Osteochondropathy of the ischium in children. Osteochondropathies in children

Osteochondropathies (aseptic osteochondronecrosis)- self-
persistent type of degenerative-necrotic process in the epiphy-
And apophyses, spongy bones, accompanied by pain
In most cases, successive changes in necrosis, resorption
0removal of the affected areas of the bone and subsequent restoration
renewal of bone structure.

Involvement in the pathological process
articular cartilage leads to dysfunction of the joint.

Etiology

osteochondropathy is still unclear. At the core
illness lies aseptic necrosis spongy bone. Accepted
consider this process the result of the action of many pathological
factors: macro- and microtrauma, increased mechanical
stress, metabolic disorders, vascular and neurotrophic disorders.
The immediate cause of necrosis is considered to be a violation
bone blood circulation due to mechanical damage vessels,
thrombosis, obliteration or prolonged persistent spasm.

There are four groups of osteochondropathy.

1. Osteochondropathies of the epiphyseal ends tubular bones:
heads femur(Legg-Calvé-Perthes disease);
heads II-III metatarsal bones(Köhler's disease II).

2. Osteochondropathies of short cancellous bones:
navicular bone of the foot (Köhler's disease I);
patella (Larsen's disease);
vertebral body (Calvet's disease);
lunate bone of the hand (Kienböck's disease).

3. Osteochondropathies of the apophyses:
tuberosities tibia(Osgood-Schlatter disease);
vertebral apophyses (Scheuermann-Mau disease);
mound calcaneus(Gaglund-Schinz disease).

4. Partial wedge-shaped osteochondropathy articular surfaces:
femoral condyles (Konig's disease);
capitate eminence humerus(Panner's disease) -
In most cases, the process develops slowly and proceeds
chronically and in most cases benign, despite
significant destructive changes in the bones. Muscle atrophy is pronounced
moderately. Expressed pathological changes in analyzes
there is no blood.

Osteochondropathies combine a group of diseases occurring in childhood and adolescence that affect the subchondral parts of the epiphyses of some bones. From a morphological and pathophysiological point of view, osteochondropathy is aseptic necrosis, which has a peculiar clinical picture.
Aseptic necrosis often develops in the femoral head (Legg-Calvé-Perthes disease), in the heads of the II and III metatarsal bones (Köhler-II disease), in the tibial tuberosity (Osgood-Schlatter disease), in the lunate bone of the hand (Kienbeck disease), in the internal condyles of the femur (König's disease) and much less often - in the navicular bone of the foot (Köhler's disease-I), in the tubercle of the calcaneus (Schinz's disease), very rarely - in the epiphyses of the vertebrae (Showerman-May disease) and in the vertebral bodies (Calvé's disease) .
Main goal of treatment- restore impaired blood circulation of the periosteum, prevent deformations and the development of deforming arthrosis.
The main methods of rehabilitation such patients are massage, Exercise therapy, physio- and hydrotherapy procedures, cryomassage, vibrating massage, hydrokinesitherapy and etc.

Legg-Calvé-Perthes disease

Osteochondropathy of the femoral head often occurs in children aged 5 to 12 years. Boys suffer 4-5 times more often than girls. The disease begins unnoticed with the appearance of minor pain in the hip joint and lameness. Atrophy of the muscles of the diseased limb is determined, and in advanced cases - functional shortening of the leg by 1-2 cm, as well as limited mobility in the hip joint.
Conservative treatment consists in early unloading of the affected limb (unloading devices, traction or crutches). Massage, LH are indicated (in the supine position, include general developmental and breathing exercises, mainly for the muscles of the trunk and healthy limb, isometric tension of the quadriceps muscle), physiotherapy ( mud applications on the joint, phonophoresis with mumiyo ointment or mobilate). If the patient is on inpatient treatment, then glue or cuff traction is prescribed to completely unload the limb and LH, massage, and physiotherapy are used. After discharge, hydrokinesitherapy is indicated, vibration massage backs and lower limbs.

Köhler's disease-II

Osteochondropathy of the metatarsal head It is more common in girls aged 13 to 19 years. In 90% of cases, the head of the second metatarsal bone is affected. Swelling and tenderness in the area of the metatarsophalangeal joint are characteristic. On palpation, thickenings and bone growths are noted on the head of the metatarsal bone. Movement in the metatarsophalangeal joint is limited.
massage of the thigh and calf muscles, physiotherapy (paraffin-ozokerite, mud applications, phonophoresis), LH (lying and sitting), wearing inserts in shoes. Hydrokinesitherapy is indicated. Doing exercises in a standing position (squats, jumps, jumps, etc.) is excluded.

Osgood-Schlatter disease

Osteochondropathy of the tibial tuberosity often observed in adolescents 12-16 years old. It develops due to overload of the quadriceps femoris muscle, acute injury, chronic microtraumatization, etc. In the area of the tibial tuberosity, swelling and slight swelling of the soft tissues appear.
Conservative treatment includes massage, LH in water, physiotherapy (ultrasound with mobilate, 10% mumiyo ointment). Loads on the lower limb are avoided for 2-3 weeks. The site of the disease is fixed with an adhesive plaster, and cryomassage is also used in the first 3-5 days.
Massage technique
From the first day of the disease, a suction massage is carried out, that is, first the muscles of the thigh, knee joint, calf muscles using stroking, kneading, rubbing. After this, massage the site of the disease, using stroking, and in subsequent days, rubbing with the base of the palm and fingertips. After the pain subsides, you can carefully use kneading with fingertips, forceps-like rubbing, alternating with stroking. It is advisable to use massage in combination with physiotherapeutic procedures. Duration of massage is 10-15 minutes.

Kienböck's disease

Osteochondropathy of the lunate observed in persons exposed to frequent injuries. Characterized by pain in the area of the lunate bone, which intensifies with pressure. Movements in wrist joint cause severe pain. Swelling appears in this area.
Conservative treatment includes immobilization, massage of healthy tissues, physical therapy (general developmental exercises, breathing, isometrics, etc.), physiotherapy (UHF No. 3, phonophoresis, electrophoresis with a 10% mummy solution), training on a bicycle ergometer, massage is used after removing the plaster cast, swimming , vibration massage of the back and lower limbs.
At surgical treatment (removal of the lunate bone) LH is performed, massage of the collar area, shoulder girdle muscles and healthy limb. Workout on a bicycle ergometer or treadmill. After removing the plaster cast, a vibration massage of the back, arms and legs is started.

Koenig's disease

Aseptic necrosis of the femur is an aseptic subchondral necrosis of a small semicircular area of the epiphysis, which often leads to the formation of a free intra-articular body. The localization of the process is most often noted in the area of the internal condyle, that is, in those areas of the epiphysis that are subject to the greatest functional load.
The disease is characterized joint pain, feeling unwell, or instability in the affected joint. IN late stage diseases, characteristic phenomena arise - “blockade” of the joint, synovitis.
Surgical treatment- removal of the affected area of the bone.
IN postoperative period carry out massage of healthy tissues, LH (general developmental, breathing exercises in a lying position). After removing the sutures and splints - electrical stimulation of the quadriceps femoris muscle, hydrokinesitherapy and cryomassage. Then the motor mode gradually expands and exercises on exercise machines and walks are included. After discharge from the hospital, the patient does exercise therapy at home.

Osteochondropathy is common name bone diseases of aseptic (non-infectious) etiology, causing necrotic processes in the area of the spongy substance of the epiphyses (the end part of the tubular bone from which the joint is formed). The development of the disease leads to gradual deformation and destruction of the joint, accompanied by curvature of the affected bone. The disease can affect any bone of the skeleton, but pathology of the leg bones is more likely to develop. The hip, knee, lower leg and foot, which bear the bulk of the load during movement, are more at risk of developing pathology. Most often, osteochondropathy of bones occurs in children and adolescents aged 5 to 16 years, but sometimes this diagnosis is also made to older young people - up to 20 years.

Main causes of osteochondropathy

According to statistics, osteochondropathy accounts for approximately 2.5 - 3% of total number identified osteoarticular pathologies. Unambiguous reasons for the development of osteochondropathy medical science on this moment is not defined, since this bone disease has a wide variety of forms. But most experts agree that the cause of the disease is a disruption of the normal blood supply to various parts of the skeletal system.

The lack of regeneration stimulants supplied with the blood causes a failure in the process of recovery processes. Bone tissue of the lower extremities in areas of deficiency nutrients becomes fragile, easily susceptible to injury and deformation, osteophytes - bone growths - develop in places of greatest load on the joint. Simultaneously with the spongy substance that makes up the head of the joint, the cartilaginous membrane surrounding it is also destroyed. As a result, the process leads to necrosis - the gradual death of osteochondral cells.

provoke local violation blood circulation leading to the development of osteochondropathy, the following factors can:

Limb injuries. During restoration (fusion) after injury to bone and cartilage tissue, partial pinching may occur blood vessel, leading to restriction of blood flow through it;
Hormonal imbalance that occurs during the restructuring of body systems during puberty (adolescence);
Rapid growth, leading to a deficiency in the body of phosphorus salts, calcium, and other microelements necessary to strengthen bones;
Lagging development of the blood supply system from skeletal growth in adolescence;
Excessive load on the bone apparatus in childhood and adolescence - sports or choreography;
Physical inactivity is a common occurrence among modern teenagers who are passionate about computer games and social networks, leading to stagnation of blood flow;
Deficiency in the diet of protein necessary to strengthen the structure of muscles and osteochondral tissue;
Lack of vitamins;
Excess weight, which not only increases the chronic load on the joints, but also deprives them of a significant volume of blood due to the need to supply it to adipose tissue;
Congenital anomalies of the development of the osteoarticular apparatus, such as dysplasia - underdevelopment of the joint;
Infections of various etiologies;
Endocrine pathologies
Hereditary predisposition. If one of the parents has ever suffered from osteochondropathy, the likelihood of developing it in the child increases significantly.

Osteochondropathies are classified as a separate group in ICD-10 (tenth version International classification diseases). The ICD 10 code for osteochondropathy depends on the location of the pathology:

Osteochondropathy of the tibial tuberosity – M92.0;
Osteochondropathy of the knee joint – M92.5;
Osteochondropathy kneecap– M92.4;
Osteochondropathy of the pelvis and osteochondropathy of the pubic ischial joint, as well as osteochondropathy of the femoral head and hip joint– M91.

Pathologies of other parts of the skeletal system of the lower extremities - osteochondropathy ankle joint, osteochondropathy of the foot, including osteochondropathy of the navicular bone of the foot, osteochondropathy of the talus, osteochondropathy of the calcaneus and 1 2 metatarsal bones of the foot, belong to the subgroup called “Other osteochondropathy”. It has a general code M93.

Interesting!
Any form of illness requires long-term complex therapy. Pathological process has a reversible nature, and when timely diagnosis and treatment, complete recovery may occur. Without treatment, osteochondropathy leads to serious consequences– the affected bone can break simply under the weight of the person’s body.

Stages and symptoms of osteochondropathy

Classification of osteochondropathy by stage and stage depends on the degree of damage. Experts distinguish the following stages of osteochondropathy:

The initial stage lasts several months and leads to the development of necrosis of osteochondral tissues;
Moderate stage - ends compression fracture, in which partial destruction and wedging of bones into each other occurs. Lasts up to six months;
The fragmentation stage lasts up to three years. At this stage, the area of bone tissue affected by the disease begins to be reabsorbed and replaced by granulation cells;
The recovery stage after a course of therapy has individual character and lasts from several months to one and a half years. The shapes and structures of the affected bones are completely restored at this stage.

It takes 2-4 years from the initial stage to the recovery stage. Each type of osteochondropathy of the lower extremities has its own specific symptoms:

Damage to the hip joint, also known as Legg-Calvé-Perthes disease, is manifested by pain in the area of the injury, radiating to the knee, limited joint dynamics, partial atrophy muscles of the thigh and lower leg. The sore leg may become shorter by one and a half to two centimeters;
When the disease is localized in the area of the tibial tuberosity, Osgood-Schlatter disease is diagnosed. It is characterized by swelling and swelling of the affected area, pain that intensifies with exercise (climbing stairs, kneeling), mild dysfunction of the knee joint;
Disease of the navicular bone of the foot, or Keller disease 1, causes foot pain and lameness. Redness and swelling are rare;
Osteochondropathy of the metatarsal bones (Keller's disease 2) is expressed in shortening of the 2nd and 3rd toes, limited dynamic capabilities, redness skin in this zone;
Schinz's disease (osteochondropathy of the calcaneal tubercle) has a poor clinical picture, expressed in swelling and pain in the affected area.

On a note!
Similar symptoms are characteristic of many osteoarticular pathologies. For proper treatment, it is important to differentiate the listed types of osteochondropathy from other diseases of the lower extremities. Put correct diagnosis an experienced orthopedic surgeon will be able to full examination sick.

Diagnosis and treatment of pathology

Establishing a diagnosis begins with an examination of the patient by a doctor and a detailed interview with him. The orthopedist palpates the affected area of the limb and checks the dynamic qualities of the joint. The patient is then advised to undergo instrumental diagnostics, which will help confirm or refute the doctor’s preliminary conclusion. In number diagnostic procedures includes:

X-ray examination of the affected area of the limb;
Ultrasound examination (ultrasound) of bone tissue;
Magnetic resonance imaging (MRI) of the joint and cartilaginous membrane;
Computed tomography (CT).

Also held general tests blood (BAC), its biochemical composition, specialized tests to identify hormonal levels. Based on the data obtained, a course of therapeutic procedures is prescribed.

Treatment of osteochondropathy of bones includes both conservative and surgical techniques. Surgical intervention is indicated in in rare cases, when separating the affected area from the main part of the bone. More often, the problem is solved with the help of medications and physiotherapeutic procedures.

Pharmaceutical part of the course severe pain in bones includes the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the form of ointment - Diclofenac, Ketoprofen, Inlometacin. It is also necessary to consume a complex of vitamins and microelements that help activate regenerative processes.

But the main emphasis is on physical therapy. If the femoral head is affected, it is recommended skeletal traction with cargo. If the metatarsal (navicular) bones of the foot are damaged, a special plaster “boot” is applied, and in the future it is necessary to wear shoes with arch support. Also important role in the treatment process, massage and physical therapy are used for osteochondropathy of the metatarsal bone and other parts of the skeleton.

Attention!
To treat pathology, many drugs are used, the use of which allows you to completely recover from osteochondropathy of the lower extremities. But healing process It may take a long period, during which it is necessary to follow all the recommendations of the attending physician.

If you follow the orthopedist's instructions, there is a high probability of recovery. To prevent recurrence of bone disease, it is necessary to healthy image life, maintain moderate physical activity, avoiding overload and injury, monitor body weight, undergo regular preventive examinations.

In the article you will learn what osteochondropathy is, why this disease appears in children, what the first symptoms are and how to treat this disease.

One of the joint diseases that can be found most often in adolescents is osteochondropathy. The disease is associated with metabolic disorders with joint tissues as a result of impaired blood supply to a certain area. Dead areas of bone form, e.g. physical activity. With osteochondropathy, the bones become brittle and the child is susceptible to spontaneous fractures, so it is very important to consult a doctor at the first signs of the disease. The main symptom of the pathology is pain in the affected area; the child also becomes lethargic and may complain of weakness.

Osteochondropathy main causes

The etiology of the disease is not fully understood, but doctors say that the following factors underlie osteochondropathy:

Hereditary predisposition. If one of the family members suffered from bone pathology, the child’s risk of getting the disease is increased.
Hormonal disorders. Often osteochondropathy is associated with pathology endocrine system.
Injuries. More susceptible to illness are children who are often injured, who also play sports and undergo large physical exercise.
Metabolic disease. Pathology can be caused by a lack of calcium and vitamin D in the body, which is why it is so important to monitor the child’s nutrition.
Circulatory disorders. In this case, lack of nutrition provokes bone necrosis.

The disease most often affects the legs, since they bear the main load. The onset of the disease practically does not manifest itself, but when the first symptoms appear, it is important to consult a doctor. By taking a picture, a specialist can determine the extent of the lesion and the complexity of the disease. Typically, treatment can be complex (bed rest, therapy, medications) or surgical.

Symptoms of the disease

The first signs of bone tissue damage can be determined by the following factors:

Swelling appears at the site of the lesion, but signs inflammatory process may be missing.
Pain occurs. It can be either constant or occur under a certain load.
In the presence of such a disease, fractures can often occur.
Appear visual signs posture changes. There may be lameness.

Despite the danger of the disease, it can be brought under control and even completely eliminated. Correct treatment and in time will avoid bone deformation and additional difficulties will not arise in the future.

Classification of osteochondropathy

Distinguish the following types osteochondropathy:

Pathology of short tubular bones. This type of disease includes Köhler I, Kienbeck, Calve, and Praiser diseases.
Pathology of tubular bones. The second type includes Legg-Calvé-Perthes and Köhler II disease.
In the apophyses. This type includes Haglund-Schinz, Osgood-Schlatter, and Scheuermann-Mau disease.
Osteochondropathy of the joint surface. The latter type is called Koening's disease.

Vertebral osteochondropathy

Diseases that affect the spine are called Sherman-Mau disease and Calvet disease. Sherman-Mau disease is characterized by destruction of the apophyses of the vertebrae; this disease occurs most often in boys during adolescence.

In this case, there are often no symptoms, patients do not complain of pain, but there is a pronounced deformation of the spine, the back becomes round. This condition often forces parents to consult a specialist.

With Calvet disease, damage to the vertebral body occurs, and this condition usually occurs before the age of 7 years. The disease is accompanied by pain in the spine, and the child becomes lethargic, weak, and capricious. For osteochondropathy of the spine, treatment should be carried out in a hospital setting, since the patient needs complete rest.

Osteochondropathy of the hip joint

This pathology is called Perthes disease, the disease occurs most often in boys under the age of 9 years, and the head of the femur is affected. Often the disease occurs after a pelvic injury, the child suddenly begins to limp and complains of pain in the pelvis, which radiates to the leg.

The disease gradually progresses, the function of the hip joint is impaired and motor activity is impaired, the muscles atrophy. If hip subluxation occurs, the affected leg may become shorter.

This pathology requires compulsory treatment, otherwise the head of the hip joint is formed incorrectly, which leads to the occurrence of deforming arthrosis. In most cases, the disease is treated conservatively, but in advanced stages of the pathology it may be necessary surgical intervention.

Osteochondropathy of the tibia

Schlatter's osteochondropathy most often occurs in boys during adolescence, and is characterized by pain in the area of the tibia.

Unpleasant sensations worsen when the patient gets up from a chair, or climbs stairs, as well as in a kneeling position. Sometimes there may be dysfunction of the knee joint.

In most cases, this pathology does not leave complications; the disease is treated on an outpatient basis, surgical methods do not apply.

Osteochondropathy of the foot

In Köhler's disease II, the 2nd and 3rd metatarsal bones are destroyed. The disease occurs more often in girls during adolescence, develops gradually, the first symptoms of the disease are mild pain in the foot area. Over time, the pain intensifies, the child limps, and the skin around the affected area swells slightly.

The disease can be cured at home by prescribing limb immobilization and then physical therapy. If you consult a doctor in a timely manner, the prognosis is favorable.

In Köhler's disease I, the scaphoid bone is affected and occurs mainly in boys under 7 years of age. The symptoms of the pathology are similar to the previous one, the child limps and complains of pain, there is swelling of the foot with outside.

Schinz's disease is characterized by damage to the tubercle of the calcaneus; children aged 6 to 14 years are susceptible to pathology. The child complains of pain in the heel, swelling of the affected area is observed, the patient limps and tries to take care of the affected heel.

Koenig's disease

This pathology is called osteochondropathy dissecans and is more common in boys during adolescence. When the disease occurs, the knee and hip joints are affected, a section of cartilage undergoes necrosis and peels off, sometimes fragments penetrate into the joint.

Patients who are faced with this diagnosis are interested in how arthrosis differs from osteochondropathy. With arthrosis, deformation of the joint occurs, and with osteochondropathy, destruction of cartilage tissue occurs.

The disease is accompanied characteristic symptoms: joint pain, impaired motor activity. The advanced stage of the disease is characterized by atrophy muscle tissue, and the complication is deforming arthrosis.

Most often, diseases are provoked by increased physical activity, while the blood circulation of any part is disrupted, and its destruction occurs due to lack of nutrition. Treat the disease surgically, since the dead section of cartilage must be removed.

Stages and symptoms of the disease

The following stages of osteochondropathy are distinguished:

The disease begins with gradual necrosis of bone tissue, while symptoms may not be observed at all, or the patient may be bothered aching pain in the affected area. Painful sensations worsen with movement and when pressing on the affected area, may also be disrupted physical activity affected limb.
On next stage disease, a fracture of the affected bone occurs, with corresponding symptoms.
At the next stage, the affected tissue is resorbed and replaced by granulation tissue.
On last stage bone tissue is restored. Without treatment full recovery does not occur, complications arise in the form cosmetic defects and deforming arthrosis.

The average duration of the disease is 3 to 4 years.

Echo signs of osteochondropathy

Only a doctor can correctly diagnose the disease, so at the first signs of the disease it is necessary to show the child to an orthopedist as soon as possible. During the examination, the doctor interviews the patient and examines him, based on the data received. experienced specialist can immediately make a preliminary diagnosis.

To confirm the diagnosis, the patient is referred for radiography and ultrasound, or computed tomography. On initial stages The disease is difficult to identify pathology using radiography, and with the help of ultrasound, the doctor detects echo signs of the disease even in the initial stages.

Treatment of osteochondropathy

There are 2 stages of treatment for osteochondropathy. First, the patient is prescribed complete rest and non-steroidal anti-inflammatory drugs to stop the destruction of bone tissue and relieve pain. The next step is for the patient to massotherapy, physiotherapy, physiotherapy.

For severe pain, they can apply plaster cast, and if the foot is affected, wearing special orthopedic insoles. The operation is performed for severe deformation of the spine or limb, and if the hip joint is affected, skeletal traction may be indicated.

reading information

Osteochondropathy is necrosis (death) of a section of bone due to various reasons. The area adjacent to the bone also suffers cartilage tissue. The disease is chronic, gradually causing deformation of bones and joints; with age, arthrosis and limited mobility (contracture) develop. Most often, children and adolescents aged 5-14 years are affected, but osteochondropathy also occurs in adults. In the structure of orthopedic morbidity, it accounts for 2.5-3% of the total number of visits.

Impaired blood flow through the arteries leading to the epiphysis of the bone leads to the development of osteochondropathy

The cause of osteochondropathy is a violation of blood circulation in the area of the bone near the joint (epiphysis), leading to its necrosis and associated complications - deformation, fractures. The following factors can lead to circulatory disorders: :

Injuries: bruises, hematomas, damage to soft tissue, bone, cartilage.
Hormonal and metabolic disorders, mainly during puberty (adolescence), lack of phosphorus and calcium salts.
Lack of protein in the diet (for example, vegetarians).
Increased bone growth when it outstrips vascular development.
Excessive functional load on joints, especially in childhood and adolescence.
A sedentary lifestyle (hypodynamia), leading to blood stagnation.
Congenital anomalies of the development of the osteoarticular system.
Excess weight, which increases stress on bones and joints.
Hereditary predisposition (feature of bone structure).

Important! Persons at risk for osteochondropathy, Special attention should be addressed skeletal system, and at the slightest complaint, consult a doctor.

Classification of osteochondropathy, its types

Osteochondropathy varies according to the location of the disease, which has 3 main “favorite” places:

epiphyses (articular ends) of tubular bones;
bone apophyses (protrusions, tuberosities);
short bones (vertebrae, tarsal bones of the foot).

The following types of osteochondropathy develop in the area of the epiphyses of bones::

femoral head;
heads of metatarsal bones of the foot;
upper epiphysis of the leg;
fingers;
sternal epiphysis of the clavicle.

Apophyseal osteochondropathy:

tibia of the leg;
vertebral apophyses;
calcaneus;
knee joint;
pubic bone.

Study in more detail on our portal.

Osteochondropathies of short bones:

vertebral bodies;
navicular bone of the foot;
lunate carpal bone;
sesamoid (accessory) bone at the base of the 1st toe.

Stages of development and clinical manifestations of osteochondropathy

The disease develops gradually over 2-3 years, going through the following 3 phases:

First stage- initial, when necrosis (necrosis) of a section of bone occurs due to circulatory problems. Manifested by aching pain in the bones, joints or spine (depending on location), increased fatigue, movement disorders.
Second stage- destruction, fragmentation of bone (separation into fragments). Characterized by increased pain, bone deformation, and pathological fractures(without visible injury). The function is significantly impaired.
Third stage- bone restoration. The destroyed bone is gradually restored, defects are replenished bone tissue, but sclerotic phenomena and arthrosis of nearby joints develop. Pain syndrome decreases, but deformation and limited function may remain.

Phases of development of osteochondropathy: a - circulatory disorders, b - development of necrosis, c - formation of bone fragments, d, e - restoration, bone healing

Diagnostic methods

The following methods are used to diagnose osteochondropathy:

radiography;
computed tomography (CT);
magnetic resonance imaging (MRI);
radioisotope study of the entire skeleton (scintigraphy);
ultrasound scanning (ultrasound);
densitometry (determination of bone density).

Information. When examining children, preference is given to non-radiation methods - ultrasound, MRI.

Certain types of osteochondropathy, treatment

Each type of osteochondropathy has its own characteristics of manifestation, treatment program is also compiled individually, taking into account the age and stage of the disease.

Legg-Calvé-Perthes disease

This is osteochondropathy of the hip joint. Most patients are boys from 5 to 14 years old, the lesion is often unilateral. Necrosis develops in the head of the femur. The disease manifests itself as pain in the joint, difficulty walking, lameness, and later the muscles of the thigh and buttocks atrophy, and the limb shortens.

Treatment of the disease requires a long time (2-4 years). The joint is immobilized, the limb is isolated from the load (splint, crutches or traction). Prescribe calcium and phosphorus supplements, vitamins, vasodilators, locally - iontophoresis with calcium, massage, exercise therapy. Good effect provides treatment in a specialized sanatorium. The disease usually responds well to treatment, and only if it is ineffective is surgery indicated (osteotomy, removal of necrotic areas of bone, joint plastic surgery or endoprosthetics).

Important. Perthes disease can lead to irreversible changes joint when prosthetics are needed. Therefore, its treatment must be timely and qualified.

Schlatter's disease (Osgood-Schlatter)

This is osteochondropathy of the tibia, or more precisely, its tuberosity, located on the front surface of the leg, immediately below knee joint. Both boys and girls aged 10 to 17 years old, mostly those who actively engage in sports, are affected. A painful swelling appears below the knee; walking and movements in the knee are painful.

To treat osteochondropathy of the tibia, the limb is fixed with a splint, physiotherapy, massage, and calcium supplements are prescribed. The disease usually responds well to treatment, although the “bump” on the bone remains.

Osteochondropathy of the foot in children

The navicular, calcaneal, and metatarsal bones are most often affected. Necrosis in the scaphoid bone located along the inside foot, called Keller disease I. Mostly boys from 3 to 7 years old are affected; the lesion is one-sided. When walking, the child begins to limp and leans on the outer part of the foot (crooks the leg). Usually the disease does not cause severe symptoms, may remain undiagnosed, and goes away on its own within a year. If detected, they are prescribed to wear arch supports, special shoes, physiotherapy, and exercise therapy.

Osteochondropathy of the heads of the II-III metatarsal bones (Keller's disease II) more common in girls adolescence, both feet are affected. When walking, pain appears in the foot, which then becomes permanent and can bother you even during sleep. Swelling of the foot and shortening of the toe appear. The disease lasts 2-3 years until it stops enhanced growth bones. The treatment regimen also includes calcium supplements, vitamins, physiotherapy, massage and exercise therapy.

Osteochondropathy of the calcaneus (Schinz disease) can develop in both boys and girls aged 7-12 years, most often both limbs are affected. There is pain, swelling on the back of the heel, lameness, and difficulty wearing shoes. The child begins to walk, relying more on his toes. Over time, atrophy of the calf muscle may develop.

Osteochondropathy of the calcaneus in children is a fairly common phenomenon that lasts quite a long time, until the end of bone growth, and compaction in the area of the tuberosity of the heels can remain for life. Treatment of osteochondropathy of the calcaneus in children consists of immobilizing the foot with a splint, prescribing physiotherapy, vitamin and anti-inflammatory drugs, and means to improve blood circulation and microcirculation.

Spinal osteochondropathy

Osteochondropathy is more common thoracic spine, there are 2 types of it:

Scheuermann-Mau disease, in which the destructive process occurs in the epiphyses of the vertebrae, that is, near the discs;
Calve's disease is a lesion of the vertebral bodies themselves.

Mostly teenagers and young adults (11-19 years old) get sick. The disease is common, especially in recent decades. Symptoms include spinal deformity (flat or round back), concavity of the sternum (“cobbler’s chest”), back pain, muscle atrophy chest, increased fatigue. The patient cannot remain in the vertical position, perform physical activity. A wedge-shaped deformity of the vertebrae gradually develops, they take on the appearance of a trapezoid (the height of the bodies in the anterior sections decreases). Later, these changes are joined by osteochondrosis and spondylosis deformans.

Changes in the vertebral bodies during osteochondropathy: on the left - their wedge-shaped deformation, on the right - its result (kyphosis of the back)

Long-term treatment of spinal osteochondropathy: physiotherapy, exercise therapy, massage, wearing a corrective corset, vitamin therapy, chondroprotectors, sanatorium treatment. In rare cases, when spinal deformity is severe or disc herniations or vertebral displacement have occurred, operations are performed (correction and fixation of vertebrae, plastic arches and discs).

Osteochondropathy is an age-related disease that can be treated. If it is started on time, carried out comprehensively and skillfully, in most cases recovery occurs.