Perthes disease is a disease in which the blood supply to the hip is impaired, which causes its non-infectious necrosis. It affects not only bone tissue, but also joints, vessels and nerves. This ailment, in fact, is one of the most common forms of osteochondropathy.
Perthes disease - causes
To date, there is no single factor that provokes the emergence of this disease. Experts believe that this is a polyethological pathology. Aseptic necrosis of the head of the femur occurs if there is a hereditary predisposition to the development of such a disease. In addition, this ailment is diagnosed when there is a disturbance in metabolic processes in the body and the impact of negative factors from the outside.
The mechanism that triggers Legg-Calve-Perthes disease in children is considered to be such factors:
- violation of metabolic processes, including minerals, which participate in bone formation;
- mechanical damage (bruising, stretching and so on);
- Inflammations occurring in the hip heads in microbial or viral infections;
- hormonal failure in adolescence.
This disease affects between the ages of 3 and 12 years. In boys, the disease is diagnosed 5 times more often than in girls. The following persons are at high risk:
- suffered rickets ;
- weakened (often ill);
- passive smokers (children whose parents have this bad habit);
- with malnutrition.
Perthes' disease in children - symptoms
More often the disease meets with one-sided defeat, and much less often - with bilateral. At the initial stage the disease is asymptomatic. Further, Perthes' disease in children may be accompanied by the following symptoms:
- lameness;
- painful sensations arising when walking;
- weakness of gluteal muscles;
- swelling in the joints;
- increased sweating ;
- decreased heart rate;
- wrinkling of the feet;
- a violation of the gait.
The stages of Perthes disease
This disease is represented by five stages. Aseptic necrosis of the head of the femur, whose stages have their own characteristics, is defined as follows:
- The latent form - small pains in the field of hip joints, periodic limping.
- Impression stage - there is a slight shortening of the limb.
- The fragmentation stage - the hip head becomes flat, and the bone tissue itself begins to dissolve.
- Restorative stage - replacement of bone-cartilaginous connective tissue.
- The final form - ossification of connective tissues takes place. The mobility is lost.
Perthes disease - diagnosis
Before you begin to treat the disease, you need to undergo a complete examination. It is based on the X-ray examination of the affected hip joint. This procedure allows you to identify the degree of deformation and accurately establish the stage of the lesion. If a priori diagnosis of aseptic necrosis of the head of the femur, it is desirable to make an x-ray in several projections. This will allow the doctor to obtain full information about the affected area.
The following studies also help to diagnose Perthes' disease:
- CT;
- arthroscopy;
- Ultrasound.
Perthes disease in children - treatment
The less the deformation of the hip head, the easier it is to recover. Perthes disease, whose treatment requires an integrated approach, does not necessarily end with a disability. Therapy provides a goal - to keep the shape of the head of the tibia. A child can go through a wellness course at home, in a hospital or in a sanatorium. If aseptic necrosis of the femoral head is diagnosed, the treatment is represented by the following aspects:
- complete unloading of the affected joint - bed rest, movement on crutches;
- wearing orthopedic shoes;
- rest on special beds;
- the course of mud therapy.
In addition, Perthes' disease with severe hip inflammation provides for the following medications:
- drugs that improve blood flow (Trental, Pentoxifylline);
- medicinal products with regenerative action (Wobenzym, Methyluracil);
- anti-inflammatory non-steroid drugs (Ibufen, Neurofen);
- biologically active additives (vitamins A, D and calcium ).
Massage with Perthes disease
The usefulness of this procedure is difficult to overestimate. Massage has the following effects:
- gives the desired shape to the muscles;
- increases blood flow in atrophied tissues;
- normalizes metabolic processes in affected areas.
Perthes' disease in children involves performing such a massage:
- stroking the gluteal region;
- squeezing, performed by the edge of the palm;
- kneading muscles.
During the procedure, the child can lie on his side, stomach or back. He should relax muscles as much as possible. If the osteochondropathy of the head of the femur is accompanied by severe pain, all manipulations during the massage should be carried out easily. Pressures or other deep tricks in this case are unacceptable. The child should not experience discomfort.
Perthes disease - LFK
The main purpose of such exercises is to accelerate the process of recovery. These exercises help restore the tone of the body. In addition, they have a positive effect on the emotional state of the patient, which also contributes to the recovery process. If the osteochondropathy of the femoral head in children is diagnosed at an early stage, exercise therapy is recommended for 2-3 months. With a protracted form of ailment, it takes 1.5-2 years.
Leggy-Calve-Perthes disease excludes the following exercises:
- Jumping;
- squats;
- lifting weights;
- walking over long distances.
Perthes disease - operation
If conservative therapy is unsuccessful, the doctor can advise surgical intervention. The operation is performed during the prolonged stage of the disease. It is done only for those patients who have reached the age of six. If due to pathology a shortening of the muscle appeared, during the operation the damaged joint is returned to its original position. To fix it, a plaster cast is used. The patient needs to wear it for 4-8 weeks. During this time, the joint "gets used" to its location.
Even when Legg-Calvet-Perthes disease recedes, the patient should refrain from loading the hip joints. In addition, you need to exclude a long stay on your feet. During the rehabilitation period and after it, such activities are allowed:
- bicycle ride;
- physiotherapy;
- swimming.
Perthes disease - consequences
If pathology is detected at the initial stage and therapy is started on time, the disease can be completely overcome. In neglected form, the ailment leads to disability. Aseptic necrosis of the head of the femur in children is fraught with the following consequences:
- osteoarthritis;
- violation of gait;
- lifelong lameness;
- muscle hypotrophy.