REVIEW OF PATIENTS WITH PERTHES DISEASE RESPONDING POORLY TO NEAR INFRARED IRRADIATION THERAPY

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Since 1993, we have applied a combination of brace treatment and near infrared irradiation therapy (NIIT) in 23 cases of Perthes disease. We previously reported that in patients in whom this combined therapy was started before the early fragmentation stage, lateral pillar formation through ossification of the lateral femoral head occurred quickly and exacerbation of femoral head deformity was mild, thereby shortening the period required for treatment. However, of the 16 patients who began to receive the combination of brace treatment and near infrared irradiation therapy during the early stage of Perthes disease, 4 developed evident femoral head collapse of varying degrees during treatment and 2 of these 4 were rated as poor according to Mose’s criteria. Collapse occurred 5-6 months after the start of treatment. In the 2 cases rated as poor according to Mose’s criteria, it seemed that weight-bearing and one-month suspension of treatment had also affected the onset of collapse. To improve the outcome of near infrared irradiation therapy, it seems desirable to continue daily application without allowing any intervals to the treatment of one week or longer. Furthermore, it is essential to ensure the correct parameters of the NIIT system and the number of sessions, restrict weight bearing and use a brace carefully during the first 7 months of treatment.