Hip osteochondropathy has been increasingly found in pediatric practice lately. Pathologies in this category usually occur in 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. It will also talk about the methods of treatment used.
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. At first there is a slight lameness, pain in the hip joint. Then the discomfort intensifies, contractures arise. The head of the bone undergoes severe deformation. In most cases, only one hip is diagnosed, but bilateral joint damage is not ruled out.
Legg-Calve-Perthes disease is most often diagnosed in children aged 3 to about 14 years. To a greater extent, boys are susceptible to its development, but in girls it is characterized by a more severe course. In addition, the probability of the onset of the disease is affected by the birth weight of the baby. For example, in children under 2.5 kg, the risk of detecting it is 5 times greater than in children weighing more than 3.5 kg.
According to ICD-10, Perthes disease has the code M91.1.
Main reasons
Doctors still cannot identify the single cause of the disease. It is generally accepted that a whole set of factors leads to its development. Even at birth, some children are predisposed to this pathology. We are talking about myelodysplasia - congenital maldevelopment of the spinal cord in its lumbar region. With this deviation, the circulation of the femoral head is limited or completely stopped. As a result, due to oxygen deficiency, tissues begin to die, which leads to aseptic necrosis. Myelodysplasia may not occur during life, but under the influence of certain factors provoke various orthopedic disorders.
A certain role in the development of Perthes disease in children is assigned to a 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, inflammation of the joint against the background of influenza or sinusitis);
- metabolic disease;
- transferred rickets, malnutrition;
- hormonal disorders in the puberty;
- second hand smoke;
- increased load on the joints during the acute course of infectious diseases;
- traumatic injuries.
The body of a child with the above disorders 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 thigh area. After some time, the clinical picture is supplemented by the following symptoms:
- pain when walking;
- weakness in the gluteal muscles;
- lameness and gait disturbance;
- inability to turn the leg out;
- limited rotation of the joint.
Violation of blood supply leads to a decrease in vascular pulsation in the affected area. Doctors pay attention to this symptom 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 the development of the disease
There are 5 stages of Perthes disease:
- Complete cessation of blood supply to the femoral head, the beginning of the necrotic process.
- Fracture of the head of the bone.
- Resorption of previously dead tissue, shortening of the femoral neck.
- The proliferation of connective tissue.
- Fusion fracture and ossification of connective tissue.
Determining the stage of the pathological process during the diagnosis allows you to choose the optimal 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 lead the child to the doctor. Diagnosis of hip joint pathologies in children and Perthes disease involves orthopedists and traumatologists.
Immediate medical attention is necessary. The specialist is not only involved 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 an x-ray. This study is conducted both in direct and lateral projection according to Launstein. 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 disturbance. MRI and CT are most often used in complicated cases.
Therapy Features
The 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 observation on the radiograph in the dynamics does not show significant changes, the orthopedist appoints a simple control over the condition of the small patient. With an aggravation of the pathological process, they switch to conservative treatment options.
Regardless of the treatment option chosen, 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 progression of the deforming process is observed, a plaster cast is recommended. She immobilizes the affected joint for a while. Her alternative is the Petri dressing. It is a lining of gypsum on both legs, which is combined by a wooden bar. This design does not allow a small patient to bring his legs together, leaving them a little divorced. Petri dressing is applied only in the surgery department.
Drug treatment
The fight against Perthes disease begins with the appointment of drugs. The following medicines are used:
- Osteo- and chondroprotectors (Wobenzym, Teraflex, Aflutop) are used to regenerate bone tissue.
- Trenal helps to improve blood flow.
- Metabolic agents (Solcoseryl, Mildronate) are used to normalize microcirculation.
- With 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.
Surgical intervention
Hip surgery in children with Perthes disease is recommended after 6 years. During the intervention, the femoral head is placed deep in the acetabulum, then fixed by means of special plates. After the operation, a gypsum corset is necessarily applied to the area from the sternum to the feet for 2 months.
Rehabilitation includes performing exercises under the supervision of specialists, massage, physiotherapy and taking chondroprotectors. Long walks, weight lifting, running will have to be forgotten.
Exercise therapy and physiotherapy
To restore the mobility of the affected joint, exercise therapy is recommended. A set of exercises is always selected individually and depends on the task of rehabilitation. For example, in the presence of a plaster cast on the body, breathing exercises, simple flexion of a limb in a diseased joint are recommended.
If the disease is at 1 or 2 stages of development, a standard course of exercise therapy for 3 months is usually sufficient. With a running form, 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. These include flexion and subsequent extension of the lower extremities.
- Then the exercises are performed while sitting. They are aimed at preparing the body for walking and subsequent movement.
The load is gradually increased. After a while, it is supplemented by activities in the pool. 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 characterized by particular effectiveness:
- electrophoresis;
- UHF;
- ozokerite;
- heat exposure;
- mud therapy.
Forecast
Perthes disease does not pose a threat to the life of a small patient. However, if untreated, it can lead to disability. Two outcomes of this pathology are possible:
- The hip joint does not lose normal performance. For this reason, a person can lead a familiar lifestyle until old age. Such an outcome is likely only if the problem is timely detected and the child is provided with the necessary medical care.
- There is deforming arthrosis. This is a rapidly progressing pathology that often results in disability. Moreover, 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 outbreak 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 areas of bone tissue thicken. As a result of the changes that occur, the functioning of the joint is impaired. Due to necrotic disorders, all pathological processes are only exacerbated.
The course of pathology in adults
Calve-Perthes disease is predominantly pediatric. In adult patients, it can also be diagnosed. However, in this case, during the survey of the patient, it usually becomes clear that he had worried about hip problems in childhood.
Various infections and destruction against the background of excessive physical exertion can provoke the appearance of clinical signs. At risk are patients with the following disorders:
- venous insufficiency;
- weakened immunity;
- muscle 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, treatment involves only surgical intervention. With the necrosis of the head and subsequent deformation of the cartilage tissue, their replacement by prosthetics is indicated.
Pet disease
Not only people have Perthes disease. In dogs of miniature breeds, this pathology is diagnosed very often. At risk are the Pekingese, Yorkshire terriers, pugs, spitz and dachshunds. The disease manifests itself at the age of 6-7 months with the following symptoms:
- fatigue on a walk;
- sharp weight loss;
- lameness;
- 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 is reduced to massage, warming up with the mandatory use of anabolics. A neglected form of the disease requires surgical intervention.