抄録
In the treatment of Perthes disease, femoral head collapse often develops during conventional treatment, and some investigators have reported the absence of any significant difference in the prognosis between conservatively treated cases and untreated cases. Thus, no consensus has been reached about the effectiveness of the conventionally used conservative therapy. We previously reported, for the first time in the international literature, the possibility of shortening the treatment period and preventing aggravation of femoral head deformity in patients with Perthes disease by starting treatment as early as possible using a combination of non-weight bearing brace therapy and near-infrared (near-IR) irradiation. In the present study, we compared the treatment outcomes in 16 cases of Perthes disease treated with near-IR irradiation with 11 cases not treated with near-IR energy focusing on the time-course of changes in the lateral pillar height (which is the factor most closely related to the treatment outcome) and demonstrated that if treatment with near-IR energy,combined with leg traction and brace therapy, is started in the early stage of Perthes disease, alleviation of all of the restricted range of hip motion, hydrarthrosis and lateral subluxation of the hip could be obtained, with stimulation of lateral pillar formation. In addition, it was shown that when thorough non-weight bearing brace therapy is combined with near-IR treatment, patients are unlikely to show delayed healing of necrosis due to femoral head collapse or the vicious circle of aggravation of the femoral head deformity; the therapy may be expected to accelerate repair on the medial and lateral sides of the femoral head nucleus, with shortening of the disease treatment period and prevention of aggravation of femoral head deformity. Near-IR irradiation is more useful than conventional conservative therapy and is an exciting and novel therapeutic modality for aseptic necrosis of the femoral head, the characteristic feature of Perthes disease.
