Perthes disease in children and adults: symptoms and treatment

The causes, symptoms and treatment of Perthes disease in children and adults

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Perthes disease - necrosis of a part of the head of the femur; still this process is called aseptic necrosis.

Aseptic means that it has arisen not as a result of a purulent process or bacterial infection, but rather a process of a dystrophic nature.

The edge of the bone that is adjacent to the acetabulum, or the upper hemisphere, undergoes necrosis.

Perthes' disease in children occurs from the age of five. In adults, this disease is not diagnosed, since all primary symptoms and related disorders appear in childhood.

Of course, an adult lame person can come to the doctor, and his diagnosis will be exposed in adulthood. But at the poll it will be found out that the problems with the leg worried him in childhood and adolescence.

Usually, the girls have a more severe illness, with a high probability of disability, but mostly the boys fall ill: for every 5 boys there is one case for the girl.

The pathology of Perthes can significantly reduce the quality of human life. The prognosis can be as favorable, when the person as a whole keeps health and can lead a full-fledged way of life, and unfavorable - when coxarthrosis and disability develops.

Treatment is necessary for a long and complex.Therapy can be successful - it depends heavily on the parents' prompt response to the problem symptoms of their children.

Next, I will talk about this disease and the ways of its timely correction, which can lead to a full recovery.

Causes and development of Perthes disease

For a long time, doctors (scientists) did not know why this particular disease occurs; they believed that the reason could be be virtually any negative factor: from increased stress on the joint to congenital endocrine diseases.

Now (this article was written in 2016) the most likely mechanism for the development of the pathology of "Perthes disease" is the following:

1. There are predisposing factors to pathology: congenital maldevelopment of the spinal cord (myelodysplasia) in the department that controls the innervation (nerve connection) of the head of the femur.

2. As a result, the vessels and nerves that feed and control the hip joint are worse in these children, smaller in size, fewer in number than in healthy children. For example, instead of 10 arteries and medium-sized veins in children with children, there are 3-5, and underdeveloped.

3. This leads to chronic malnutrition of the head of the femur.

But this condition does not lead to necrosis, as for this the blood supply should practically stop.

This is what leads to so-called "producing" factors: it can be a minor injury or a local inflammatory process in the joint area.

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They will lead to the final squeezing of the vessels, which are already narrow and do not have reserve capacity for blood flow in conditions of inflammatory edema.

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For example, a small respiratory infection or harmless baby jumps can trigger the process of necrosis and the development of a myocardial infarction. It is from this moment that clinical manifestations begin.

Symptoms

Click on photo to enlarge

1 st stage

Perthes' disease at its initial stage (the first stage) has scant symptoms:

• weak and unstable pain in the thigh or hip joint,
• easy periodic limping or "flapping" of the foot.

Such a blurred picture leads to the fact that these symptoms are regarded as the consequences of a bruise, and the treatment is late, when exactly at this first stage, recovery is sometimes possible, if the focus of necrosis is small, and blood circulation can be restored quickly enough.

2 stage

If treatment was not prescribed at an early stage of the pathology, and necrosis occurred in a significant area of ​​the upper hemisphere, there is no hope of restoring blood flow.And the second stage begins, the key event of which is the process of prolonged deformation (destruction) of the necrotic bone tissue of the head of the femur.

It is the treatment of deformed and, in fact, dead tissue and is a serious problem for traumatologists and orthopedists.

This long process is connected with the fact that the dead head is much more fragile and unstable, it collapses under the influence of the usual load. Subsequently, depressed (impression) fractures of the femoral head are developed.

In the second stage, Perthes' disease has the following symptoms:

• lameness and pain in the leg;
• periodic violations of the function in the hip joint;
• vegetative-trophic disorders in the foot: pallor, sweating;
• periodic increase in temperature to 3, -38 degrees.

Two outcomes of the disease

There is a favorable and unfavorable outcome of events:

1. In the first case, the hip joint retains its efficiency until old age, without creating any special problems (this happens when parents pay attention to early symptoms).

2. With an unfavorable outcome, deforming coxarthrosis develops, which leads to frequent disability at the most "blooming" age: 16-25 years.

Perthes disease and its treatment is a complex and complex problem of traumatology and pediatric orthopedics (respectively, traumatologists and orthopedists treat the disease).

the task of therapy: in any circumstances and by any means to preserve the round anatomical shape of the head of the femur and its position (to achieve the center of the head in the acetabulum).

Conservative treatment

It is necessary:

• Under no circumstances, with the early detection of Perthes disease, one can not rely on a sore leg, up to the appointment of bed rest.
• When lying in bed, legs should be planted, lying on one side is not recommended.
• To do special therapeutic gymnastics, massage.
• Conduct electromyostimulation of the muscles adjacent to the hip joint.
• Treat concomitant inflammation in the hip joint (apply NSAIDs, vitamins, antibiotics).
• Take drugs that improve blood flow (pentoxifylline, trental).
• Take reparant drugs - improving the regeneration of tissues: it is methyluracil, vobenzym;
• Take osteo-protectors (means that protect, restore bone tissue) and chondroprotectors (means to protect and restore articular cartilage).

Widely used special tires, holding the legs in a dilute position, plaster casts - struts, coaxial dressings.

With stationary and postoperative treatment, skeletal traction is possible.

The suffering pathology of "Perthes' disease" when performing rehabilitation programs is very useful for swimming, since it does not load hip joint axial, longitudinal load, but, conversely, unloads it, forcing the muscles to work and maintain at the optimal level circulation. Treatment with swimming and other methods of balneotherapy is very shown in adolescence.

Conservative treatment is effective only if the parents are attentive to the complaints of the child, within just a few days or weeks from the onset of the disease, they turned to the orthopedist and put the baby in bed even before the doctor's consultation - and thus did not allow the head to deform bones.

Operative intervention

In the event that conservative treatment is not effective, then the operation is indicated.

Perthes' disease is treated surgically in severe cases: with early, complete and bilateral necrosis. For the operation, the children are selected after reaching the age of 6-7 years old, having the symptoms of a developing subluxation of the head of the femur.

With Perthes' disease, plastic surgeries are performed, both aimed at correcting the head, and on the "turn" of the acetabulum.

If the operation is performed according to the indications, then with a favorable outcome and timely intervention, the patient gets the opportunity to move without the help of crutches, walking stick and even without lameness (or with a light limp). But physical activities such as running and carrying heavy loads - are prohibited.

Summary

I would like to hope that after reading this article, parents will closely monitor their children, take note of their complaints with due attention and carefully observe their gait. In the event that the above symptoms occur - you need to contact a pediatric trauma or orthopedist in time to not miss the time and start treatment.

Stanislav Gromovoy

A source: http://SustavZdorov.ru/raznoe/bolezn-pertesa-275.html

Perthes' disease in a child and adult - diagnosis, symptoms, drug therapy and therapeutic gymnastics

Pathology is directly related to a malnutrition, blood supply to the head of the thigh.

The essence of Perthes' disease lies in inflammation and further necrosis of the hip joint tissues, the disease refers to a group of ailments called osteochondropathy.

Pathology develops in childhood or adolescence, does not threaten life, but greatly reduces its comfort.

Legg-Calvet-Perthes disease

There is an ailment in the hip joint area, in some cases affects bone tissue, vessels, articular region and nerves.

Perthes' syndrome will progress, so early diagnosis is extremely important, in most cases the development of the disease remains without due attention from the parents. Children more often sick boys 4-14 years old, girls have Perthes syndrome 5 times less often.

The affliction, as a rule, the right joint is affected, in severe cases there is a lesion on both sides, but one of them has a less pronounced violation and is quickly restored itself.

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This pathology refers to childhood diseases. Perthes' disease in adults can be detected, but a detailed survey reveals that problems with the hip worried the patient in childhood.

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All the symptoms that indicate the earlier development of Perthes' syndrome, typical disorders occur in a child aged 4 to 14 years.

The appearance of signs already in adulthood was not recorded in humans.

Perthes' disease in children

It affects the pathology of girls much less often than boys, but it is more severe, the probability of disability is high. In 5 cases of boys, there is only one case of girls.

Each 20th diseased child has a symmetrical lesion of both joints, in case of aseptic isolated lesion, necrosis affects the right femur head. In children, the symptoms of the disease significantly reduce the comfort of life.

In most cases, the prognosis is favorable, the patient can lead a full-fledged activity, but the possibility of developing coxarthrosis and disability is also noted.

Doctors can not name a single reason why Perthes syndrome develops. There are several theories that explain the occurrence of the disease depending on the root cause:

1. Traumatic. There is a disease as a result of displacement, trauma to the head of the femur.
2. Infectious. Microbes or viruses strike their joints with toxins, triggering the launch of an immune response to an infection.
3. Hormonal. In the transition years, there is a shift in the hormonal status.
4. Exchange. With the development of the pathology of metabolism of minerals, phosphorus and calcium, which play an important role in bone formation.
5. Genetic. Congenital, hereditary disease, which was transmitted from the parents.

One of the factors that affects the probability of the appearance of Perthes syndrome is the presence of myelodysplasia in the lumbar spinal cord. This part is responsible for the innervation of the hip joints, ensures adequate blood flow. More often the disease occurs in children who:

• suffered rickets;
• weakened, often sick;
• have infectious allergic diseases;
• suffer from malnutrition (malnutrition).

Stages of

The development of the disease occurs gradually, without sudden deterioration of the condition. There are 5 stages of the pathogenesis of Perthes syndrome (hip joint disease):

1. The hidden form. This is the initial stage of the disease, during which there are minor, minor changes in bone tissue. There is a development of necrosis of spongy substance, penetration into the bone marrow.
2. The impression break. The weakened head of the thigh can no longer bear a heavy load. The shortening of the limb develops.
3. Resorption. The third stage of Perthes syndrome is characterized by bone resorption, the femoral head becomes flat. Pain with weight transfer to the affected leg becomes unbearable.
4. Recovery. The fourth stage of the disease is characterized by the beginning of the process of replacement of bone-cartilaginous connective structures. Painfulness decreases slightly, but the mobility of the leg does not return.
5. The final stage. Completely ossifies the connective tissue. The pain passes, the mobility of the limb is completely lost.

Symptoms

The development of Perthes' syndrome occurs smoothly, the parents do not immediately notice the problems with the child. Further, they connect the appearance of symptoms with a previous infection of the oropharynx (sinusitis, tonsillitis, etc.). Symptoms of the disease manifested as follows:

• slight, dull pain when walking in the joint region, sometimes along the entire length of the leg or in the knee zone;
• lameness, change in gait (the child starts to fall on the injured leg or is hanging it).

When these signs of Perthes' syndrome appear, parents do not immediately go to the doctor, because they do not restrict the child in activities, and he continues his usual activities. This leads to a deformation, a fracture of the head of the bone. With Perthes's syndrome, at the stage of severe changes in the anatomy of bone tissues, there are:

• edema in the affected area of ​​the joint;
• painful pain when walking;
• weakness of gluteus muscle;
• development of deforming arthrosis;
• pronounced, obvious lameness;
• difficulties with the rotation, extension and flexion of the joint;
• turn out the leg does not work;
• increase of lymphocytes, increase of ESR value with leukocytosis;
• sometimes there is an increase in body temperature to 3, degrees;
• the pulse on the toes decreases;
• vegetative disorders appear in the limb region: severe sweating of the foot, cooling, pallor;
• wrinkledness of the foot skin.

Diagnostics

For the diagnosis of Perthes syndrome, the most important study is the radiography of the hip joint.

If necessary, the standard projection images and the X-ray diffraction pattern of the Lauenstein projection are used to check the assumption. The brightness of the picture on the results depends on the severity of the disease.

To classify the Perthes syndrome according to the X-ray picture, the Salter-Thomson and Catterol system is used.

Classification of Catterol

According to this system there is a division of Perthes's syndrome into 4 groups, each of which is characterized by a certain set of symptoms and the brightness of their severity:

1. Group 1. Symptoms of Perthes syndrome are poorly expressed, there is a slight defect in the subchondral or central zone. The configuration of the femoral head is normal, there are no changes in the metaphysis, the fracture line is not determined.
2. Group 2. There are violations of the contour of the head, sclerotic, destructive changes are seen on the roentgenogram. There is an emerging sequester, signs of fragmentation of the head.
3. Group 3. The head is almost completely affected, the head is distorted, the fracture line is revealed.
4. Group 4. The head is completely affected, the fracture line, the changes in the acetabulum are visible.

Classification of Salter-Thomson

Another system for determining the group by the stage of development of Perthes syndrome. If in doubt at the first stage of the definition of the disease, a hip MRI of the hip joint may be prescribed to the patient. The following categories are distinguished by the results of radiography:

1. Group 1. Determine the subchondral fracture can only be done with a picture in the Lauenstein projection.
2. Group. A subchondral break is visible in all the pictures, the outer border of the head is changed.
3. Group 3. Affects subchondral fracture of the outer part of the epiphysis.
4. Group 4. It spreads to the entire epiphysis fracture.

Treatment

In most cases, Pertes syndrome is treated conservatively. The physician selects the optimal treatment regimen based on the studies based on the general condition of the patient.

The course lasts at least one year, if the stage of Perthes's pathology is neglected, then this period increases to 4 years.

The operation is prescribed to the patient only if the child is older than 6 years and severe complications of the disease have manifested itself.

Medication Therapy

This method refers to the conservative treatment of Perthes's syndrome.

To stop or reduce intensity in the hip joint of inflammatory processes, medics prescribe non-steroidal medications, for example, ibuprofen.

Take this remedy a long time (several months), a change in tactics of application occurs after the beginning of the process of tissue repair.

If there is a progression of deformation, restriction of motion, may prescribe a plaster bandage for the treatment of Perthes syndrome.

It helps for a while to immobilize the statute, so that the restoration of articulation of the articular cavity and bone head begins.

A dressing is applied by a surgeon, in the presence of a spasm, cuts of the external thigh muscle can be performed. Also necessary:

• remove fully the load from the hip joint (exclude running, jumping, riding a bicycle);
• maintenance of muscle tone;
• use orthopedic structures, skeletal hoods in the treatment of disease;
• prescribe an appointment with Perthes syndrome of angioprotectors, chondroprotectors, vitamins, microelements, food with high protein content.

The disappearance of pain will occur only when the tissues are fully restored (adherent). If the disease was diagnosed at the first stage, then for the treatment of Perthes's syndrome may be appointed:

• walking on crutches, with special insoles;
• LFK (gymnastics) - a complex of special exercises;
• massages;
• mud therapy, diathermy.

Surgical intervention

With Perthes syndrome, surgical operations are performed only if the disease is severely started. As a rule, it can be assigned to 2-3 stages.

During the operation, the patient is removed from the biomechanical disorders of the joint, establishes special designs for traction, apply the needles. The orthopedist should correct the position of the joint in the acetabulum if necessary.

During the operation, the problem of shortening the muscle will be solved. This helps to fix the joint in a certain position for 2 months.

A source: http://sovets.net/12413-bolezn-pertesa.html

What is Perthes' disease: symptoms (photos, stages), treatment in adults, causes of children

Legg's disease Pertesa is a pathology in which the bone tissue is a disorder of the vasculature. This process occurs in the region of the femoral head with its further necrosis (necrosis).

This disease belongs to the most common diseases of the hip joint, which develop not only in children (3-14 years), but also in adults.

Most of all such pathology are affected by boys, but girls can also be found to have a Perthes disease, which takes place in a very severe form.

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Early stages of the disease can not be determined, since their symptoms are invisible. In 5% of people, the development of Perthes' disease has a two-sided nature. In the absence of timely treatment, the last stages of the disease can be very difficult.

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Moreover, the patient may experience deformity (shortening) of the limb, ankylosis, secondary coxarthrosis and lameness, which often leads to disability both in childhood and in adulthood.

Diagnosis of leggie Perthes disease may be based on the patient's age, results of X-ray diagnostics, symptoms and characteristic complaints.

The process of treatment of the pathology is quite long, and in the presence of severe consequences, a reconstructive-restorative operation of the hip joint is done.

International Classification of Diseases 10 revision (ICD 10), children's osteochondropathy of the femoral head is located under the code M91.1.

Presumably the causes of the appearance of this disease are polyethyl.

In other words, it is associated with the innate tendency of the body and the influence of unfavorable environmental factors.

The most popular hypothesis of the origin of the disease says that by its development it is obliged to the pathological processes developing in utero - myelodysplasia of mild degree.

This disease is an underdevelopment of the lumbar segments of the spinal cord, the symptoms of which are mostly not manifested for many years.

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However, myelodysplasia is associated with various orthopedic diseases, while osteochondropathy (adolescent) of the femoral head is also no exception.

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So, the reasons for the development of Perthes' disease may be as follows:

• inflammation (allergic, bacterial, viral) of the hip joint;
• mechanical damage to the hip joint, even the minimal (harsh actions, jumps, falls, etc.);
• disorder of mineral metabolism;
• hormonal disorder occurring in the child's body, for example, during hormonal adjustment in adolescents.

As a rule, many parents attribute the causes of the appearance of Perthes' disease to a recent acute respiratory infection.

Stages and symptoms

There are five stages in the course of Legg-Calvet-Perthes disease. The disease that occurs in the initial stage of osteonecrosis is characterized by such signs as the cessation of blood supply to the head of the femur, in consequence of which focal necrosis develops.

In this case, the site is not affected often and reaches 10% of the bone mass of the hip joint.

This stage passes without any clinical manifestations although sometimes there are minor gait disturbances (foot dragging, loss of one leg).

In the second stage (impression fracture of the femoral head) of Perthes' disease, even ordinary loads lead to partial destruction of bone tissue - appears depressed by the break and develops deformation of the head of the hip joint, and the zone of structural changes is from 10 to 30%.

At this stage, there are symptoms such as pain and uncomfortable sensations in the knee and hip area during movement, which causes the child to limp when walking.

At the stage of fragmentation, Perthes' disease progresses and some of the dead bone tissue is fragmented and disintegrated. The damage area increases - it is 30-50%.

At this stage, the symptoms are severe and constant pain. The functions of the hip joint are limited, soft tissues swell.

Moreover, Perthes' disease in children is manifested by a change in gait, expressed by lameness, and in In some cases, the supporting functions of the legs are violated, there is a high fever and other symptoms intoxication.

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Regeneration processes predominate at the stage of repair over degenerative processes. Between some places of bone tissue connective tissue is formed and blood vessels develop. The composition of the newly formed bone is similar to the usual, but its strength is much less.

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In addition, at the stage of repair, the growth of the femoral head is restored.

If the correct treatment of Perthes' disease is not carried out, the development of the head will be promote further deformation, due to the fact that its form will become anomalous, to example, mushroom. Such pathologies lead to the appearance of secondary coxarthrosis and subluxation.

At the stage of the outcome, Perthes' disease becomes chronic, so the consequences develop. However, probably an absolute recovery without the occurrence of complications.

An important factor is the unity of the cartilaginous growth area. In a child, it provides growth of the femur along.

With the development of deformation of the femoral head at the fourth stage, there are symptoms of deforming progressive arthrosis of the hip joint.

Treatment of Perthes disease

Perthes' disease in children, as a rule, is treated in a conservative way. The therapy is quite long - it takes from 1 to 2.5 years. But sometimes the duration of treatment lasts up to 4 years.

Surgery is only performed in case of complications. In addition, surgical methods for treating Perthes' disease can only be used when the child reaches the age of six.

Conservative therapy, mainly carried out in special orthopedic centers. After that the child should be constantly observed at the orthopedist in a local out-patient department.

Perthes' disease is treated with:

• The use of plaster casts, stretching, complex orthopedic structures and special beds that prevent deformation of the femoral head, which can be seen in the photo below.
• Stimulation of regeneration of a healthy bone tissue structure;
• The activation of blood flow in the thigh area with the use of medicamentous and non-medicamentous methods of therapy.
• Full discharge of the hip joint for a certain period of time.
• The formation and subsequent strengthening of the muscular system of the thigh through exercise therapy and therapeutic gymnastics.

If it is necessary to use skeletal traction or immobilization with the use of tires, gypsum dressings, braces to support the muscles of the skeleton, electromyostimulation is used.

As a rule, Perthes' disease is treated with chondroprotectors, vitamins, angioprotectors, microelements. Motor abilities develop in the fourth stage of the disease.

Surgical Therapy

To eliminate the symptoms and consequences of Peters's disease (using reconstructive-reconstructive surgery.

However, it can be done only when the child reaches the age of six.

Indication for the surgical intervention - a large area of ​​osteonecrosis, dislocation and progression of severe deformation of the femoral head, as shown in the photo.

Often, such operations as medializing corrective osteotomy of the femur and rotational transposition of the acetabulum are performed according to Salter. After surgery, you should definitely undergo a long rehabilitation course.

A source: http://sustav.info/bolezni/drugie/bolezn-pertesa.html

Perthes' disease in children

Perthes disease, or Legg-Calvet-Perthes disease, is a disease in which blood supply to the bone tissue in the region of the femoral head is violated, followed by necrosis (necrosis).

This pathology is one of the most common diseases of the hip joint in children from three to fourteen years old.

Boys are more often ill, but in girls the osteochondropathy of Legga-Perthes has a heavy course.

The disease has several stages and in the beginning it is practically asymptomatic, which considerably complicates its diagnosis. In 5% of cases, Perthes' disease is bilateral.

If treatment is not started on time, the consequences can be very severe.

Secondary coxarthrosis, deformity of the limb, its shortening, ankylosis, various abnormalities of the gait may develop, which often becomes the cause of disability even in childhood or in adults.

Juvenile osteochondropathy of the femoral head can cause disability

The diagnosis of Calve-Perthes disease is established on the basis of the patient's age, typical complaints and symptoms, and X-ray diagnosis data.

Treatment is long, conservative.

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In especially severe cases or in the presence of complications resort to reconstructive and restorative operations on the hip joint.

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According to the international classification of diseases 10 revision (ICD 10), juvenile osteochondropathy of the femoral head is under the code M91.1.

Causes and mechanism of development

At the moment there is no single theory of the development of Perthes' disease. It is believed that this ailment has a polyethological origin, that is, it is associated with a congenital predisposition of the organism and the impact of negative environmental factors.

According to the most common hypothesis of the origin of the pathology, it is caused by a defect in the intrauterine development, such as myelodysplasia of mild degree.

This is the underdevelopment of the lumbar segments of the spinal cord, which in most cases is not manifested in any way throughout life, but is associated with a variety of orthopedic ailments, including with juvenile osteochondropathy femoral head.

With Perthes' disease, the blood vessels of the head of the femur are underdeveloped

Under normal conditions (in people without myelodysplasia), these vessels are 10-12, they have a relatively large caliber and manage their task well, providing the bone with all the necessary substances.

In children with myelodysplasia of such arteries, only 2-4, their caliber is shallow. Therefore, the head of the thigh is constantly in a state of deficiency of nutrients and oxygen.

Factors that contribute to the development of Perthes' disease:

• mechanical trauma of the hip area, even insignificant (jump, light bruise, roll, fall, clumsy and abrupt movement, etc.);
• inflammatory lesions of the hip joint (viral, bacterial, allergic nature);
• hormonal imbalance in the child's body, for example, during the period of hormonal adjustment in the transition years;
• a violation of the mineral metabolism in the body.

Even an ordinary jump can provoke Perthes' disease in children predisposed to her

Most often, parents associate the appearance of symptoms of hip injury with a previous acute respiratory infection. Some children manage to trace and hereditary predisposition to ailment.

Stages and symptoms

During the course of the disease, 5 consecutive stages are isolated.

Stage of osteonecrosis

It is at this point in the development of the termination of the blood supply to the head of the femur and its focal necrosis develops. The affected area rarely reaches 10% of the entire bone mass of the femoral head.

This stage is asymptomatic. Very rarely there can be a minimum disruption of the child's gait by the type of foot dragging, hitting on one limb.

Also, sometimes, low-intensity pain develops in the hip area.

Stage of Impression Hip Fracture

Under the influence of usual loads, a part of the bone tissue is gradually destroyed - a depressed fracture develops and a deformation of the femoral head is formed.

The area of ​​structural changes reaches 10-30%.

At this stage, pain and discomfort develops in the hip and knee area during movements, the baby begins to limp.

In the picture, the depression of the femoral head

Fragmentation stage

During this period, part of the destroyed bone begins to fragment and disintegrate into parts. The amount of damage increases to 30-50%. The pain is pronounced, does not pass and at rest.

The restriction of movements in the hip, swelling of soft tissues develops. Gait changes, limping becomes distinct, sometimes the supporting function of the limb is broken.

Some children have fever and other symptoms of intoxication.

The stage of repair

Gradually over the processes of destruction, the processes of healing and recovery begin to predominate.

Between the separate fragments of bone tissue connective tissue develops, blood vessels grow, a new cat tissue is formed.

The structure of the newly formed bone is close to normal, but, unfortunately, its mechanical strength is much lower.

Also at this stage, the growth of the femoral head resumes.

Sometimes, in the absence of adequate treatment for Perthes disease, head growth becomes the cause further deformations, since often it does not acquire a normal spherical shape, but, for example, mushroom-shaped. Such changes lead to subluxation and secondary coxarthrosis.

Outcome stage

At this stage, the effects of Perthes' disease develop, if they occur. Perhaps complete recovery without any residual effects.

An important point is the integrity of the cartilaginous growth zone. In children, it provides the growth of the femur in length.

In the case of extensive necrosis, this zone can be completely or partially destroyed.

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As a result, the formation of the upper end of the femur is impaired, the true shortening of the leg, the violation of gait and the supporting function of the limb develop.

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Perthes disease may be the cause of limb shortening, which in the future requires a complex surgical correction

In case of forming the deformation of the femoral head at the 4 th stage, a clinical picture of the progressive deforming arthrosis of the hip joint develops.

Diagnostics

The main method of diagnosis, which allows you to confirm or refute the diagnosis, is the radiography of the hip joints. Apply two projections:

• antero-posterior,
• the Lauenstein projection.

This is the necessary minimum of studies that are needed for diagnosis. It allows you to recognize the disease with high probability even in the first stage. In case of doubt, the specialist may additionally be assigned to the child a joint ultrasound and magnetic resonance imaging.

Differential diagnosis in children is necessary with such diseases as neurodysplastic coke and infectious-allergic arthritis of the hip joint.

Radiography of hip joints - the main method of diagnosis of osteochondropathy of the femoral head

Treatment of Perthes disease

Treatment of Perthes' disease in children is mostly conservative and prolonged. The minimum period is one year. On average, therapy takes a year, and in some cases increases to four. The operation is prescribed only in the presence of severe complications to children after 6 years.

Conservative therapy

Conservative treatment, as a rule, begins in specialized orthopedic centers with the subsequent supervision at the children's orthopedist in an out-patient department on a residence.

You can also read:Children's dysplasia of the hip joint

Therapy includes:

• complete unloading of the hip joint for the required time;
• application of traction, plaster casts, special orthopedic structures and beds to prevent deformation of the femoral head;
• improvement of blood flow in the region of the hip joint with the help of medicines and non-medicamentous methods;
• stimulation of restoration of normal structure of bone tissue;
• formation and strengthening of the muscular corset of the thigh with the help of therapeutic gymnastics and exercise therapy.

In establishing the diagnosis, support for the leg is partially or completely eliminated.

To do this, the child is prescribed a strict bed rest, and the older children are given a semi-bed with walking on crutches during wakefulness.

The main treatment is physiotherapy, massage, special medical exercises.

With Perthes' disease, a prolonged immobilization is given to the child by special tire-struts

If there is a need for skeletal traction or immobilization with gypsum bandages, struts, tires, then electromyostimulation is used to maintain the tone of skeletal muscles.

Medicamentous treatment includes the appointment of angioprotectors, chondroprotectors, microelements, vitamins. The motor mode is expanded at the 4th stage of the disease. All exercises are selected only by a specialist and monitor their implementation.

Surgery

Reconstructive and restorative operations are applied only from the age of 6 in patients with an extensive osteonecrosis zone, development of severe deformation of the femoral head, dislocation.

Most often perform such interventions as rotational transposition of the acetabulum according to Salter, correcting medializing osteotomy of the femur.

After surgical treatment it is necessary to undergo a long rehabilitation period.

Adults who have suffered Perthes disease, it is necessary throughout life to limit the load on the hip, because they have an increased risk of deforming arthrosis. It is also desirable to regularly undergo therapeutic and preventive courses of therapy and sanatorium treatment.

A source: http://MoyaSpina.ru/bolezni/bolezn-pertesa-detey

Perthes disease: symptoms and treatment

Category: Children's diseases 5458

• Increased temperature
• Pain in the hip joint
• Pain in the knee
• Pain in the hips
• Violation of gait
• Lameness
• Cold feet
• Restriction of joint mobility
• Edema of the periarticular tissues
• Leg pain
• Pain in walking
• Sweating of foot
• Weak muscle weakness
• Skin wrinkles on the foot
• Inability to turn the leg outward
• Paleness of the foot

Perthes disease is a malaise in which the blood supply to the bone structures in the region of the femoral head is impaired. As a result, necrosis develops.

This disease belongs to the most common hip joint pathologies that occur in children aged 2 to 14 years. Boys are more often ill, but the progression of the disease can occur in girls.

The disease occurs in several stages. As a rule, only one joint is affected. Bilateral lesion is noted only in 5% of cases. If you do not begin to treat pathology, then it is possible to develop very serious consequences:

• violation of gait;
• secondary coxarthrosis;
• ankylosis;
• deformity of the limb up to its shortening.

It is worth noting that Perthes' disease can cause disability even in childhood or even in adults. Therefore, it is important to diagnose it in a timely manner and carry out complex treatment.

Causes

The exact reasons, because of which the progression of Perthes' disease in children begins, is not accurately established to date. The leading theory is hereditary predisposition. Pathology can begin to progress under the influence of such factors:

• increased load on legs;
• previously suffered injuries - dislocations, fractures, strokes and so on;
• a malfunction in the immune system, as well as a physiological change in the hormonal status that occurs during adolescence;
• penetration into the body of infectious agents;
• a violation of the mineral metabolism in the body.

The risk group includes children:

• previously transferred rickets;
• long and often ill with various viral and infectious diseases;
• having hypotrophy;
• who suffer from various infectious and allergic ailments.

Stages of

Perthes' disease progresses gradually. Clinicians distinguish 5 stages of development of pathological process:

• hidden.Symptoms of the disease are absent. In bone structures, minor changes begin to occur. There is necrosis of spongy substance;
• impression fracture.Visually, it can be noted that the limb is shortened. The affected head of the thigh can no longer withstand high loads;
• resorption.Bony structures of the hip joint dissolve, and the head of the bone becomes flat. When the load on the affected leg appears severe pain syndrome;
• recovery.The pain syndrome subsides a little, but the normal functioning of the leg is not possible. Bony and cartilaginous structures are replaced by connective tissue;
• the final one.Formed earlier connective tissue gradually ossified. The pain syndrome disappears completely, but the mobility of the joint is completely lost.

Stages of development of Perthes disease

Symptomatology

Symptoms of Perthes' disease appear gradually.

At the first stage, signs of progression of pathology may be completely absent, but more often a aching pain in the thigh and knee arises in a person.

It is worth noting the fact that the first symptom to which the child complains is pain in the knee. Later the clinical picture is supplemented by such symptoms:

• pain syndrome manifested when walking. The pain is blunt and more often localized either in the region of the hip joint, or along the entire length of the affected limb;
• weakness of gluteal muscles;
• lameness;
• violation of normal gait. The patient moves with a characteristic attack on the leg, from the localization of the lesion (a characteristic symptom);
• a person does not have the opportunity to fully turn his foot out;
• rotation of the hip joint is limited;
• The joint is not flexed or bent;
• In the region of the affected joint there is a strong edema;
• pulsation in the fingers of the limbs is reduced;
• rise in temperature to 37.5 degrees;
• The foot turns pale and on palpation its coldness is noted;
• increased sweating of the foot;
• the skin on the foot is wrinkled.

Diagnostics

The most informative diagnostic method is the radiography of the hip joint. The research is carried out in two projections.

This technique makes it possible to identify the progression of Perthes disease in the early stages of development.

As an additional method of diagnosis using ultrasound, as well as CT.

Differential diagnostics:

• neurodysplastic coke;
• infectious-allergic arthritis.

Treatment

Treatment of Perthes' disease is usually conservative. The optimal method is chosen only by the doctor on the basis of the data of the carried out researches, and also proceeding from the general condition of the patient.

The minimum period of treatment is one year. With the advanced stage of Perthes disease, the course of treatment can last up to 4 years.

Operative intervention is shown to lead only in the presence of severe complications (children after 6 years).

Methods of conservative treatment:

• completely relieve the hip joint;
• to exclude the possibility of deformation of the femoral head, use gypsum dressings, extensions, orthopedic structures;
• drug treatment. Prescribe drugs to normalize blood circulation in the area of ​​the affected joint;
• stimulation of the restoration of the structure of bone tissue;
• therapeutic gymnastics and exercise therapy. This method of treatment allows to fully form the muscular corset of the thigh.

Medication includes:

• chondroprotectors;
• angioprotectors;
• vitamin complexes;
• microelements.

Surgical treatment is given to patients with a large osteonecrosis zone, pronounced deformation of the femoral head, and the presence of a dislocation. Doctors resort to such methods:

• Corrective medializing osteotomy;
• Rotational transposition of the acetabulum according to Salter.

Diseases with similar symptoms:

Epiphysiolysis (concurrent symptoms: 4 of 16)

Epiphysis is the defeat of the area of ​​the growth plate of the bone.

By this area is meant a part of the cartilaginous tissue, which is located on the end of long bones and constantly develops.

From the formation of the growth plate, the length and shape of the bone in an adult depends.

... Deforming osteoarthritis (coinciding symptoms: 4 of 16)

Deforming osteoarthritis - is considered a frequent pathology of joints, against which there is development degenerative-inflammatory process, leading to the destruction of their structures and their premature aging.

.

The main reason for the development of this pathology is excessive physical activity, but there are a number of other predisposing factors.

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They include excess body weight, professional sports, sedentary working conditions and many other sources.

... Osteoarthritis (coinciding symptoms: 3 of 16)

Osteoarthritis is a fairly common disease in which joints are degenerative and dystrophic.

Osteoarthrosis, the symptoms of which are initially associated with the gradual disintegration of cartilaginous tissue, and then with the decay of the subchondral bone and other structural constituting the joint, develops against the background of a lack of oxygen in them and can manifest itself in various forms with different areas of localization of the pathological process. In general, this disease is diagnosed in patients aged 40 to 60 years.

... Osteochondrosis of the knee joint (coinciding symptoms: 3 of 16)

Osteochondrosis of the knee joint (dissecting) is a disease of a degenerative-degenerative type. It mainly affects people at a young age, in most cases has a favorable course and ends with the recovery of patients.

... Tuberculosis of bones (coinciding symptoms: 3 of 16)

As a result of their penetration into the joint, fistulas are formed, which do not heal for a long time, its mobility is disrupted, and in more severe cases it completely collapses.

With the development and progression of tuberculosis of the spine, a hump and a spin may develop. Without proper treatment, limb paralysis occurs.

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A source: http://SimptoMer.ru/bolezni/detskie-zabolevaniya/1278-bolezn-pertesa-simptomy