Osteochondropathy of the hip joints is increasingly common in pediatric practice. Pathologies belonging to this category usually occur in a severe form. One of these is Perthes disease. In today's article, we will dwell in more detail on the causes of its occurrence and the main symptoms. The treatment methods used will also be discussed.
Medical certificate
Legg-Calve-Perthes disease is accompanied by a violation of the blood supply to the head in the femur, resulting in necrosis. Its development is gradual, and the first symptoms are hardly distinguishable. First, there is a slight lameness, pain in the hip joint. Then the discomfort intensifies, contractures occur. The head of the bone is severely deformed. In most cases, disorders in only one hip are diagnosed, but bilateral joint damage is possible.
Legg-Calve-Perthes disease is most often diagnosed in children inage from 3 to about 14 years. Boys are more susceptible to its development, but in girls it is characterized by a more severe course. In addition, the weight of the child at birth affects the likelihood of the onset of the disease. For example, babies under 2.5 kg are 5 times more likely to be diagnosed than babies weighing over 3.5 kg.
According to the ICD-10, Perthes disease has the code M91.1.
Main reasons
Doctors cannot identify a single cause of the disease until now. It is generally accepted that a whole combination of factors leads to its development. Even at birth, some children have a predisposition to this pathology. We are talking about myelodysplasia - a congenital underdevelopment of the spinal cord in its lumbar region. With this deviation, the blood circulation of the femoral head is limited or stops completely. As a result, due to oxygen deficiency, tissues begin to die, which leads to aseptic necrosis. Myelodysplasia may not manifest itself throughout life, but under the influence of certain factors, provoke various orthopedic disorders.
Certain importance in the development of Perthes disease in children is given to hereditary predisposition. Among other factors that increase the likelihood of its occurrence, doctors call the following:
- infectious processes in the body and their complications (for example, joint inflammation due to influenza or sinusitis);
- metabolic disorder;
- postponed rickets, malnutrition;
- hormonal disorders in puberty;
- passive smoking;
- increased stress on the joints during the acute course of infectious diseases;
- traumatic injuries.
The body of a child with the above violations is very vulnerable. Therefore, any infection or injury can become a trigger for the pathological process.
Clinical picture
Symptoms of Perthes disease in children appear gradually. At first, the child may complain of discomfort in the knee and hip area. After some time, the clinical picture is supplemented by the following signs:
- pain when walking;
- weakness in the gluteal muscles;
- limping and gait disturbance;
- inability to turn the leg outward;
- limited joint rotation.
Impaired blood supply leads to a decrease in vascular pulsation in the affected area. Doctors pay attention to this sign during the physical examination of the patient. As the pathology progresses, subfebrile condition appears, characterized by a rise in temperature to 37.5 degrees.
Stages of disease development
There are 5 stages of Perthes disease:
- Complete cessation of blood supply to the femoral head, the beginning of the necrotic process.
- Fracture head of bone.
- Resorption of previously dead tissue, shortening of the femoral neck.
- Growth of connective tissue.
- Fracture union and connective tissue ossification.
Determination of the stage of the pathological process during the diagnosisallows you to choose the best treatment option.
Medical examination of patients
Physical examination plays an important role in confirming the diagnosis. Usually the first symptoms do not go unnoticed by the parents. Attentive mothers and fathers immediately take the child to the doctor. Orthopedists and traumatologists are engaged in the diagnosis of pathologies of the hip joint in children and Perthes disease.
Immediate medical attention is essential. The specialist is engaged not only in the diagnosis, but also monitors the development of the disease. Patients are forced to be registered with orthopedists throughout their lives.
The most informative method for diagnosing Perthes' disease is considered to be an x-ray. This study is carried out both in frontal and lateral Launstein projections. It allows you to determine the presence of pathology at an early stage.
Additional diagnostic methods include ultrasound, MRI and CT. Ultrasound with Doppler mapping allows you to determine the degree of circulatory disorders. MRI and CT are most often used in complicated cases.
Features of therapy
Treatment of Perthes disease depends on its stage, the age of the child. If a pathology is detected at the initial stage of its development, specific therapy, as a rule, is not required. If the follow-up radiograph in dynamics does not show significant changes, the orthopedist prescribes a simple control over the condition of a small patient. With the aggravation of the pathological process, they switch to conservative options.therapy.
Regardless of the chosen treatment option, all patients are advised to control body weight, and if necessary, reduce weight. For this purpose, an individual diet rich in proteins, calcium and vitamins is selected. Otherwise, the hip joint affected by Perthes disease will receive an increased load, which will only aggravate the situation.
When there is a progression of the deforming process, a plaster cast is recommended. It immobilizes the affected joint for a while. An alternative is the Petri bandage. It is a plaster overlay on both legs, which is combined with a wooden crossbar. This design does not allow the small patient to bring the legs together, leaving them slightly apart. Petri dressing is applied only in the Department of Surgery.
Medicated treatment
The fight against Perthes disease begins with the appointment of drugs. The following medications are used:
- Osteo- and chondroprotectors ("Wobenzym", "Teraflex", "Aflutop") are used for bone tissue regeneration.
- Trenal helps to improve blood flow.
- Metabolic agents ("Solcoseryl", "Mildronate") are used to normalize microcirculation.
- In case of inflammation of the composition, it is mandatory to take non-steroidal anti-inflammatory drugs. One of the most effective is "Ibuprofen".
The duration of medication, their dosage is determined by the doctor. As a rule, the course of treatment is from 2.5 to 4 years.
Surgery
Hip surgery in children with Perthes disease is recommended after 6 years of age. During the intervention, the femoral head is placed deep into the acetabulum, then fixed with special plates. After the operation, a plaster corset is necessarily applied to the area from the sternum to the feet for 2 months.
Rehabilitation includes exercise under the supervision of specialists, massage, physiotherapy and taking chondroprotectors. You will have to forget about long walks, weight lifting, running.
Exercise and physiotherapy
Exercise therapy is recommended to restore the mobility of the affected joint. A set of exercises is always selected individually and depends on the task of rehabilitation. For example, if there is a plaster cast on the body, breathing exercises are recommended, simple flexion of the limb in the diseased joint.
If the disease is at the 1st or 2nd stage of development, a standard course of exercise therapy for 3 months is usually sufficient. Once the form is running, recovery can take up to two years.
Exercise therapy for Perthes disease consists of 2 stages:
- Initially, all exercises are performed in a horizontal position. They include flexion and subsequent extension of the lower limbs.
- Then the exercises are done while sitting. They are aimed at preparing the body for walking and subsequent movement.
The load is gradually increased. After some time, it is supplemented with classes inpool. Swimming does not load the affected joint, but relaxes it and makes all the muscles function successfully.
Physiotherapeutic effects play an important role in eliminating the symptoms of Legg-Perthes disease. The following procedures are particularly effective:
- electrophoresis;
- UHF;
- ozocerite;
- thermal effect;
- mud treatment.
Forecast
Perthes' disease does not pose a threat to the life of a small patient. However, if left untreated, it can lead to disability. There are two possible outcomes of this pathology:
- The hip joint does not lose its normal performance. For this reason, a person can lead a habitual way of life until old age. Such an outcome is likely only if the problem is detected in a timely manner and the necessary medical care is provided to the child.
- There is a deforming arthrosis. This is a rapidly progressive pathology, which often ends in disability. At the same time, the age of patients often does not exceed the threshold of 25 years.
The consequences of the disease depend on the degree of damage and the effectiveness of the therapy. If the focus is small, recovery is very fast.
With extensive necrosis due to a fracture, the head grows together incorrectly. It is deformed, and the edges begin to protrude outward. Depressions gradually form, some parts of the bone tissue thicken. As a result of the ongoing changes, the functioning of the joint worsens. due to necroticviolations, all pathological processes are only aggravated.
The course of pathology in adults
Calve-Perthes disease is predominantly childhood. It can also be diagnosed in adult patients. However, in this case, during the interview of the patient, it usually turns out that he had been worried about hip problems since childhood.
Provoke the appearance of clinical signs can various infections and destruction on the background of excessive physical exertion. Patients with the following disorders are at risk:
- venous insufficiency;
- compromised immunity;
- muscular hypotension;
- violation of posture;
- genetic predisposition;
- viral infections.
The clinical course of the disease in adults does not differ from that in young patients. However, the treatment involves only surgical intervention. With necrosis of the head and subsequent deformation of the cartilage tissue, their replacement by prosthetics is indicated.
Disease in pets
Not only humans have Perthes disease. In miniature breed dogs, this pathology is diagnosed very often. Pekingese, Yorkshire terriers, pugs, spitz and dachshunds are at risk. The disease manifests itself at the age of 6-7 months with the following symptoms:
- quick fatigue on a walk;
- drastic weight loss;
- limping;
- when trying to examine the affected limb, the dog bends it.
Perthes disease in dogs is hereditary. When the first signs appear, you should immediately contact your veterinarian. In the case of a mild form of pathology, treatment comes down to massage, warming up with heat, with the obligatory use of anabolic steroids. The advanced form of the disease requires surgical intervention.
