New characteristics of clinical classification for avascular necrosis of the femoral head in children / 中国组织工程研究

ABSTRACT

BACKGROUND:The etiological factor of pediatric avascular necrosis of the femoral head(Legg-Calv?-Perthe disease) is unclear right now,and the disease typing,treatment and prognosis outcome are also different.Thus a simple,practical and reliable clinical classification is necessary to guide treatment and estimate result.OBJECTIVE:To summarize and analyze the criteria commonly used for Legg-Calv?-Perthe disease in clinical typing as well as their advantage and shortcoming,which provides evidences for the treatment and instruction.RETRIEVAL STRATEGY:A computer-based search of Medline database was undertaken to identify the articles regarding the classification criteria for Perthes disease,published between January 1970 and September 2007,with the key items of "Perthes,classification" in English.After the primary check,the full-texts of the remained articles were looked for.Inclusion criteria:①X-ray,bone scanning and MRI classification criteria for Perthes disease.②the study of the correlation between the classification reliability and the prosthesis.Exclusion criteria:repeated researches.Totally 76 articles about the classification criteria for Perthes disease were retrieved,and 32 of them were in accordance with the inclusion criteria.LITERATURE EVALUATION:Among 32 included articles,24 ones concerned with X-ray examination,4 with bone scanning image,and 4 with MRI image.DATA SYNTHESIS:There were many related researches to the clinical classification of Legg-Calv?-Perthe disease,but uniform conclusion is absent.A reliable and unified clinical classification is beneficial for the orthopaedic physicians to find out the risk factors at early stage,and take therapeutic measures as soon as possible,so as to prevent the malformation of the femoral head.Ideal classification criteria with good reliability and consistency,are closely related to the disease prosthesis,and should be used at early stage.CONCLUSION:X-ray typing is commonly used in the clinical classification for Legg-Calv?-Perthe disease,but it is difficult to apply at early stage.Bone scanning can forecast results,and also induce irradiation.Due to good sensitivity and high resolution,MRI has an earlier effect on detecting necrosis and collapse,and is potential for further development and application,however,it also calls on a long-term clinical follow-ups.