Osteochondropathy of the ischium in children. Osteochondropathy in children

Osteochondropathy (aseptic osteochondronecrosis)- self-
standing view of the degenerative-necrotic process in the epiphy-
And apophyses, spongy parts of the bones, accompanied by pain
in most cases, a successive change of necrosis, resorption
0 rejection of the affected areas of the bone and subsequent restoration
changes in bone structure.

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

Etiology

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

There are four groups of osteochondropathy.

1. Osteochondropathy of the epiphyseal ends tubular bones:
heads femur(Legg-Calve-Perthes disease);
heads II-III metatarsal bones(Kehler II disease).

2. Osteochondropathy of short spongy bones:
navicular bone of the foot (Kohler's disease I);
patella (Larsen's disease);
vertebral bodies (Calve's disease);
semilunar bone of the hand (Kinböck's disease).

3. Osteochondropathy of the apophyses:
tuberosity tibia(Osgood-Schlatter disease);
apophyses of the vertebrae (Scheuermann-Mau disease);
mound calcaneus(Gaglund-Shinz disease).

4. Partial wedge-shaped osteochondropathy articular surfaces:
condyles of the femur (Koenig's disease);
capitate eminence humerus(Panner's disease)-
The process in most cases develops slowly, 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.

Osteochondropathy unite a group of diseases occurring in childhood and adolescence, in which the subchondral sections of the epiphyses of some bones are affected. From a morphological and pathophysiological point of view, osteochondropathy is an aseptic necrosis, which has a peculiar clinical picture.
Aseptic necrosis often develops in the femoral head (Legg-Calve-Perthes disease), in the heads of the II and III metatarsal bones (Kohler-II disease), in the tuberosity of the tibia (Osgood-Schlatter disease), in the lunate bone of the hand (Kinbeck's disease), in the internal condyles of the thigh (Koenig's disease) and much less often in the navicular bone of the foot (Kohler-I disease), in the calcaneal tubercle (Sheen's disease). ca), very rarely - in the epiphyses of the vertebrae (Showerman-May disease) and in the vertebral bodies (Calve disease).
The main goal of treatment- restore disturbed blood circulation of the periosteum, prevent deformities and the development of deforming arthrosis.
The main methods of rehabilitation such patients are massage, exercise therapy, physio and hydrotherapy, cryomassage, vibration massage, hydrocolonotherapy and etc.

Legg-Calve-Perthes disease

Osteochondropathy of the femoral head often occurs in children aged 5 to 12 years. Boys are affected 4-5 times more often than girls. The disease begins imperceptibly 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 limitation of mobility in the hip joint.
Conservative treatment is in early unloading of the affected limb (unloading devices, traction or crutches). Massage, LH are shown (in the supine position, include general developmental and breathing exercises, mainly for the muscles of the trunk and a healthy limb, isometric tension of the quadriceps femoris), physiotherapy ( mud applications on the joint, phonophoresis with mummy ointment or mobilat). If the patient is on inpatient treatment, then glue or cuff traction is prescribed for complete unloading of the limb and LH, massage, and physiotherapy are used. After discharge, hydrokinesitherapy is indicated, vibration massage back and lower extremities.

Kohler-II disease

Osteochondropathy of the metatarsal head more common in girls aged 13 to 19 years. In 90% of cases, the head of the second metatarsal bone is affected. Characterized by swelling and soreness in the area of ​​the metatarsophalangeal joint. On palpation, there are thickenings and bone growths on the head of the metatarsal bone. Movement in the metatarsophalangeal joint is limited.
massage of the thigh and calf muscle, physiotherapy (paraffin-ozocerite, mud applications, phonophoresis), LH (in the supine and sitting position), wearing an insert in shoes. Shown hydrokinesitherapy. Exercises in a standing position (squats, jumps, jumps, etc.) are 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. Swelling and slight swelling of soft tissues appear in the area of ​​tibial tuberosity.
Conservative treatment includes massage, LH in water, physiotherapy (ultrasound with mobilat, 10% mummy ointment). Loads on the lower limb are excluded for 2-3 weeks. The place of the disease is fixed with adhesive tape, cryomassage is also used in the first 3-5 days.
Massage technique
From the first day of the disease, a suction massage is performed, that is, first the muscles of the thigh, knee joint are massaged, calf muscles applying stroking, kneading, rubbing. After that, the place of the disease is massaged, applying stroking, and in the following days - rubbing with the base of the palm, fingertips. After the pain subsides, you can carefully apply kneading with fingertips, tong-like rubbing, alternating it with stroking. It is advisable to use massage in combination with physiotherapy procedures. The duration of the massage is 10-15 minutes.

Kienböck's disease

Osteochondropathy of the semilunar bone observed in individuals undergoing frequent injuries. Characterized by pain in the area of ​​the lunate bone, aggravated by pressure. Movements in wrist joint cause severe pain. There is swelling in this area.
Conservative treatment includes immobilization, massage of healthy tissues, LH (general developmental exercises, breathing, in isometry, etc.), physiotherapy (UHF No. 3, phonophoresis, electrophoresis with 10% mummy solution), training on a bicycle ergometer, after removing the plaster bandage, massage, swimming, vibration massage of the back and lower extremities are used.
At surgical treatment (removal of the lunate bone) is performed LH, massage of the collar region, muscles of the shoulder girdle and a healthy limb. Workouts on a bicycle ergometer or on a treadmill. After removing the plaster bandage, vibration massage of the back, arms and legs is included.

Koenig's disease

Aseptic necrosis of the femur is an aseptic subchondral necrosis of a small area of ​​the epiphysis of a semicircular shape, which often leads to the formation of a free intraarticular body. Localization of the process is more often noted in the region of the internal condyle, that is, in those parts of the epiphysis that are subjected to the greatest functional load.
The disease is characterized joint pain, feeling unwell, or instability in the affected joint. IN late stage diseases occur characteristic phenomena - "blockade" of the joint, synovitis.
Surgical treatment- removal of the affected area of ​​the bone.
IN postoperative period carry out a massage of healthy tissues, LH (general developmental, breathing exercises in the supine position). After removing the sutures and splints - electrical stimulation of the quadriceps femoris muscle, hydrocolonotherapy and cryomassage. Then the motor mode gradually expands and classes on simulators and walks are included. Exercise therapy after discharge from the hospital, the patient does at home.

Osteochondropathy is common name bone diseases of aseptic (non-infectious) etiology, causing necrotic processes in 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 the development of pathology of the bones of the legs is more likely. The hip, knee, shin and foot, which take on the bulk of the load during movement, are more at risk of developing pathology. Most often, osteochondropathy of the bones occurs in children and adolescents 5 to 16 years old, but sometimes this diagnosis is also made to older young people - up to 20 years old.

The main causes of osteochondropathy

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

The lack of regeneration stimulants supplied with blood causes a malfunction in the course of recovery processes. Bone tissue of the lower extremities in places of deficiency nutrients becomes fragile, easily injured and deformed, in places of the greatest load on the joint, osteophytes develop - bone growths. 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 bone and cartilage cells.

provoke local disturbance blood circulation, leading to the development of osteochondropathy, are capable of the following factors:

• Limb injuries. When restoring (fusion) after trauma to the bone and cartilage tissue, partial pinching may occur blood vessel, leading to a restriction of the blood flow through it;
• Hormonal imbalance that occurs during the restructuring of body systems in puberty (adolescence) period;
• Rapid growth, leading to a deficiency in the body of salts of phosphorus, calcium, and other trace elements necessary for strengthening bones;
• The lag in the development of the blood supply system from the growth of the skeleton in adolescence;
• Excessive load on the bone apparatus in childhood and adolescence - playing sports or choreography;
• Hypodynamia 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 bone and cartilage tissue;
• Lack of vitamins;
• Excess weight, which not only increases the chronic load on the joints, but also deprives them of a significant amount of blood due to the need to supply it with adipose tissue;
• Congenital anomalies in 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 a child is significantly increased.

Osteochondropathies are singled out in a separate group in the ICD-10 (the tenth version International classification diseases). The code of otseochondropathy according to ICD 10 depends on the location of the pathology:

• Osteochondropathy of the tibial tuberosity - M92.0;
• Osteochondropathy of the knee joint - M92.5;
• Osteochondropathy patella- M92.4;
• Osteochondropathy of the pelvis and osteochondropathy of the pubisciatic joint, as well as osteochondropathy of the femoral head and hip joint- M91.

Pathologies of other parts of the bone apparatus 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 the general code M93.

Interesting!

Any form of illness needs a long complex therapy. Pathological process is reversible, and timely diagnosis and treatment can lead to a full recovery. Without treatment, osteochondropathy leads to serious consequences- the affected bone can break simply under the weight of the human body.

Stages and symptoms of osteochondropathy

The classification of osteochondropathy by stages depends on the degree of damage. Specialists distinguish the following stages of osteochondropathy:

• The initial stage - lasts several months and leads to the development of necrosis of bone and cartilage tissues;
• Moderate stage - ends compression fracture, in which there is a partial destruction and wedging of bones into each other. Lasts up to six months;
• The fragmentation stage lasts up to three years. At this stage, the resorption of the affected area of ​​the bone tissue begins and its replacement with granulation cells;
• The stage of recovery after the course of therapy has individual character and lasts from several months to one and a half years. The forms and structures of the affected bones are completely restored at this stage.

From the initial stage to the recovery stage, 2-4 years pass. Each of the varieties of osteochondropathy of the lower extremities has its own specific symptoms:

• Damage to the hip joint, also known as Legg-Calve-Perthes disease, is manifested by pain in the area of ​​​​damage extending to the knee, limiting the dynamics of the joint, partial atrophy thigh and leg muscles. A sore leg can become shorter by one and a half to two centimeters;
• When the disease is localized in the zone of tibial tuberosity, Osgood-Schlatter disease is diagnosed. It is characterized by swelling and swelling of the lesion site, pain, aggravated by exertion (climbing stairs, kneeling), mild dysfunction of the knee joint;
• Involvement of the navicular bone of the foot, or Keller's disease 1, causes foot pain and lameness. Redness and swelling are rare;
• Osteochondropathy of the metatarsal bones (Keller's disease 2) is expressed in the shortening of the 2nd and 3rd toes, the limitation of their dynamic capabilities, redness skin in this zone;
• Shinz's disease (calcaneal osteochondropathy) has a poor clinical picture, expressed in swelling and soreness of 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 complete examination sick.

Diagnosis and treatment of pathology

Establishing a diagnosis begins with an examination of the patient by a doctor and a detailed questioning of him. The orthopedist performs palpation of the affected area of ​​the limb, checks the dynamic qualities of the joint. The patient is then advised to 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 analyzes blood (UAC), her biochemical composition specialized tests to detect hormonal level. Based on the data obtained, a course of therapeutic procedures is prescribed.

Treatment of osteochondropathy of the bones includes both conservative and operational techniques. Surgery is shown 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 medication and physiotherapy procedures.

Pharmaceutical part of the course severe pain in the bone includes the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the form of an ointment - Diclofenac, Ketoprofen, Inlomethacin. It is also necessary to use a complex of vitamins and microelements that contribute to the activation of regenerative processes.

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

Attention!

For the treatment of pathology, many means 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 prescriptions of the orthopedist, the probability of recovery is high. To prevent recurrence of bone disease, it is necessary to conduct healthy lifestyle life, observe 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 are the first symptoms 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 the tissues of the joint as a result of a violation of the blood supply to a certain area. Dead areas of the bone are formed, for example, with physical activity. With osteochondropathy, the bones become brittle, and the child undergoes 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 has an increased risk of getting sick.
• Hormonal disorders. Often osteochondropathy is associated with pathology endocrine system.
• Injuries. Children who are often injured are more susceptible to getting sick, as well as playing sports and undergoing great physical exercise.
• Metabolic disease. A lack of calcium and vitamin D in the body can provoke pathology, which is why it is so important to monitor the child's nutrition.
• Circulatory disorders. In this case, the lack of nutrition provokes bone necrosis.

The disease most often affects the legs, since they bear the brunt of the load. The onset of the disease practically does not manifest itself in any way, but when the first symptoms appear, it is important to consult a doctor. Having taken a picture, a specialist can determine the degree of damage and the complexity of the disease. Usually, treatment can take place both complex (lying down, therapy, taking medications) and surgical.

Symptoms of the disease

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

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

Despite the danger of the disease, it can be brought under control and even get rid of it completely. Proper Treatment and in time will avoid deformation of the bones and in the future there will be no additional difficulties.

Classification of osteochondropathy

Distinguish the following types osteochondropathy:

• Pathology of short tubular bones. This type of disease includes diseases of Koehler I, Kienbeck, Calve, Preiser.
• Pathology of tubular bones. The second type includes Legg-Calve-Perthes and Koehler II disease.
• in apophyses. This type includes Haglund-Shinz, Osgood-Schlatter, Scheuermann-Mau disease.
• Osteochondropathy of the surface of the joints. The latter type is called Koening's disease.

Osteochondropathy of the vertebrae

Diseases in which the spine is affected are called Sherman-Mau's disease and Calve's disease. Sherman-Mau disease is characterized by the destruction of the apophyses of the vertebrae; this disease occurs most often in boys in adolescence.

Symptoms in this case are often absent, 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 turn to a specialist.

With Calve's disease, the vertebral body is affected, and this condition usually occurs before the age of 7 years. The disease is accompanied by pain in the spine, while the child becomes lethargic, weak, capricious. With osteochondropathy of the spine, treatment should be carried out in a hospital, as 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, while 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 disturbed and there is a violation of motor activity, the muscles atrophy. If hip subluxation occurs, the affected leg may become shorter.

This pathology requires mandatory 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 the advanced stages of the pathology, it may be necessary surgical intervention.

Osteochondropathy of the tibia

Schlatter's osteochondropathy most often occurs in boys in adolescence, it is characterized by pain in the tibia.

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

In most cases, this pathology does not leave complications, diseases are treated on an outpatient basis, surgical methods do not apply.

Osteochondropathy of the foot

In Koehler II disease, destruction of the 2nd and 3rd metatarsal bones occurs. The disease occurs in girls in adolescence more often, develops gradually, the first symptoms of the disease are weak pains in the area of ​​the foot. Over time, the pain intensifies, the child limps, the skin around the affected area swells a little.

You can cure the disease at home, for this, immobilization of the limb is prescribed, and then physiotherapy. With timely treatment to the doctor, the prognosis is favorable.

In Koehler's disease I, the navicular bone is affected, it 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.

Shinz's disease is characterized by a lesion of the calcaneal tuber, 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 dissecting osteochondropathy, it occurs more often in boys in adolescence. When the disease affects the knee and hip joints, the area of ​​cartilage undergoes necrosis and exfoliates, sometimes fragments penetrate the joint.

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

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

Most often, diseases are provoked by increased physical activity, while the blood circulation of any part is disturbed, 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:

1. The disease begins with a gradual necrosis of bone tissue, while symptoms may not be observed at all, or the patient is disturbed aching pain in the affected area. Pain aggravated by movement and by pressing on the affected area, may also be disturbed physical activity the affected limb.
2. On next stage disease, a fracture of the affected bone occurs, with corresponding symptoms.
3. At the next stage, the affected tissue is resorbed and replaced by granulation tissue.
4. On last step bone regeneration takes place. In the absence of treatment full recovery does not occur, complications arise in the form cosmetic defects and deforming arthrosis.

The duration of the disease averages from 3 to 4 years.

Echo signs of osteochondropathy

Only a doctor can correctly diagnose the disease, therefore, 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, based on the data received experienced specialist can immediately make a preliminary diagnosis.

To confirm the diagnosis, the patient is referred for X-ray and ultrasound, or computed tomography. On initial stages diseases, it is difficult to identify the pathology using x-rays, 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 of 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 to show the patient massotherapy, physiotherapy, physiotherapy.

With severe pain, they can impose plaster cast, and in case of damage to the foot, wearing special orthopedic insoles. The operation is performed with severe deformity of the spine or limb, and with damage to the hip joint, skeletal traction may be indicated.

information to read

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

Violation of blood flow through the arteries going 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 ​​\u200b\u200bthe bone near the joint (epiphysis), leading to its necrosis and associated complications - deformities, fractures. The following factors can lead to circulatory disorders :

1. Injuries: bruises, hematomas, damage to soft tissues, bone, cartilage.
2. Hormonal and metabolic disorders, mainly in the pubertal (adolescent) period, lack of phosphorus and calcium salts.
3. Lack of protein in the diet (for example, in vegetarians).
4. Increased bone growth when it outpaces vascular development.
5. Excess functional load on the joints, especially in childhood and adolescence.
6. A sedentary lifestyle (physical inactivity), leading to stagnation of blood.
7. Congenital anomalies in the development of the osteoarticular system.
8. Being overweight puts more stress on the bones and joints.
9. Hereditary predisposition (feature of bone structure).

Important! Individuals at risk for osteochondropathy Special attention should be referred to 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;
• apophyses of bones (protrusions, tuberosities);
• short bones (vertebrae, tarsal bones of the foot).

In the region of the epiphyses of bones, the following types of osteochondropathy develop:

• head of the femur;
• heads of the metatarsal bones of the foot;
• upper epiphysis of the leg;
• fingers of the hand;
• sternal epiphysis of the clavicle.

Apophyseal osteochondropathy:

• tibia of the lower leg;
• apophyses of the vertebrae;
• calcaneus;
• knee joint;
• pubic (pubic) bone.

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Osteochondropathy of short bones:

• vertebral bodies;
• navicular bone of the foot;
• semilunar bone of the wrist;
• sesamoid (additional) bone at the base of the 1st toe.

Stages of development and clinical manifestations of osteochondropathy

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

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

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

Diagnostic methods

The following methods are used to diagnose osteochondropathy:

• radiography;
• computed tomography (CT);
• magnetic resonance imaging (MRI);
• radioisotope examination of the entire skeleton (scintigraphy);
• ultrasonic 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 It is also compiled individually, taking into account the age and stage of the disease.

Legg-Calve-Perthes disease

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

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 preparations, vitamins, vasodilators, locally - calcium iontophoresis, massage, exercise therapy. good effect provides treatment in a specialized sanatorium. The disease usually responds well to treatment, and only if it is ineffective, surgery is indicated (osteotomy, removal of necrotic bone, joint plasty or arthroplasty).

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

Schlatter's disease (Osgood-Schlatter)

This is osteochondropathy of the tibia, or rather, its tuberosity, located on the anterior surface of the lower leg, immediately under knee joint. Both boys and girls from 10 to 17 years old are ill, mostly strenuously involved in sports. Painful swelling appears below the knee, walking and movements in the knee are painful.

For the treatment of osteochondropathy of the tibia, the limb is fixed with a splint, physiotherapy, massage, and calcium preparations are prescribed. The disease usually responds well to treatment, although the "bump" on the bone remains.

Osteochondropathy of the foot in children

The navicular, calcaneus, and metatarsal bones are most commonly affected. Necrosis in the scaphoid located along inside foot, called Keller's disease I. Boys from 3 to 7 years old get sick in the majority, the lesion is unilateral. When walking, the child begins to limp, leans on the outer part of the foot (curves the leg). Usually the disease does not give sharp symptoms, it may remain undiagnosed, it goes away on its own within a year. When detected, the wearing of arch supports, special shoes, physiotherapy, exercise therapy is prescribed.

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 in the foot appears, which then becomes permanent, can disturb even during sleep. There is swelling of the foot, shortening of the toe. The disease lasts 2-3 years - until it stops increased growth bones. The treatment regimen also includes calcium supplements, vitamins, physiotherapy, massage and exercise therapy.

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

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

Osteochondropathy of the spine

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 people (11-19 years old) get sick. The disease is widespread, especially in recent decades. Symptoms are expressed in spinal deformity (flat or round back), concavity of the sternum (“shoemaker’s chest”), back pain, muscle atrophy chest, their increased fatigue. The patient cannot stay in vertical position to perform physical activity. A wedge-shaped deformity of the vertebrae gradually develops, they take on the form of a trapezoid (the height of the bodies in the anterior sections decreases). In the future, osteochondrosis and deforming spondylosis join these changes.

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

Long-term treatment of osteochondropathy of the spine: physiotherapy, exercise therapy, massage, wearing a corrective corset, vitamin therapy, chondroprotectors, spa treatment. In rare cases, when the spinal deformity is pronounced or disc herniations, displacement of the vertebrae have formed, operations are performed (correction and fixation of the vertebrae, plasty of the arches and discs).

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