Perthes disease (aseptic necrosis of the femoral head)

May 7, 2013

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Perthes Disease   (completely this disease called Legg-Calve-Perthes ) - Is a relatively frequent pathology of the hip joint in children. Quiet hip disease , Which is observed in this disease primarily manifest in patients age - 3 to 15 . However, in adults and is a disease also occurs. In the course of its progression disturbed blood supply to the cartilage of the joint. Manifestation Necrosis   aseptic nature and has nothing to do with the influence of infections on the human body. Violation of the blood supply is temporary. However, under its influence tissue femoral head gradually die. As a consequence, there is irritation and inflammation. With Perthes' disease   most commonly it affected one joint, but in some cases it is possible and a bilateral joint damage.

About five times more likely Legg-Calve-Perthes   diagnosed in boys. At the same time this disease in girls is more severe. The first time a description of the disease appeared about a hundred years ago. Then, it was defined as a specific form Arthritis   hip joint in children.

Causes

Peters disease develops in a child when he observed some have congenital and acquired factors. The background on which appears necrosis of the femoral head, it is often the underdevelopment of the lumbar spinal cord ( myelodysplasia ). This part of the spinal cord provides innervation of the hip joints. This pathology can be congenital due to hereditary. It is observed in many children, it is determined by a few degrees of severity.

Mild myelodysplasia may remain undiagnosed during life. But the more severe disorders in the development of the spinal cord then become a cause of orthopedic diseases, including Perthes' disease.

When myelodysplasia structure of the hip joints is slightly different from the normal version. This pathology is expressed in children less and caliber of the nerves and blood vessels, resulting in decreased blood flow to the tissues of the joint. The investigation of the phenomenon - an insufficient supply of nutrients, as well as reducing the tone of the vascular wall.

But Perthes disease in the child begins to develop only if a complete cessation of blood supply to the femoral head. This may occur because of several factors. This injury leads to clamping of blood vessels, inflammation of the hip joint, which develops under the influence of the infection. The joint infection gets sometimes even with colds or other contagious illnesses.

As a result, blood flow is completely blocked, and the femoral head are formed foci of necrosis.

Symptoms

Aseptic necrosis of the femoral head in children is developing by stages. Provided Five stages of the disease . In the first phase developing aseptic necrosis, a second secondary compression fracture occurs. The third stage of Perthes' disease is a process of fragmentation and dispersal areas of dead spongy Tacna. At the fourth stage, the recovery, and the fifth secondary changes occur.

Consequently, the symptoms depend on the stage of the disease, the spread and degree of necrosis. In the first stage of the disease Perthes noticeable symptoms of the disease may not be marked, or they are minor. A child can talk about periodically manifested moderate pain in the hip or knee. Sometimes the children are marked changes in gait: it starts a little privolakivat leg.

If the disease develops further, then gradually deforms the femoral head, which in turn leads to changes in the biomechanical joint. As a consequence, the child begins to limp, suffers from joint pain or leg. And the pain and lameness appears from time to time, sometimes a period when the patient did not care, can last for weeks or months. Often the pain develops due to muscle spasm, which occurs due to irritation in the joint. The pain becomes more intense when driving, sometimes it moves to the groin, buttocks. Once the child rest in a state of rest, the pain becomes less pronounced.

If left untreated avascular necrosis of the femoral head, the subsequent period IMPRESSION fractures   in the area of ​​necrosis. Then the child of the affected limb is getting shorter, which significantly even during the visual inspection. The child gets tired during the walk, he has a pronounced limp.

At the same time in the first stage osteochondropathy femoral head is reversible, and provided a relatively small foci of necrosis and the rapid restoration of normal blood circulation disease can be cured, and not going into the stage of deformation of the femoral head. Therefore, at the slightest suspicion of such pathology should undergo a thorough examination.

Diagnostics

Determine the development of Perthes' disease in the initial stages allows carrying out X-ray examination. If necessary, the expert also appoints conducting magnetic resonance imaging and ultrasound hip. Such methods allow for more information.

In some cases, to differentiate from other diseases assigned for laboratory studies. In the treatment of X-ray examinations are carried out several times to follow the dynamics of improvement.

Treatment

Perthes disease, identified in the diagnostic process, require specific treatment. Treatment in children involves periods immobilization   any restriction of motor activity. Once a child is diagnosed the disease as soon as it is necessary to adhere bed rest to avoid stress on the affected joint. Therefore, the patient can walk only with crutches. To provide centration Apply different orthotics. It is also practiced massage, physiotherapy. Usually, Perthes disease   children can be cured, and after about 2 years of a child can lead completely normal lives without reason to take any motor limitations.

Practice more intensive process of treating the girls, but boys worse prognosis for recovery and the effects of the disease.

If you have children in the age group of 2 to 6 years, the survey results indicate weakly expressed signs of the disease, the treatment of Perthes' disease is only in the observation. If the symptoms of the disease have been reported in children at an older age, is held in a certain therapy, depending on the individual characteristics of the disease.

Perthes disease in adults treated with all the individual characteristics   - Age, comorbidities, severity. However, in adult disease leads to irreversible changes which result can sometimes even be disabled. In adults most often practiced surgical treatment. In the early stages of the disease is carried out tunneling of the femoral head, and in severe cases, may conduct arthroplasty .

Treatment of Perthes' disease in children, doctors are trying to carry out with the help of non-surgical methods. In order to reduce inflammation in the hip assigned treatment with nonsteroidal anti-inflammatory drugs. Sometimes these drugs can take a child for several months. But the doctor periodically conducts a study tracking how extensively restored tissue. In the process of restoring the child shows the execution of simple exercises from a special complex of physiotherapy.

Sometimes, the doctor decides to use the cast, which can be used to hold the femoral head in the acetabulum. It is used so-called Headband Petri . This two-sided patch of plaster, which is applied to both feet. In the middle of the dressing is a wooden beam, which gives the opportunity to keep your feet divorced position. Such a bandage for the first time applied to the patient in the operating room.

Surgical treatment   It allows you to restore the hip bones of a normal location. To do this, the surgeon carries out the necessary manipulations. After surgery, the patient bandage corset made of gypsum, which is to be worn for about two months. After removing the plaster cast is assigned a set of physiotherapy with a minimum load on the hip joint.

Preventive measures aimed at avoiding prevention of Perthes' disease in children and adults, does not exist. But it is very important to diagnose the disease as early as possible and to provide the right treatment. In this case, therapy will be most effective.