{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T20:11:47Z","timestamp":1777407107915,"version":"3.51.4"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Oper Orthop Traumatol"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:sec>\n                <jats:title>Operationsziel<\/jats:title>\n                <jats:p>Die proximale femorale Varisationsosteotomie (PVO) ist eine chirurgische Technik zur Rezentrierung des H\u00fcftkopfes, sofern es bspw. im Rahmen der ablaufenden Legg-Calv\u00e9-Perthes(LCPD)-Krankheit zur Subluxation gekommen ist.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Indikationen<\/jats:title>\n                <jats:p>Bis anhin existieren keine einheitlichen Indikationskriterien f\u00fcr die Containment-Therapie bei LCPD-Patienten. Einzelne, f\u00fcr die Deformit\u00e4tsentwicklung pr\u00e4diktive radiologische Faktoren, Alter bei Diagnosestellung oder Symptombeginn und Klassifikationen, welche die Pathomorphologie des Femurkopfes bezogen auf die Nekrose beschreiben, k\u00f6nnen die Indikationsstellung erleichtern.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Kontraindikationen<\/jats:title>\n                <jats:p>Die absolute Kontraindikation stellt die Entwicklung eines Scharniergelenkes dar (Hinge-Abduktion). Bleibt der Femurkopf in einer Abduktionsr\u00f6ntgenaufnahme von\u00a020\u00b0 auch in Abwesenheit einer Hinge-Abduktion dezentriert oder besteht ein Total-Kopf-Befall, ergibt sich ebenfalls eine Kontraindikation. Relativ kontraindiziert ist die PVO bei Kindern mit Beginn der Erkrankung &lt;\u202f6\u00a0Jahren, in der Lateral-Pillar-Klassifikation Gruppe A soiwe bei I\u00a0und\u00a0II nach Catterall.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Operationstechnik<\/jats:title>\n                <jats:p>Lateraler Standardzugang zum proximalen Femur. Platzieren des Anteversions-K-Drahtes ventral des Schenkelhalses. Weitere K-Dr\u00e4hte werden parallel mithilfe von Positionierinstrumenten in den Schenkelhals eingebracht. Der optimale Bereich f\u00fcr die Osteotomie wird aufgesucht. F\u00fcr die Vereinfachung der Manipulation des distalen Fragments und als Referenz f\u00fcr die Derotation werden am Femurschaft weitere K\u2011Dr\u00e4hte eingebracht. Nach Femurosteotomie erfolgt proximales Fixieren der Platte durch sukzessives Auswechseln der K\u2011Dr\u00e4hte gegen winkelstabile Schrauben. Die interfragment\u00e4re Kompression erzeugt eine exzentrisch positionierte Kortikalisschraube im mittleren distalen Plattenloch. Die weitere distale Fixation der Platte erfolgt mit winkelstabilen Schrauben. Auswechseln der Kortikalisschraube gegen eine weitere winkelstabile Schraube. Alternativ zur hier beschriebenen winkelstabilen Technik wurde fr\u00fcher meist mittels Winkelplatte korrigiert.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Weiterbehandlung<\/jats:title>\n                <jats:p>Mobilisation unter Abrollbelastung an 2\u00a0Gehst\u00f6cken \u00fcber 6\u00a0Wochen. R\u00f6ntgenkontrolle und bei gen\u00fcgender Knochenkonsolidation Steigerung der Belastung. Implantatentfernung nach 9 bis 12\u00a0Monaten. R\u00fcckkehr zum Sport ab 3\u00a0Monaten.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Ergebnisse<\/jats:title>\n                <jats:p>Die PVO ist eine in der Behandlung von LCPD nahezu seit 60\u00a0Jahren angewendete und weltweit etablierte chirurgische Technik. Durch ein stetig wachsendes Verst\u00e4ndnis der Grunderkrankung wird einerseits die Indikationsstellung f\u00fcr operative Interventionen optimiert. Andererseits tragen neue Implantate zur Verbesserung der klinisch-radiologischen Resultate und Verringerung von Komplikationen w\u00e4hrend und nach Operation bei.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00064-022-00778-3","type":"journal-article","created":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T18:12:04Z","timestamp":1659377524000},"page":"307-322","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Proximale Varisationsosteotomie des Femurs beim Morbus Perthes","Proximal femoral varus osteotomy in Legg\u2013Calve\u2013Perthes \ufeffdisease"],"prefix":"10.1007","volume":"34","author":[{"given":"Adam","family":"Kr\u00e1tk\u00fd","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel Johannes","family":"Kraus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas H.","family":"Krieg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,8,1]]},"reference":[{"key":"778_CR1","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1302\/0301-620X.47B3.489","volume":"47","author":"A Axer","year":"1965","unstructured":"Axer\u00a0A (1965) Subtrochanteric osteotomy in the treatment of Perthes\u2019 disease: a preliminary report. 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