combined Surgery For Severely Legg-Calve’-Perthes Disease In Children

BackgroundThe optimal management of children with severely involved Legg-Calve’-Perthes Disease is still controversial.Some reports have shown that some traditional single surgery have limited effectiveness.However,there are few reports about the effect of combined surgery.ObjectiveThe purpose of this study was to compare the efficacy of femoral varus osteotomy and femoral varus osteotomy combined with triple pelvic osteotomy in the treatment of severe Perthes’s disease in children,and to analyze the related factors for prognosis.Methods32 patients(32 hips)with severe Perthes disease in our hospital from January 2014 to January 2020 were analyzed retrospectively,including 25 males and 7 females,aged from 6 to 11 years,with an average of 7.8 years.Herrring classification was performed before operation.According to the inclusive treatment,the patients were divided into two groups:group A,single surgery(femoral varus osteotomy)(n=17),and group B,combined surgery(femoral varus osteotomy combined with triple pelvic osteotomy)(n=15).Acetabular index(AI),femoral head herniation index(FHEI),central marginal angle(LCEA)and Sharp angle were compared between two groups in pre-operation and post-operation,and the prognosis was evaluated by Harris hip score and Stulberg classification.ResultsAll the patients were followed up for an average of 24 months(12 to 60 months).There were 23 cases of B/C type(12 cases in group A and 11 cases in group B)and 9 cases in type C(5 cases in group A and 4 cases in group B)according to Herrring classification before operation.At the last follow-up,LCEA and AI increased,femoral head Extrusion index and Sharp angle decreased in group A and B,and the difference was statistically significant(P<0.05).There was no significant difference in postoperative Harris hip score between group An and group B(P>0.05).According to Stulberg classification,type Ⅰ and Ⅱ indicated a good prognosis,including 9 hips(52.9%)in group A and 8 hips(53.3%)in group B,and the results were not statistically significant(P=0.28).During the follow-up,1 child in group A had affected limb shortening,which was about 1cm shorter than the contralateral limb.Another child required a third triple pelvic osteotomy due to poor healing of the femoral head.ConclusionThrough the analysis of clinical and radiographic,the combined procedure can provides a better inclusion and prevent the complications caused by excessive correction of the single operation,such as coxa vara,trochanteric prominence and shortening of lower extremities.Therefore,proximal femoral varus osteotomy combined with pelvic triple osteotomy is more suitable for the treatment of severe Legg-Calve’-Perthes disease in children.