[Can follow-up scintigraphy be a decision aid for therapy choice in Perthes disease?].
In the period from 1988 to 1982 91 patients with M. Legg-Calvé-Perthes received orthopaedic treatment. In 51 cases surgical treatment for femoral head containment by intertrochanteric derotation varus osteotomy was performed. 40 patients were treated conservatively. Most cases received a Thomas-splint to eliminate weightbearing on the affected hip, some used crutches. Out of this group we present 6 cases that showed during the time of their first examination the radiologic stages 1 and 2 according to Waldenström. At the time when the M. Perthes was diagnosed these patients received a radionuclide bone scan, which was repeated of the average 6 months later to aid in the choice of therapy. Two other cases are presented for comparison, who received the first bone scan in the Perthes stage 2 and 3 according to Waldenström (fragmentation stage) showing an activity defect and were then operated with a derotation varus osteotomy after the follow-up bone scan had not shown revascularisation. All patients that had a complete revascularisation in the follow-up bone scan during the fragmentation stage had a good final result after conservative treatment. For other cases, where the bone scan in the fragmentation stage shows a persisting lack of epiphysis perfusion, it is recommended to decide for surgical treatment with derotational varus osteotomy, since the development of "head-at-risk" signs is likely, which will not resolve after later surgery.
Naumann
T
T
Orthopädische Klinik, Universität Ulm.
Bischoff
U
U
Puhl
W
W
D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D010027:Osteotomy; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D012189:Retrospective Studies
Kann die Verlaufsszintigraphie eine Entscheidungshilfe für die einzuschlagende Therapie beim Morbus Perthes geben?