[Fifteen years' results of surgery of perthes disease.].
In 1979-1985, i.e. in the course of 7 years, surgery of the hip joints was performed in 91 children suffering from Calvé-Legg-Perthes disease. The surgery involves creation of "containment", i.e. a situation favourable for healing of the head affected with avascular necrosis. The basic operation was always Salter's osteotomy of the pelvis and in one case triple osteotomy; in 68 hip joints the operation comprised also varization of the proximal femur. The mean age at the time of operation was 85 months, the mean follow-up period 138 months (11.5. years with a range from 9-16 years).The author compares different classifications and uses Catterall's system. The extent of the deformity of the head and the relation of the head to the acetabulum was investigated by arthrography in an axial projection. In all children retardation of bone age, as compared with chronological age, was found when evaluated by Greulich and Pyle's method. The group of operated patients was divided into three subgroups with regard to the stage of Perthes disease in which the operation was indicated. Thus from the total of 91 hip joints 52 were included in the subgroup of early stages of the disease without impairment of the spherical shape of the head. The subgroup of advanced stages of the disease is formed by 33 hip joints: in all instances arthrography revealed flattening of the head. The third sub-group (6) comprises severely deformed heads in the remodelling stage of the disease with the arthrographic finding of a saddle-shaped head. During the final evaluation 80 joints (88%) were assessed as spherical congruence according to Stulberg, 10 (11%) as non-spherical congruence and one as aspherical congruence. The total period of treatment did not exceed three months. All children could be discharged home, a prolonged stay in an in-patient facility was not necessary. Key words: Calvé-Legg-Perthes disease, surgery of CLP, Salter's osteotomy of the pelvis in treatment of CLP, Salter's osteotomy of the pelvis and varization in the treatment of CLP.
Dungl
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Ortopedická klinika IPVZ FN Bulovka, Praha.