REVASCULARIZATION FROM THE NUTRIENT ARTERIES IN THE EPIPHYSIS OF PERTHES' DISEASE
Atsumi T, Kajiwara T, Hiranuma Y, Tamaoki S, Asakura Y
Department of Orthopaedic Surgery, Fujigaoka Hospital, Showa University School of Medicine, Yakohama, Japan

Revascularization from the lateral epiphyseal arteries supplying the blood to the lateral extensive area of the epiphysis was observed in 28 hips of 25 patients with Perthes' disease using super selective angiography of the femoral medial circumflex artery. In 10 of 11 hips of the initial stage, revascularization was formed by numerous small arteries from extra osseous area of the epiphysis. These arteries were noted on the lateral periphery of the femoral head. The revascularization was observed into the femoral head until demarcation area according to the disease progression. However, visualization was absent below the acetabular roof. Of vascularization from the ligamentum teres arteries in 22 hips, revascularization was not found in 15 hips without lateral displacement. Vascular penetration consisting of numerous small arteries was noted in medial small portion of the epiphysis of 7 hips with marked subluxation. From this observation, we assume that revascularization was affected by mechanical loading.