Perthes disease (osteochondropathy of the hip joint, osteochondropathy of the head of the femur) - the most common disease in children from three to fourteen years of hip joint disease, which is the most common in this age range of a kind of necrosis of the spongy substance of the femur. The most common lesion is the right hip joint (both joints are affected in 5% of cases). Sometimes there are minor changes in the second joint, but often their independent reverse development is observed.
Perthes' disease in children predominantly affects boys from five to fourteen years old, but in girls it is much heavier. The pathological process is divided into several stages and usually develops over many months. Frequency of occurrence is 1 case per 1200 children. If the disease affects a child under the age of six, the chances of recovery without significant health effects are greatly increased. The frequency of occurrence of Perthes' disease from the number of all known osteochondropathies is about 17-18%
Perthes disease - causes
To date, the views of different researchers on the causes of the development of this disease significantly diverge. However, the most common theory, to which most scientists are inclined, is as follows.
The determining condition for the onset of Perthes' disease is the presence of certain acquired (producing) or congenital (predisposing) factors in the child. The so-called "background" for the development of Perthes' disease is considered myelodysplasia (myelodysplasia - in our case, the development 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 hereditary-congenital conditioned character, differs in degrees of severity and is observed in a significant proportion of children. An easy degree of myelodysplasia can remain unnoticed throughout life, while more significant disorders in the development of the spinal cord are manifested by a number of orthopedic diseases, including Perthes disease.
However, I want to note that this disease develops exclusively in the case of complete cessation of the blood supply to the head of the femur, which occurs under the influence of producing factors. Typically, the producing factors of Perthes' disease are inflammatory hip injury or insignificant in strength trauma, leading to compression (compression) from the outside of underdeveloped and small vessels.
In addition, the expected causes of the development of this disease include metabolic diseases, complications of infectious diseases, excessive strain on the joints (especially with a weakened body).
Pertes's disease risk factors include:
• Children of small stature (in comparison with children of their age group) who are exposed to significant physical exertion
• Children between the ages of three and fourteen
• In boys, the disease is observed five times more often
• Children who are exposed to tobacco smoke (passive smokers)
• Children who have suffered diseases such as rickets and hypotrophy
Perthes disease - symptoms
Perthes' disease in children almost always develops gradually. Pain syndrome is sometimes completely absent, although usually in the beginning there is lameness and pain in the knee, and after hip joints. The baby will seriously change the gait (the child is marked by the so-called "dragging the foot"). Pain sensations in Perthes' disease usually develop sharply, accompanied by an increase in temperature, data from a general blood test indicate inflammation. With the further development of necrosis, deformation of the femoral head occurs, which leads to the appearance of such symptoms as pain in the joint, leg, pronounced lameness.
Already at the beginning of the course of the disease, hypotrophy of the muscles of the thigh and gluteal region is observed in patients, vegetative-vascular disorders (excessive sweating, coldness and pallor of the foot, capillary pulse decreases in the region of the fingers, the skin of the plantar surface of the foot is wrinkled).
In the successful treatment of this disease, its early diagnosis plays a huge role. That's why if a child limps, complains of pain in the hip, groin, inner thigh and knee, you should immediately consult an orthopedic doctor.
Diagnosis of Perthes disease in addition to visual examination includes the radiography of the hip and knee joints, radiation diagnosis and ultrasound examination. Laboratory tests are performed in case of a disputable diagnosis, for differentiation with other possible diseases of the hip joint (coxitis, juvenile epiphysiolism, etc.)
Perthes disease - treatment
Most orthopedists stick to conservative complex treatment of Perthes' disease in children, which includes actions aimed at improving blood circulation in the affected joint, complete unloading of the affected limb, stimulating the process of gradual resorption of bone necrotic tissue followed by bone formation, maintaining the proper functional state of the muscles and maintaining the function the joint. Due to the fact that the disease can occur for several years, treatment of Perthes' disease can be carried out both in the conditions of a sanatorium or a specialized hospital, and at home.
To unload the joint with the help of a tutor or langets, it is stretched. In some cases, it is possible to use a gypsum crib or bandage, alternating with a course of functional treatment or with skeletal traction. Simultaneously, physiotherapy, restorative gymnastics and massage are shown throughout the treatment period. During the first three stages of the course of the disease, active exercises should be ruled out for the affected joint. In the fourth stage of the movement should be used in light conditions, while limiting the axial load. In the fifth stage, you can already do active exercises with an increase in the amplitude of joint movements and an increase in the axial load on the affected limb. Beginning with the second stage, ultrasound therapy, UHF therapy, electrophoresis with calcium chloride or calcium iodide, diathermy are assigned to the joint area to increase the repair. Thermal procedures (warm baths, mud, ozocerite, paraffin) should be used starting only with the third stage of the disease, as before they can contribute to an increase in venous stasis. Treatment is carried out against the backdrop of aerotherapy, heliotherapy and adequate nutrition (increased content of vitamins and proteins in the food intake + calcium gluconate and multivitamins).
Allow full load on the limb is possible only after the structure of the neck and head of the femur on two radiographs with an interval of three months against the background of a limited axial load remains unchanged.
Surgical treatment of Perthes' disease is used quite rarely, usually in the late stages of the disease and consists in correcting the violation of joint function. If, as a result of lameness, the muscles are shortened and the resulting displacement of the head of the femur or the restriction of mobility of the hip joint is observed, the muscle is lengthened by surgical correction, and the hip joint is fixed with a plaster bandage for a period of four to eight weeks. This is exactly the time when the muscle can recover to the required length. In some cases, surgical intervention on the acetabulum or femoral head is indicated to correct the location of the femoral head.
The prognosis of further life after the transferred Perthes disease is generally favorable. In the case of timely diagnosis and subsequent rational adequate treatment, people remain functional and do not make any complaints. However, in the future, due to irrationally chosen profession, as a result of overloads and after childbirth, there may be progression of coxarthrosis.