Perthes' disease (osteochondropathy hip osteochondropathy femoral head) - the most common in children from three to fourteen years of disease of the hip joint is the most common in this ageinterval variation spongy necrosis femur.Most often there is a defeat of the right hip joint (two joints are affected in 5% of cases).Sometimes minor changes observed in the second joint, but often there is the opposite of self-development.
Perthes disease in children predominantly affects boys from five to fourteen years of age, but in girls it is much greater.The pathological process is divided into several stages and usually develops over many months.The frequency of - 1 in 1,200 children.If the disease struck a child under six years old, the chances of recovery without significant health effects strongly increased.The incidence of Perthes' disease of all known osteochondropathy is about 17-18%
Perthes Disease - Causes
Today looks different researchers on the causes of the disea
determines the conditions for the emergence of Perthes' disease is the presence of a child certain acquired (manufacturing) or congenital (predisposing) factors.So-called "background" for the development of Perthes' disease is considered myelodysplasia (myelodysplasia - in our case, the underdevelopment of the spinal cord) of the lumbar spinal cord, which is directly responsible for the innervation of the hip joint.Underdevelopment of the spinal cord is caused by a congenital hereditary in nature, it varies in severity and there is a significant proportion of children.Mild myelodysplasia can be lifelong and unnoticed, while the more significant violations in the development of the spinal cord are shown a number of orthopedic diseases, among which belongs and Perthes disease.
However, we note that the disease develops only in the event of a complete cessation of blood supply to the femoral head, which is influenced by producing factors.Normally producing factors Perthes' disease is an inflammation of the hip joint or by the strength of his minor injury, leading to clamping (compression) outside underdeveloped and small vessels.
addition to the suspected cause of the disease include metabolic diseases, complications of infectious diseases, excessive stress on your joints (especially in a weakened body).
Risk factors for Perthes' disease include:
• Children's small growth (compared with the children of their age group), which are subject to considerable physical stress
• Children aged three to fourteen
• Boys disease observed infive times more likely
• Children who are exposed to tobacco smoke (passive smokers)
• Children who have suffered diseases such as rickets and malnutrition
Perthes 'disease - symptoms
Perthes' disease in children is almost alwaysIt develops gradually.Pain syndrome is sometimes completely absent, though usually first appears limp and pain in the knee and hip joints and after.The child seriously alter gait (the child says so-called "privolakivanie feet").Pain in Perthes' disease usually develop rapidly, accompanied by fever, general blood analysis data indicate inflammation.With further development of necrosis of the femoral head is deformed, which entails the appearance of symptoms such as joint pain, leg, severe lameness.
At the beginning of the disease in patients observed muscle wasting thighs and buttocks, vegetative-vascular disorders (sweating, cold and pallor of the foot, in the area of the fingers decreases capillary pulse, the skin of the plantar surface of the foot wrinkled).
The successful treatment of the disease plays an important role of its early diagnosis.That is why if a child is limping, complaining of pain appeared in the hip, groin, inner thigh and knee, should immediately consult a doctor-orthopedist.
Diagnosis of Perthes' disease in addition to the visual inspection includes X-ray hip and knee joints, beam diagnostics and ultrasound.Laboratory studies were conducted in the case of a controversial diagnosis, to differentiate from other possible diseases of the hip joint (Cox, Junior epifizeolizm and so forth.)
Perthes 'disease - treatment
Most orthopedists loiter for holding conservative comprehensive treatment of Perthes' disease in children, which includesan action aimed at improving blood circulation in the affected joint, the complete unloading of the affected limb, stimulation of bone resorption process of gradual necrotic tissue with subsequent bone formation, maintaining a proper functional state of muscles and preserve joint function.Because the disease can occur for a number of years, treatment of Perthes' disease can be carried out in a nursing home or a specialized hospital and at home.
To unload the joint with the help of a splint or splints spend its extension.In some cases it is possible to use a plaster or bandage beds, alternating with the course of functional treatment or with skeletal traction.At the same time throughout the treatment period is a physiotherapy gym and restorative massage.During the first three stages of the disease should be excluded for the active exercise of the affected joint.In the fourth stage of movement should be used under easier conditions, limiting the axial load.The fifth stage is already active exercises you can do with an increase in the amplitude of joint movements and an increase in the affected limb axial load.Starting from the second stage to increase the repair, the joint area is assigned to ultrasound therapy, UHF therapy, electrophoresis with calcium chloride or calcium iodide, diathermy.Thermal procedures (warm baths, mud, ozokerite, paraffin) to be applied only from the third stage of the disease, as before, they can contribute to venous stasis.Treatment is carried out against the background of aerotherapy, heliotherapy and nutrition (high content of vitamins and received food protein + calcium gluconate and multivitamins).
allow full weight bearing is possible only after the structure of the neck and the femoral head in two radiographs with an interval of three months against a background of limited axial load remains unchanged.
Surgical treatment of Perthes' disease is rarely used, usually in the later stages of the disease and is to adjust the dysfunction of the joint.If as a result of lameness observed shortening of muscles and has arisen as a consequence of the displacement of the femoral head or the limited mobility of the hip joint by surgical correction of the muscle is lengthened, and the hip joint is fixed plaster cast for a period of four to eight weeks.This is exactly the time when the muscle can be restored to the desired length.In some cases, to correct the location of the femoral head is shown surgical intervention on acetabulum and the femoral head.
forecast later in life after undergoing Perthes' disease generally favorable.In case of timely diagnosis and subsequent management of adequate treatment of people keep working and do not make any complaints.However, in the future as a result of irrational chosen profession as a result of overload and after childbirth can occur progression of coxarthrosis.