Nature gave man a sufficiently strong physical shell, thanks to which he in the previous millennia not only survived, but also managed to occupy a major place on Earth. But there is a flip side to this long process. A significant modification of the human body (from the original "sample" to the modern) has led to many diseases that are uncharacteristic of most other living things. Numerous joint ailments (according to one version) are precisely the result of evolution. One of these pathologies is Legg-Calve-Perthes disease.
Disease onset
Perthes disease (in other words, Perthes-Legg-Calve) is an ailment in which the supply of blood to the femoral head with further aseptic necrosis is disrupted. This ailment appears during adulthood and, according to medical statistics, is one of the most common osteochondropathies.
The onset of illness 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 “tucking” of the sore leg. Then the pains become more intense, severe lameness, swelling and muscle weakness of the affected leg occurs, separate contractures develop. If treatment is not started, the most likely outcome is a distortion of the shape of the head and the formation of coxarthrosis.
The diagnosis is determined on the basis of the noted symptoms and radiological picture. The treatment process is long, a conservative approach is often 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 a normal position and characterized by a breakdown in blood supply and advancing 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 get sick. 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 either a unilateral disease or a bilateral one, while the other joint, as a rule, gets sick less and is more quickly rehabilitated.
Dog disease
This ailment is common among some animals. In dogs, Legg-Calve-Perthes disease is similar in symptoms and ailment to human disease. In general, orthopedic ailments in dogs are often repeated. This is especially true for large breeds. Often sick dogs are killed because their hind legs are completely out of order. However, the dog “small fry” is not spared such troubles. In this case, the ending of her life is rather sad.
Risk factors
Despite the efforts of the medical community, there is still no single approach to treating Perthes disease. Symptoms, stages, treatment differ from school to school. Doctors suggest that this ailment is polyetiological in nature, in the formation of which both the initial tendency and metabolic disturbances, as well as the adverse effect of the external environment, are of certain importance. In accordance with the most common concept, Perthes disease occurs in children with myelodysplasia - congenital serious underdevelopment of the lumbar spinal cord, mass pathology, which in various forms may not be detected in any way or, conversely, can cause the development of various orthopedic deviations.
Myelodysplasia
In case of Legg-Calve-Perthes disease (traumatology and orthopedics are the sections of medicine that study this disease), the supply of nerves to the hip joints is disrupted, and the volume of various vessels delivering blood to the tissues of the joint is also reduced. In a primitive sense, it looks like this: instead of the usual 10-12 large vessels, the patient has only 2-4 underdeveloped arteries and veins of smaller sizes. Due to this, 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 relatively less unfavorable circumstances (with partial disruption of the arterial and vein pathways due to various factors), in a patient with a normal number of vessels, blood supply to the bone weakens, but still remains normal. In a patient with myelodysplasia under the same conditions, blood completely ceases to flow 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 a classic joint disease.
Reasons for the appearance
According to some doctors, the reasons for the appearance of the Legg-Calve-Perthes disease can be such factors:
- Minor mechanical damage (in particular, even a slight leg kick during children's games, etc.) In some cases, the injury is so weak that it can 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 infections (in particular, such massive ones as the flu).
- Changes in hormonal levels in adolescence.
- Disorders of the metabolism of trace elements that are involved in bone formation, etc.
Features of the disease
There is a clear algorithm for determining the level of development of Perthes disease. Causes, symptoms, diagnosis are separated. Usually, five main stages of malaise are considered, which determine the subsequent treatment:
- Stop or violation of blood supply, the formation of an aseptic necrosis site.
- Secondary dented fracture of the femoral head in the damaged area.
- Resorption of dead tissue, accompanied by a narrowing of the femoral neck.
- An increase in the volume of connective tissue in the area of necrosis.
- Replacement of damaged connective tissue of the joint with a grown bone, recovery of the fracture site.
The end of Perthes disease fully depends on the volume and place 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 combining it can get an irregular shape: in some cases flatten, go beyond the area of location, and so on. Violation of the typical physiological dimensions between the head and the adjacent acetabulum may cause new pathological changes.
Symptoms
It is not difficult to distinguish Legg-Calve-Perthes disease. Causes, symptoms can be easily determined. At the onset of the disease, slight dull pain occurs when moving. As a rule, pain occurs in the area of the hip joint, but sometimes there can 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 a damaged leg or drags it. Usually at this time, the clinical symptoms are so poorly distinguishable that parents do not even realize that they need to see a doctor.
With subsequent destruction of the head and the transition to the stage of an impression fracture, the pain is significantly aggravated, lameness is clearly visible. Soft tissues swell around the joint. The limitation of a number of movements is obvious: the child is not able to twist the limb, makes poor movements in the hip joint. Movement is difficult. There are vegetative disorders in the injured leg - the foot is too hot or cold, there is a certain pallor, increased sweating. Possible increase in total body temperature. In the future, pains are less acute, support on the leg is again possible, but other signs may persist. In some cases, a shortening of the leg occurs.
Diagnostics
In case of Legg-Calve-Perthes disease in children, the main stage that is crucial in establishing a diagnosis is radiography of the damaged area. With the certainty that such a disease already exists, not only pictures are 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. Two to six-year-old children with mild symptoms and the presence of small changes in the radiographs should undergo therapy at the doctor's office. In other cases, patients are referred for treatment to 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, as a rule, combines:
- absolute physical unloading of the leg;
- the imposition of a certain skeletal traction, the use of plaster casts, orthopedic devices and functional medical beds to prevent deformation of the head of the damaged thigh;
- improved blood supply to the joint;
- stimulation of the 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 a sore leg is only possible after an X-ray examination of the recovery of the fracture.
Any drugs can be used only after the femoral head is completely "plunged" into the cavity (as it should be in a healthy state). This is achieved by using certain orthopedic devices: functional tires, plaster casts, various types of traction, and the like. Therapeutic gymnastics is used as a stimulus to the bone restoration process. They support activity and prevent muscle volume reduction by tonic massage and electrical muscle stimulation.
Of the drugs, chondroprotectors and osteoprotectors are usually prescribed. They stimulate the blood supply to the diseased area, stimulate the formation of new tissue forming the articular surfaces, and bones.
At the fourth stage, patients are allowed to carry out active exercises; at the fifth, doctors use a complex of exercise therapy for muscles and a complex of movements in the joint. Surgery for such an ailment is indicated in complex cases and only in children over six years of age. As a rule, they do a few typical operations. In the postoperative period, various physiological procedures are prescribed, etc.
Diet
Small patients with Legg-Calve-Perthes disease are inactive for some 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. In this case, nutrition should be rich in trace elements and various substances.
Mode
People who have a history of Legg-Calve-Perthes disease, regardless of the complexity of the disease, are advised not to exert great pressure on the damaged part of their body throughout their lives. Enhanced exercise is contraindicated. Water treatments and bike rides are allowed (but you can not load the limbs too much). It is necessary to constantly engage in sports, but in moderation. Do not work where there is great physical exertion or prolonged standing. It is necessary from time to time to undergo rehabilitation treatment on an outpatient basis and at sanatoriums.