Therapeutic effect of greater trochanteric epiphysiodesis on the children with Legg-Calve-Perthes disease

Abstract:

Objective：To evaluate the therapeutic effect of greater trochanteric epiphysiodesis（GTE） on Legg-Calve-Perthes disease（LCPD） in children. Methods：A total of 78 patients with LCPD treated by surgery in Children’s Hospital of Chongqing Medical University from January 2013 to June 2019 were included in the study. They were divided into crisis group and no-crisis group according to that if there were radiographic crisis of overgrowth of the greater trochanter（OGGT） based on X-ray films before the surgery，and the patients in crisis group were divided into the GTE group and the non-GTE group according to different surgical pro－cedures. The GTE group were treated with inclusive surgery combined with GTE including 14 cases（16 hips），and the non-GTE group were only treated with inclusive surgery including 33 cases（33 hips）. There were 31 cases and 31 hips in the no-crisis group. The above cases were followed up and the therapeutic effect was evaluated by the clinical symptoms and radiographic data. Results：The patients were followed up for 12 to 89 months（mean，30.6 months）. The rate of OGGT in the non-GTE group（75.8%） was sig－nificantly higher than that in the no-crisis group（6.5%）（P<0.001），and the rate of OGGT in the GTE group（21.4%） was significantly lower than that in the non-GTE group（75.8%）（P=0.001）. According to the comparative analysis of the development of the greater trochanter between the affected side and the healthy side in the GTE group，the growth of the greater trochanter that underwent GTE was inhibited by 1.32 mm/year，while greater inhibition（1.77 mm/year） was noted in children who underwent the hollow nail epiphysiodesis. The clinical effect in the GTE group was also better than that in the non-GTE group. Conclusion：Radiographic crisis of OGGT has definite predictive significance and can be the indication for GTE，and selective GTE can effectively inhibit the growth of greater trochanter and avoid OGGT. Combined with traditional inclusive surgery，the therapeutic effect can be improved.