Nature gave man a fairly strong physical shell, thanks to which he not only survived in the previous millennia, but also managed to take the main place on Earth. But there is a downside to this long process. Significant modification of the human body (from the original "sample" to the modern one) has led to many diseases that are uncharacteristic of most other living beings. Numerous ailments of the joints (according to one of the versions) are precisely the result of evolution. One such pathology is Legg-Calve-Perthes disease.
Onset of illness
Perthes disease (in other words, Perthes-Legg-Calve) is an ailment in which the blood supply to the femoral head is disrupted with further aseptic necrosis. This disease appears in the period of growing up and, according to medical statistics, is one of the most widespreadosteochondropathy.
The onset is slow, the first symptoms of Legg-Calve-Perthes disease often go unnoticed. Small pains begin in the joint itself, there may be a slight limp or “dragging” of the sore leg. Then the pain becomes more intense, there is a pronounced lameness, swelling and weakness of the muscles of the affected leg, separate contractures develop. If treatment is not started, the most likely outcome is head shape distortion and coxarthrosis.
Diagnosis is made on the basis of noted symptoms and x-rays. The treatment process is long, more often a conservative approach is used. In the most difficult cases, it is necessary to go for reconstructive surgery.
Who is sick?
The process associated with a painful deviation from the normal position and characterized by disruption of the blood supply and the onset of necrosis of the femoral head is Legg-Calve-Perthes disease. Joint diseases of this type are diagnosed quite often (approximately 17% of the total number of patients with osteochondropathy). Mostly children are ill. Boys usually suffer from this disease several times more often than girls, but the latter have variants of the development of the disease, leading to a more severe course of the disease. It can be both unilateral and bilateral, while the other joint, as a rule, gets sick less and rehabilitates faster.
Disease in dogs
This disease is common among some animals. Legg-Calve diseasePerthes in dogs is similar to the human in terms of symptoms and the process of malaise. In general, orthopedic ailments in dogs often recur. This is especially true for large breeds. Often, sick dogs are killed because their hind legs completely fail. However, the dog "small" is not spared from such troubles. In that case, the end of her life is rather sad.
Risk factors
Despite the efforts of the medical community, there is still no single approach to treat Perthes disease. Symptoms, stages, treatment differ from school to school. Doctors suggest that this ailment is of a polyetiological nature, in the formation of which both the initial tendency and metabolic disorders, as well as the adverse influence of the external environment, are of certain importance. In accordance with the most common concept, Perthes disease occurs in children with myelodysplasia - a serious congenital underdevelopment of the lumbar part of the spinal cord, a mass pathology that in various forms may not be detected in any way or, conversely, be the cause of the development of various orthopedic abnormalities.
Myelodysplasia
In case of Legg-Calve-Perthes disease (traumatology and orthopedics - branches of medicine that study this disease), the supply of nerves to the hip joints is disrupted, and the volume of various vessels that supply blood to the tissues of the joint decreases. In a primitive sense, it looks like this: instead of the usual 10-12 large vessels, the patient has only 2-4underdeveloped arteries and veins of smaller sizes. As a result, tissues regularly suffer from insufficient blood supply. A change in the state of the vessels due to a violation of innervation also manifests its negative effect.
In comparatively less unfavorable circumstances (with partial disruption of the paths of arteries and veins due to various causes), in a patient with a normal number of vessels, the blood supply to the bone weakens, but still remains normal. In a patient with myelodysplasia, under the same conditions, the blood completely stops flowing to the femoral head. Due to the extreme lack of necessary substances, some of the damaged tissues die - a field of aseptic necrosis is created. And this is a sign of classic joint disease.
Reasons for appearance
According to some doctors, the following factors may be the causes of Legg-Calve-Perthes disease:
- Small mechanical damage (in particular, even a slight kick during children's games, etc.) In some cases, the injury is so weak that it may be unnoticed by parents. Sometimes even one awkward movement is enough.
- The appearance of even a small tumor of the damaged hip joint with various colds (in particular, such mass infections as influenza).
- Changes in hormonal levels in adolescence.
- Disturbances in the metabolism of trace elements that are involved in the formation of bones, etc.
Features of the disease
There isa clear algorithm for determining the level of development of Perthes disease. Causes, symptoms, diagnosis are divided. Usually, five main stages of malaise are considered, which determine the subsequent treatment:
- Stop or disruption of blood supply, formation of an area of aseptic necrosis.
- Secondary indentation fracture of the femoral head in the injured area.
- Resorption of dead tissues, accompanied by narrowing of the femoral neck.
- Increase in the volume of connective tissue in the area of necrosis.
- Replacement of damaged connective tissue of the joint with grown bone, recovery of the fracture site.
The end of Perthes disease fully depends on the volume and location of necrosis. With a small focus, you can achieve a full recovery. With significant damage, the head breaks up into a number of fragments and, after merging, may get an irregular shape: in some cases, flatten, go beyond the location area, and so on. Violation of the typical physiological dimensions between the head and the adjacent acetabulum can cause new pathological changes.
Symptoms
It is not difficult to distinguish Legg-Calve-Perthes disease. Causes, symptoms can be easily identified. At the beginning of the disease, there are slight dull pains when moving. As a rule, pain occurs in the area of the hip joint, but sometimes there may be pain in the area of the knee joint or along the length of the entire limb. The patient begins to barely noticeably limp, falls on the injured leg or drags it. Usually inat this time, the clinical symptoms are so poorly distinguishable that the parents do not even realize that it is necessary to see a doctor.
With the subsequent destruction of the head and the transition to the stage of an impression fracture, the pain is significantly aggravated, lameness is clearly visible. The soft tissues around the joint swell. Obviously, the limitation of a number of movements: the child is not able to twist the limb, poorly performs movements in the hip joint. Movement is difficult. There are autonomic disorders in the injured leg - the foot is too hot or cold, there is a certain pallor, increased sweating. An increase in overall body temperature is possible. In the future, the pain is less acute, support on the leg is again possible, but other symptoms may persist. In some cases, shortening of the leg occurs.
Diagnosis
In Legg-Calve-Perthes disease in children, the main step, which is crucial in establishing the diagnosis, is radiography of the damaged area. If you are sure that such a disease already exists, not only are pictures taken in ordinary projections, but a specialized radiograph is also shown. The complexity of this operation depends on the stage and depth of the disease. In modern medicine, there are various radiological classifications.
Treatment
Legg-Calve-Perthes disease can be cured. Children 2 to 6 years of age who are mildly symptomatic and have small changes on x-rays should be treated by a doctor. In other cases, patients are referred totreatment in an orthopedic institution with further hospital aftercare. Conservative treatment is long, for a period of at least one year (usually 2.5 years, in the most difficult cases - up to 4 years). Treatment usually combines:
- absolute physical unloading of the leg;
- imposition of a certain skeletal traction, the use of plaster casts, orthopedic devices and functional medical beds to prevent deformity of the head of the injured femur;
- improvement of blood supply to the joint;
- stimulation of the course of resorption of damaged tissues and bone reconstruction;
- muscle strengthening.
Forms of Therapy
The main forms of treatment for Legg-Calve-Perthes disease depend on the stage of development of the disease. Patients are prescribed certain medications, at the second stage of the development of the disease, patients can already be sent to special sanatoriums, apply procedures, and not just medication. Normal pressure on the affected leg is possible only after radiological evidence of fracture healing.
Any drugs can be used only after the head of the femur is completely "immersed" in the cavity (as it should be in a he althy state). This is achieved by using certain orthopedic devices: functional splints, plaster casts, various types of traction, and the like. Therapeutic gymnastics is used as a stimulus for the process of bone restoration. Support activity and preventto reduce muscle volume toning massage and electrical muscle stimulation.
Of the drugs prescribed, as a rule, chondroprotectors and osteoprotectors. They stimulate the blood supply to the diseased area, stimulate the formation of new tissue that forms the articular surfaces and bones.
At the fourth stage, patients are allowed to exercise actively, at the fifth stage, doctors use a set of exercise therapy for muscles and a set of movements in the joint. Surgical operations for such an ailment are indicated in difficult cases and only in children older than six years. As a rule, several typical operations are performed. In the postoperative period, various physiological procedures are prescribed, etc.
Diet
Little patients with Legg-Calve-Perthes disease are inactive for a certain time, which often stimulates the appearance of excess weight and a further increase in the load on the diseased joint. Because of this, all patients are prescribed a special diet to prevent obesity. At the same time, food should be rich in trace elements and various substances.
Mode
People with a history of Legg-Calve-Perthes disease, regardless of the complexity of the disease, are advised not to exert much pressure on the damaged part of the body throughout their lives. Strengthened physical exercises are contraindicated. Water procedures and cycling are allowed (but you can not put too much weight on the limbs). You need to constantly exercise, but in moderation. You should not work where there are bigphysical activity or prolonged standing. It is necessary from time to time to undergo rehabilitation treatment on an outpatient basis and at sanatoriums.
