Journal List > J Korean Orthop Assoc > v.26(6) > 1114690

Lee, Chang, and Ryu: Significances of Trochanteric Intra-osseous Venography for the Prediction of Prognosis and Treatment in Early Legg-Calve-Perthes' Disease

Abstract

Containment surgeries in Legg-Calve-Perthes' disease (LCPD) are usually indicated in Catterall group IV, elderly patients more than 7 years old in group II & III and in patients with head-at-risk signs. And so, it is well known that the patients who are under the age of 5, in group I, II & III without head -at-risk signs are not indicated for any operations because their prognosis are expected so good. We have analysed the total 46 patients with LCPD in relation to their trochanteric intraosseous venography (IOV) who were treated at St. Mary's hospital since Feb. 1975. In seventeen cases out of total 46 patients which were reclassified as Catterall group I (9 cases) and II (8 cases) and treated conservatively, bilateral trochanteric IOV were performed simultaneously and followed them for average 26 months, ranged form 14 months to 37 months, and analysed their final end results and IOV findings. The results obtained were as follows;1. Three cases(33.3%) out of 9 cases in group I and two cases(25%) out of 8 cases in group II had bad results with progressed collapse of femoral head radiologically. 2. The IOV in five cases with had results in group I & II showed none of gluteal and ligament teres veins, delayed disappearing time of contrast dye into the bone marrow and extensive diaphyseal dye regurgitation compared with unaffected side. 3. The IOV in twelve cases with good results in group I & II showed also none of gluteal and ligament teres veins, similar in groups with bad results, but the disappearing time of dye was relatively rapid and slight diaphyseal regurgitation of dye than that of group I & II with bad results were found. These IOV findings suggest that abnormal visualization of veins around hip in LCPD are constant findings, but dye stasis and reflux in marrow cavity of proximal femur even in group I & II are indicated the higher intraosseous pressure as well as the bad prognosis. Conclusively IOV even in group I & III are important to make early diagnosis and to predict their prognosis and to determine the method of treatment.

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