Wyniki leczenia zachowawczego dzieci z chorobą Legg-Calve-Perthes do 7 roku życia

Abstract

Introduction. Legg-Calve-Perthes disease is one of the most common avascular necroses in children and adolescents. Aims. Assessment of hip joint development and of the quality of life in conservatively treated patients. Establishing indications for conservative treatment in children with Perthes disease. Materials and methods. The inclusion criterion was the age of affected patients: under 7 years at the time of diagnosis The study population included 50 children (10 girls and 40 boys) in the mean age of 5 years and 1 month. All the children participated in follow up appointments, arranged every 3 months, during which clinical examinations (the range of hip joint motion, limb length) were carried out and radiological parameters (Salter extrusion index, ATD, Wiberg angle) were assessed. All the patients were assessed in the IPSG Modified HOOS-16 Hip Survey. Results. The patients, qualified to group A by the Herring classification, demonstrated less limits in hip joint inward rotation and no length reduction of the affected limb (p<0.05). In the patients with Wiberg angle and Salter extrusion index in the affected joint being similar to their corresponding values on the healthy side, the intensity of pain was lower, assessed in the IPSG Modified HOOS-16 Hip Survey, as well as their functioning in everyday life and in sport and recreation activities was better, thus their general quality of life was higher (p <0.05). Conclusions. Children with Perthes disease, diagnosed before the age of 7, do not usually require surgical intervention. In our study, the radiological evaluation of hip joint development showed complete healing of the proximal femoral epiphysis, while preserving femoral head sphericity and good hip functionality. In general, the quality of life of affected patients does not differ from the quality of life of healthy children. The indication for conservative treatment of children with Perthes disease is their age below 7 years. Then a regular monitoring of the course of physiotherapeutic therapy is required, combined with regular radiological controls and clinical assessments of hip joint motion range.