What's Perthes disease

Perthes disease (Legg-Calve-Perthes disease) refers to osteohondroaptiyam - diseases of osteoarticular apparatus, occurring primarily in children and proceeding with stepwise destruction and subsequent restoration of the articular surfaces of bones. When Perthes' disease is the destruction of the femoral head, the disease is called - aseptic necrosis of the femoral head (ANGBK).

AGBNK was first described by German surgeon Perthes in 1910. This disease is 1-3% of all diseases of the musculoskeletal system in children. At the age of 5 years, it is rare, the most striking age - 6-10 years. The boys are sick several times more often than girls. The disease usually is one-sided.

Causes of Perthes' disease is still found out enough. The immediate cause of bone destruction is considered a violation of local blood circulation of the joint, which can result in a previous infection, trauma, metabolic disorders Metabolism: The basis of life of all living things , Abnormal angiogenesis and some other reasons.

Signs

The first symptoms are mild and characterized by impermanence. It appears lameness that quickly disappears when unloading of course, but then again resumed. Moderate pain in the affected hip joint often give in the knee joint, and children are more often notice the pain is in the knee joint. Pain usually occur during the day, while walking. Over time, a detailed examination can detect a slight decrease in the volume of soft tissue thigh and leg, a small flexion contracture (partial extension joint) hip abduction and limit internal rotation (turning inward) hip. When the feeling the hip there is a slight soreness. With the discharge joint at bedrest these effects disappear. Over time, if timely treatment is not started, can vary the length of the limb.

The general condition of the child is not suffering, the temperature increase in the overall analysis of blood Complete blood count how to understand why taking blood from a finger   There are no changes.

How is

Duration of Perthes' disease in advanced stage is 3 to 6 years. Early proper treatment reduces these up to 1, 5 - 2, 5 years and gives much better impact. Perthes disease has clear stages:

• the first stage - the stage of the subchondral necrosis; femoral head loses its spherical form and begins to flatten;
• the second stage - the stage of Cubism (ie, defective bone, but without displacement of fragments) fracture: femoral head is flattened and sealed;
• The third stage - the stage of formation of fragments (seizures) bones; if the child continues to use the limb, the femoral head is more flattened, broken growing zone (bone may stop the growth), it is possible the output from the bone acetabulum (subluxation of the development);
• fourth stage - the stage of restoration of the structure, but the deformation of the femoral head usually stays for a lifetime;
• fifth stage - the stage of the effects of Perthes' disease; despite the complete restoration of the structure of the femoral head, the shape of it, in most cases, especially in the late begun treatment, a significant change is often formed by deforming arthrosis Osteoarthritis - when the joint loses its function   - Irreversible changes in the joint, breaking its function.

All stages of the disease are clearly visible on X-rays. But, unfortunately, due to the absence of characteristic signs of the disease, x-ray is often done too late.

Treatment of Perthes' disease

Treatment of Perthes' disease can be conservative and surgical. Conservative treatment - is, first of all, unload the affected limb in order to prevent deformation of the femoral head. In the early stages of the disease the child has to be bed rest, then he is allowed to walk on crutches or with orthosis (a special device that holds the foot in limbo). If you have severe pain for joint immobility sometimes impose cast or splint.

At the same time the child shall be appointed by restorative treatment, vitamin therapy, physiotherapy, facilities, improve blood circulation in the joint. In the absence of acute events held massage and physiotherapy. Walking with a full load is permitted only with radiographic evidence of restoration of the structure of the femoral head.

Along with conservative treatment methods are proposed operational methods designed to stimulate circulation and restore the bone of the femoral head. Carry out the operation and in the event of complications, such as subluxation of the femoral head.

When properly during begun treatment hip joint is reduced, and small changes it does not interfere with a person in the future to maintain its efficiency. Perthes disease is not treated can lead to a complete breakdown of joint function and disability.

Galina Romanenko

The causes of osteoarthritis of the hip

Osteoarthritis - a disease of the joints of the exchange nature in which the joint is slowly beginning to lose their function and develop in it changes. Arthritis often have the character of age, and almost never strongly disturb the work of the joint. The exception is arthritis of the hip joint, which often occurs at a young age, and almost always leads to disability.

Disturbances in the joint usually begin in violation of its blood supply. Primarily affects cartilage covering the bone joint. Under the influence resulting from a lack of oxygen and enzymes occur bundle cartilage thinning, and then - the division into individual pieces. And as the joint cartilage is the shock absorber begins injured and bone tissue, resulting in at the edges of the articular surfaces of the hip joint formed bony growths. In the area of ​​joint and connective tissue grows.

Osteoarthritis of the hip joint can be primary and secondary. Causes of primary osteoarthritis unidentified. Secondary osteoarthritis most often occurs after trauma or inflammation of the joint, with dysplasia Dysplasia - what is it?   (violation of) the hip joint, congenital hip dislocation Hip dislocation - the result of indirect injury , Aseptic necrosis of the femoral head (Perthes disease - a disease of unknown origin, at which the first complete destruction of the femoral head, and then restoring it).

The symptoms of osteoarthritis of the hip

Manifested osteoarthritis pain of the hip, which is directly proportional to the degree of severity of the changes in the joint. There are three stages of the disease.

In the first stage of osteoarthritis pain in the hip occur during exercise - heavy lifting, running and so on. Sometimes the pain is given in the thigh and knee. Pains are intermittent and after the holiday held on the joint function, they are not recognized. The examination of the patient can be seen that the amount of movement in the joint is not broken, the muscles in the joint atrophy (atrophy - drying, a change in volume), the gait is not changed.

The second stage of the disease is characterized by more intense pain, which may occur at rest. Pain is usually given in the groin, thigh and knee. In severe load the patient begins to limp. Disrupted joint: the foot hardly discharged to the outside and turned inwards. Since the reduced load on the muscles surrounding the joint, they begin to atrophy and shrink in volume.

In the third step, the pain becomes constant, aggravated by exertion, at rest and appear even at night. Pain when walking is so strong that the patient needed support. The joint is hardly bent and turned inward. Decrease in the volume of the thigh muscles, buttocks and lower legs, shortened limb - the patient is forced to bend over when walking in the affected side, or stand on tiptoe, which increases the load on the affected joint.

Diagnosis of osteoarthritis of the hip

The diagnosis made on the basis of characteristic features, these X-ray examination and research of joint function. The changes in the joint largely depend on the cause of the arthritis.

In the first stage of the disease on x-ray can be seen that the edges of the joint has a slight bony overgrowth and joint space (distance between the articular surfaces of the bones forming the joint) is somewhat narrowed. The second stage is characterized by bony growths, changes in the shape and the neck of the femoral head, the beginning of the displacement of the head up, further narrowing of the joint space. In the third step identifies significant bony growths on the edges of the articular surfaces, sharp breaking the mold neck and the femoral head, joint space narrowing.

There are also functional and other studies state the hip. Checks the status of the muscles (elektromorgafiya), blood vessels (rheovasography scanning - research vessels radioisotope method) and more.

Treatment of osteoarthritis of the hip

Treatment of osteoarthritis of the hip joint is carried out strictly individual and depends on its cause. Be sure to take into account the stage of the disease.

At the initial stages of the disease should be conservative therapy. Appointed painkillers, drugs, relieves swelling Prevention and treatment of edema - it is important to understand the root cause   and inflammation of the soft tissues, improves metabolic processes in the tissues and blood supply. In some cases, appointed by the extension of the limbs. Outside exacerbation conduct courses of massage, physical therapy and physiotherapy. Patients are encouraged to spend less time on their feet, do not run, to eliminate the wearing of gravity.

Advanced stage treat both conservative and operative. In addition to conventional medical treatment is being administered intra-articular administration of drugs reduces inflammation and pain, as well as reducing the work of the joint. Assign discharge joint, physiotherapy, massage, individually tailored exercise of therapeutic exercises.

Surgical treatment - these are different types of operations, restoring joint function, up to transplant the artificial joint.

The best prevention of arthritis of the hip joints is the early detection of diseases that contribute to their formation.

Galina Romanenko