Perthes disease (full name Legg – Calwe – Pertes) (synonyms: osteochondropathy of the femoral head , aseptic necrosis of the femoral head in children, subchondral necrosis of the core of the ossification of the femoral head) - a disease of the femur and hip associated with impaired blood supply to the femur and malnutrition of her articular cartilage with subsequent necrosis, belongs to the group of diseases united under the name osteochondropathy .
| Legg – Calve – Perthes disease | |
|---|---|
 The superior epiphysis of the right femur, posterior and superior. | |
| ICD-10 | M 91.1 |
| ICD-10-KM | , and |
| ICD-9 | 732.1 |
| Omim | and |
| Diseasesdb | 9891 |
| Medlineplus | 001264 |
| eMedicine | radio / 387 |
| Mesh | D007873 |
Content
Etiology
The etiology of the disease is unknown: there are various theories about the causes of the development of the disease - trauma, excessive load on the joint in weakened children, recently transmitted infectious diseases, metabolic disorders, congenital malformations of the hip joints. The most common cause may be the displacement of the fourth lumbar vertebra L4, more often one-sided, causing infringement of nearby nerve roots that control the vessels, sclera of the femoral head.
Perthes disease often affects boys (3-5 times more often) aged 3 to 14 years. The right joint is more often affected, sometimes bilateral lesions occur, although the second joint is usually less affected.
Perthes disease makes up about 17% of all osteochondropathies.
Pathogenesis
Circulatory disturbance, dystrophy of bone and cartilage tissue (mainly the epiphysis of the femur, to a much lesser extent the structures of the acetabulum), degeneration and necrosis of bone and cartilage structures, a change in the anatomy and biomechanics of the joint develop. In the pathogenesis of Perthes disease, there are five stages: I - necrosis of the core of the ossification of the femoral head, II - secondary compression / impression fracture of the femoral head, III - resorption of necrotic bone tissue and its fragmentation, shortening of the femoral neck, IV - growth of connective tissue instead of the affected bone-cartilaginous structures, V - ossification of replacement connective tissue structures due to calcium deposition with the formation of bone tissue.
As a result of these processes, the anatomy and biomechanics of the joint are disrupted, the neck of the femur is shortened, the cervical-diaphyseal angle decreases, and the structure of the acetabulum is disturbed.
Clinic
The disease most often begins gradually.
The initial manifestations of the disease are pain in both the hip and knee joints, with the disease often starting with pain in the latter. Change in gait - the child begins to limp.
Damage to the hip joint in Perthes disease is most often one-sided.
In the later stages, contractures, hypotrophy of the gluteal muscles are observed.
Clinical and radiological classifications
Classification of Catterol (Catterall) [1]
Group 1 - initial radiological manifestations. A small subchondral or central defect while maintaining the normal configuration of the femoral head. Metaphysical changes, sequestration, or fracture lines are not detected.
Group 2 - sclerotic and destructive changes in the femoral head while maintaining its contour, signs of fragmentation and the formation of sequestration.
Group 3 - subtotal lesion of the femoral head with its deformation and the presence of a fracture line.
Group 4 - total lesion of the femoral head, as well as the presence of changes in the acetabulum.
Classification of Salter - Thomson ( 2)
Group I - subchondral fracture line only in the picture in the position of Lauenstein in front of the pineal gland.
Group II - a subchondral fracture in the anterior part of the pineal gland, the lateral border of the head is preserved.
Group III - subchondral fracture in the lateral part of the pineal gland.
Group IV - subchondral fracture in the entire area of the pineal gland.
Treatment
Therapy for the disease is complex and stage-dependent.
In the early stages - unloading of the affected joint (wearing orthopedic devices that unload the hip joint, crutches), immobilization (abduction and derotation), periodic daily traction, drug treatment aimed at improving blood supply to the bone-cartilage structures of the hip joint. In the later stages - surgical intervention, elimination of biomechanical disorders in the joint.
Also in the process of treatment, physiotherapeutic methods, massage (by various methods), physiotherapy exercises, electrophoresis, hyperbaric oxygen therapy, and spa treatment are used.
The best treatment results can be achieved, as a rule, in children with an age of less than 4 years, which is associated with less development and differentiation of the tissues that make up the structures of the hip joint.
The treatment is long, for 2 - 5 years, and requires constant medical supervision by a doctor.
In the case of a displacement of the vertebrae of the lumbar L4-L5, the elimination of the displacement allows you to restore the norm much faster. The use of chondroprotectors has proven to be inappropriate.