Osteochondropathy in adolescent children. Causes of osteochondropathy, types and stages of the pathological process

The causes and mechanisms of development of osteochondropathy have not been fully established. However, there are a number of factors that play an important role in the development of the disease.

Thus, a congenital or family predisposition to the development of the disease has been proven. Osteochondropathies often occur in children with dishormonal disorders, in particular, those suffering from adiposogenital dystrophy.

Confirmation important role endocrine system The pathogenesis of osteochondropathy is also due to the high frequency of this form of pathology in patients with acromegaly and hypothyroidism.

There is also a connection between osteochondropathy and infectious diseases.
.

There are five stages in the development of osteochondropathy:
I - aseptic necrosis as a result of vascular disorders;
II - compression fracture;
III - fragmentation, characterized by the development of connective tissue in areas that have undergone necrosis;
IV - productive with intense restoration processes(reparative);
V - restoration (reconstruction bone tissue).
Play a certain role in the pathogenesis of osteochondropathy vascular disorders, among which it is necessary to highlight neuro-reflex vasospasm caused by injury or prolonged microtraumatization final branches vessels. The development of osteochondropathy is also facilitated by long-term pressure loads on cancellous bones, which leads to disruption of microcirculation and obliteration of blood vessels with the subsequent development of avascular necrosis. In case of early elimination etiological factor proliferation of osteoclasts is possible followed by complete or incomplete recovery bone structure.

IN AND. Mazurov

Reasons for appearance

Osteochondropathies develop when blood circulation is impaired in some segments of bone tissue, resulting in areas of aseptic necrosis (death) of spongy bone during exposure to physical activity.

The causes of these processes are considered to be:

• genetic factors
• metabolic disease
• injuries
• infections
• deviations in hormonal background
• malnutrition

The inflammatory process develops in the epiphyses and apophyses tubular bones, vertebral bodies. The lower extremities are most often affected due to increased loads on them.

The full etiology of osteochondropathy is unknown. But there are several factors that can trigger the development of the disease. Increase the risk of pathology the following phenomena:

• Excess body weight.
• Violation hormonal balance.
• Failure in the metabolic process.
• Hereditary predisposition.
• Excessive physical exercise.
• Injuries lower limbs.
• Deforming processes of the legs.
• Poor circulation.

Today, the causes of the disease are not fully understood, but several decisive factors are identified:

Usually, First stage The formation of pathology provokes aseptic necrosis of the navicular bone of the foot, which causes a fracture and is accompanied by the separation of bone tissue fragments.

In advanced cases, an inflammatory process develops, which leads to complex deformations. The main reason for the formation of the pathology has not been established.

Injuries, heavy loads on the bones and soft tissues of the foot, as well as associated systemic diseases.

Types of pathology

Osteochondropathies are conventionally divided into four groups:

1. Osteochondropathies of the epiphyses of tubular bones - humerus(Hass disease), sternal end of the clavicle, metacarpal bones and phalanges of the fingers (Tiemann disease), head femur(Legg-Calvé-Perthes disease), heads II-III metatarsal bones(Köhler's disease II).

2. Osteochondropathies of short spongy bones - vertebral bodies (Calvé's disease), lunate bone of the hand (Kienbeck's disease), sesamoid bone of the first metatarsophalangeal joint, navicular bone of the foot (Köhler's disease I).

Each type of disease is characterized by its own symptoms, but some signs are common:

The disease in question has several varieties.

Perthes disease

Legg-Calvé-Perthes disease is called osteochondropathy of the hip joint. It is diagnosed in children up to about 10 years of age.

The cause of the violation may be leg injury and other factors.

Osteochondropathy of the head of the pelvic (femur) bone in adults and children begins with the appearance of slight lameness. Further movements are accompanied painful sensations. Then the signs become more pronounced, and the motor ability of the legs is limited.

During the examination, doctors reveal the death of the muscle tissue of the femoral neck. Sometimes the patient's affected leg becomes shorter than the healthy leg by 1-2 cm. This is due to the presence of hip subluxation.

Osteochondropathy of the femoral head develops long time and ends with the joint being restored. But if treatment is not done, the femoral head changes, which in the future causes deforming arthrosis in a person.

Koenig's disease

The disease is also called osteochondritis dissecans.

Symptoms of osteochondropathy

Main
complaints with pronation Eyvikha
are pains in elbow joint And
limitation of limb function due to
severe pain when moving,
especially with supination of the forearm.

Usually the forearm is brought towards the body
and hangs passively while in the position
pronation. Sometimes there is a protrusion
heads radius in front,
pain in the proximal area
section of the forearm.

Typical
medical history and the presence of characteristic clinical
symptoms are quite sufficient for
productions correct diagnosis. IN
dubious and difficult cases
X-rays may be taken
to avoid fractures.

The pathological process affects:

epiphyseal ends of tubular bones, head of the femur, Legg-Calve-Perthes disease,

short spongy bones, navicular bone of the foot - Köhler's disease I,

vertebral body - Calve's disease,

apophyses, tuberosity tibia- Schlatter's disease,

vertebral apophysis - Scheuermann-Mau disease, juvenile kyphosis.

Most frequent forms osteochondropathy are juvenile kyphosis and Legg-Calve-Perthes disease. Diseases occur according to the type of primary aseptic necrosis.

The etiology of the disease is not fully understood; the main cause of juvenile kyphosis is considered to be dysontogenetic disorders: inferiority of the discs, their fibrosis and insufficient strength of the endplate of the vertebral body.

In Perthes disease, the basis for development necrotic changes considered a violation of the arterial blood supply to the bone.

Symptoms of osteochondropathy in Scheuermann-Mau disease in children

Diagnosis of the disease

To determine osteochondropathy calcaneus based on clinical data and results x-ray examination(fragmentation, compaction of the apophysis, “roughness” on the tubercle of the calcaneus are noted).

Also carried out differential diagnosis osteochondropathy with heel spur(in older patients), achillobursitis.

To put accurate diagnosis and differentiate osteochondropathy from other pathologies degenerative nature, the doctor collects an anamnesis of complaints, a history of concomitant diseases of the child, and conducts an external examination of the feet. Further diagnosis comes down to the use of a number of studies presented in the table:

Treatment of clubfoot

Treatment
for congenital clubfoot should
begin immediately after birth
child. It is necessary gradually
train the leg manually, and then
apply a plaster cast.

Especially
it is important to eliminate subluxation in the ankle
joint Redressing plaster casts
first change every 3 days, and then
the interval increases.

After sufficient
correction of the shape or position of the foot
plaster casts are removed and applied
special night splints to maintain
achieved effect.

Cure
clubfoot is considered complete,
if it becomes possible
pronation and if the foot has normal
form. If this by the time of independent
getting the child to his feet and trying to
it is not possible to walk, then it is necessary
various shoe inserts.

Starting from the 3-4th year of life there may be
appointed physiotherapy For
feet. If the specified
operational measures are shown
interventions on soft tissues before
completion of growth and formation of the skeleton.

In severe cases, interventions are necessary
on the bones of the foot, however they must
be carried out only after completion
formation and full development
skeleton.

Treatment
in case of acquired clubfoot, you should
carry out in accordance with its reason.
If it cannot be eliminated, then
surgery (arthrodesis of the foot joints) or
provision of orthopedic
aids(And
orthopedic shoes).

Treatment
always done first
conservatively. You should check
Is active straightening possible?
longitudinal arch (postural defect).

IN
positive case shown
systematic gymnastics
foot exercises, walking barefoot
on the grass, as well as wearing suitable and
well-fitting shoes.

So-called
early childhood external clubfoot
is eliminated in this way. If
Only passive straightening is possible
feet, then additionally apply
shoe inserts.

The children were well acquitted
self detorsion inserts according to Hohmann
and so on. Special ones are also used
insoles, if you correct the situation with
using the means described above do not
succeeds.

In severe cases it is necessary
wearing orthopedic shoes. Always
therapeutic exercises should be carried out
and physiotherapeutic measures.

At
congenital flatfoot immediately after
birth should be tried with the help
redressal plaster casts, step
correct defects step by step.

Later
Inserts, night splints,
Gymnastics are held regularly
exercises. In the absence of noticeable
improvements or complete fixes
surgical interventions are indicated for the defect,
first on soft tissues, and later
on the bones.

Treatment
carried out only conservatively:
Gymnastics for the feet is prescribed, in
depending on the situation apply
inserts for shoes available in a wide range
sale (butterfly rollers).

Orthopedic
boots are often necessary
with incorrect finger position
feet or if along with the transverse
flat feet also occur on the outside
clubfoot.

U
newborns (there is only an incorrect
position) it consists of a gradual
application of redressing gypsum
dressings until recovery
normal position in position
plantar flexion, which in most cases
cases is achieved within a few
weeks

Overlay is often sufficient
a simple splint to secure the foot
in the opposite position.
At
acquired calcaneal foot is produced
surgical interventions on soft
tissues and bones, it is also possible to use
night splints or orthopedic shoes.

At
fresh paralysis along with the usual
treatment requires use
orthopedic means, fixing
position of the foot at right angles to the axis
shins (night splints for heel feet).

If it is impossible to make a correction
passively should try gradually
eliminate pathological situation
feet using redressing plaster casts
dressings, and then apply night splints.

Heel pulls are used for walking
feet, heel splints, orthopedic
shoes or bandages. Through prompt
lengthening of the heel tendon can
muscle recovery can be achieved
balance.

It is also possible to carry out
arthrodesis of the ankle joint with
giving the foot the most favorable
functionally position.

During treatment various types osteochondropathy is prescribed:

• Anti-inflammatory drugs: ibuprofen, naproxen, diclofenac.
• Compresses with dimexide (it is diluted with boiled chilled water in a ratio of 1:4–5).
• For electrophoresis, solutions of novocaine 2% and calcium gluconate 5–10% are used.
• Chondroprotectors: Teraflex, Chondroxide (if age-appropriate).

The main goal of therapy for osteochondropathy is to restore the structure of bone tissue and prevent limitation of the motor ability of the joints.

To do this, it is necessary to normalize blood circulation and stabilize the metabolic process.

The patient needs to take all measures to relieve the sore joint and ensure its immobility. This requires strict bed rest and physiotherapeutic procedures. The latter include the following techniques:

• Applications with paraffin or therapeutic mud.
• Electromagnetic influence.
• Electrophoresis.
• Ultrasound.
• Foot massage.
• Hydrotherapy.

In addition to physiotherapeutic procedures, patients are recommended to perform therapeutic exercises for healthy parts of the body. Also help the body cope with osteochondropathy breathing exercises.

Conservative treatment is carried out using various medicines. They are prescribed to eliminate the symptoms of pathology, namely to relieve pain, swelling, inflammatory processes. Medicines also help normalize metabolism and blood circulation.

• Non-steroidal anti-inflammatory drugs.
• Vitamin and mineral complexes.
• Chondroprotectors.
• Medicines aimed at improving blood circulation.
• Painkillers.

Surgery is prescribed in cases where the patient has a pronounced violation of the bone structure and posture.

An indication for surgery is also a bone avulsion that needs to be eliminated.

Therapy for osteochondropathy of the calcaneus consists of prescribing non-steroidal anti-inflammatory drugs (if severe pain), physiotherapeutic procedures, and reducing physical activity. To relieve the load on the heel bone, special insoles-instep supports are used.

The device has a shock-absorbing effect on the foot.

First of all, use conservative treatment, which consists of drug therapy, orthopedic correction and physical rehabilitation.

Surgical intervention in childhood is carried out extremely rarely. To relieve pain in osteochondropathy, non-steroidal anti-inflammatory drugs (Ibuprofen, Nurofen) are used in minimal dosages that are acceptable for children of a certain age.

Mineral-vitamin complexes are prescribed to saturate tissues with B vitamins and calcium. Orthopedic insoles are used to normalize blood circulation and correct gait.

If necessary, fix the leg with a plaster or bandage. Good therapeutic effect provide folk remedies in the form of warming compresses and warm baths with the addition of sea ​​salt.

To improve blood circulation and strengthen muscles, physical rehabilitation means such as exercise therapy and massage are used. Physiotherapeutic procedures have an analgesic and anti-inflammatory effect. For this purpose the following is used:

• drug electrophoresis;
• magnetic therapy;
• mud applications;
• phonophoresis.

Prevention

Preventive measures consist of regular exercises and swimming to strengthen the muscle corset.

Excessive physical activity is contraindicated for children during their growth period. To prevent osteochondropathy of the heel bone, shoes should be comfortable, not tight.

Correct and timely treatment osteochondropathy allows you to restore blood circulation to bone tissue and prevent disability in patients.

The prognosis for osteochondropathy is favorable. But this directly depends on how timely treatment is started. The disease disappears on its own in rare cases. Only if the patient takes therapeutic measures in time will he be able to restore the functionality of his legs.

If therapy is started late or incorrectly, the joints and bones will not be able to fully rehabilitate. Therefore, in the future a person will face such a disease as deforming arthrosis.

To prevent the development of osteochondropathy of the joints, you need to know about measures to prevent this pathology. They consist of maintaining active image life, wearing comfortable shoes, lack of increased physical activity.

To prevent osteochondropathy of the calcaneus, it is recommended to wear loose shoes.

Preventive measures involve regular examination by a doctor in order to diagnose disorders in the early stages. It is important to ensure that the child alternates physical activity and rest.

Good preventive effect provide courses therapeutic massage. To protect your baby’s feet from deformation changes, you need to choose comfortable shoes.

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
The disease lies in aseptic necrosis of cancellous 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 of tubular bones:
femoral head (Legg-Calvé-Perthes disease);
heads of the 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:
tibial tuberosity (Osgood-Schlatter disease);
vertebral apophyses (Scheuermann-Mau disease);
tubercle of the calcaneus (Gaglund-Schinz disease).

4. Partial wedge-shaped osteochondropathy of articular surfaces:
femoral condyles (Konig's disease);
capitate eminence of the 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.

A disease in which degenerative-dystrophic processes occur in the apophyses of bones is called osteochondropathy. The etiology of this disease, which affects children, is not fully understood, with girls getting sick less often than boys. Osteochondropathy in children has several factors that contribute to the development of the disease: congenital; endocrine (pathologies are possible here); metabolic, in which metabolism is disrupted, in particular, the exchange of calcium and vitamins; traumatic, these include heavy loads, as well as an increase in muscle contractions, which leads to compression and obliteration of the vessels of the spongy bones; neurotrophic, leading to changes in the skeleton, which, according to M.V. Volkov, are a consequence of angio-neurogenic osteodystrophy. Osteochondropathy in children has four stages.

1. Aseptic necrosis, in which vascular disorders lead to impaired nutrition of the apophyses. This stage can only be identified by doing X-ray examination, where when the integumentary cartilage thickens as a consequence of its degenerative changes, an expanded joint space and minor osteoporosis are revealed.

2. Impression fracture(you can read about it here ) or false osteosclerosis. This stage occurs after four to six months. X-rays show “false sclerosis” resulting from flattening of the bone beams. Violation of the trabecular structure of the bone leads to compaction of the shadow of the epiphysis and a decrease in its height, its contours become wavy and scalloped. When a load is applied, the surface of the joint is deformed and the articular x-ray gap expands. The stage lasts up to five, less often six months.

3. Fragmentation. Some areas of necrotic bone are resorbed due to an impression fracture. Vessels with connective tissue grow between the fragments. Connective tissue cells are retransformed into cells that can produce bone substance, which leads to type 1 osteogenesis. X-rays show that the apophysis is composed of particles of bone tissue.

Osteochondropathy in children has several types:

Legg-Calvé-Peters osteochondropathy - disease of the femoral head. Children under 12 years of age are affected; the disease lasts a long time: from 2 to 4, sometimes 6 years. Arterial and venous circulation is disrupted throughout the entire limb, not just the hip joint. Develops slowly, the onset is asymptomatic, the first signs are mild lameness and paroxysmal pain in the groin, sometimes it radiates to the knee joint.

Osgood-Schlatter osteochondropathy. Or tibial tuberosity disease, also called aseptic necrosis Lanelong-Osgood-Schlatter. Mostly boys aged 13-18 years are affected. Quite often the process is localized in the bones. Often occurs with injuries. Swelling and pain appear, which increases with palpation. Movement is painful sharp pain when kneeling. The apophysis most often ossifies as a trunk-shaped process, but there are cases of the formation of additional small ossification nuclei. Treatment lasts from one to several years and, as a rule, ends in recovery, but sometimes surgery is required.

Scheuermann-Mau osteochondropathy. A very common disease in boys, it is also called juvenile kyphosis. The basis of this spinal disease is the inferiority of the discs and poor strength of the endplates in the vertebral bodies; there is also the influence of hormones and heavy loads on the spine.

Osteochondropathy Kalke. Manifests itself in aseptic necrosis of the spongy substance in the vertebral body. The disease lasts up to six years, affecting mainly boys from seven to fourteen years old. The first signs are back fatigue and pain in the spine. The spine is difficult to bend and straighten. in some cases, there is an increase in temperature up to 39.0 ° C, eosinophilia and increased ESR are possible.

Köhler's osteochondropathy I, occurs with injuries and rickets. Also called aseptic necrosis of the navicular bone in the foot.

Köhler's osteochondropathy II occurs in girls from ten to twenty years old. The reason may be either wearing high heels, as well as microtraumas and overloads of the foot with flat feet.

Koenig's osteochondropathy, occurs up to 60 years of age, the knee joint is most often affected. The blood circulation of part of the epiphysis is disrupted and aseptic necrosis of a small part of the subchondral cancellous bone appears. After this, the fragment with hyaline cartilage is separated into the cavity of the joint, which blocks movement in it.

Halgund-Schinz osteochondropathy. Disease of the apophysis in the heel bone, often occurs in girls from 12 to 16 years old, with sports injuries.

– a group of cyclical, long-term diseases, which are based on malnutrition of bone tissue with its subsequent aseptic necrosis. Secondary clinical and radiological manifestations of osteochondropathy are associated with resorption and replacement of damaged areas of bone. Osteochondropathies include Legg-Calvé-Perthes disease, Ostgood-Schlatter disease, Köhler disease, Scheuermann-Mau disease, Schinz disease, etc. Diagnosis of osteochondropathy is based on ultrasound, x-ray and tomographic data. Treatment includes immobilization, physiotherapy, vitamin therapy, exercise therapy. Surgical treatment is performed according to indications.

General information

Osteochondropathies develop in patients of childhood and adolescence, more often affecting the bones of the lower extremities, and are characterized by benign chronic course and relatively favorable outcome. Confirmed data on the prevalence of osteochondropathy in medical literature not available.

Classification

Perthes disease

The full name is Legg-Calvé-Perthes disease. Osteochondropathy of the hip joint. Affects the head of the hip bone. It most often develops in boys aged 4-9 years. The occurrence of osteochondropathy may be preceded (not necessarily) by trauma to the hip joint.

In order to ensure restoration of the shape of the head, it is necessary to completely unload the affected joint. Treatment of osteochondropathy is carried out in a hospital in compliance with bed rest within 2-3 years. Skeletal traction may be applied. The patient is prescribed physio-vitamin and climate therapy. Of great importance are constant exercises that allow you to maintain range of motion in the joint. If the shape of the femoral head is abnormal, osteoplastic surgery is performed.

Ostgood-Schlatter disease

Osteochondropathy of the tibial tuberosity. The disease develops at the age of 12-15 years, boys are more often affected. Swelling gradually appears in the affected area. Patients complain of pain that worsens when kneeling and walking up stairs. The function of the joint is not impaired or only slightly impaired.

Treatment of osteochondropathy is conservative, carried out in outpatient setting. The patient is prescribed a limitation of the load on the limb (in case of severe pain, a plaster splint is applied for 6-8 weeks), physiotherapy (electrophoresis with phosphorus and calcium, paraffin baths), and vitamin therapy. Osteochondropathy proceeds favorably and ends with recovery within 1-1.5 years.

Köhler's disease-II

Osteochondropathy of the heads of the II or III metatarsal bones. It most often affects girls and develops at the age of 10-15 years. Köhler's disease begins gradually. Periodic pain occurs in the affected area, lameness develops, which goes away when the pain disappears. Upon examination, slight swelling is revealed, sometimes - hyperemia of the skin on the back of the foot. Subsequently, shortening of the second or third finger develops, accompanied by a sharp limitation of movements. Palpation and axial load are sharply painful.

In comparison with the previous form, this osteochondropathy does not pose a significant threat to subsequent impairment of limb function and the development of disability. Shown ambulatory treatment with maximum unloading of the affected part of the foot. Patients are given a special plaster boot, vitamins and physical therapy are prescribed.

Köhler's disease-I

Osteochondropathy of the navicular bone of the foot. Develops less frequently than previous forms. It most often affects boys aged 3-7 years. At first without visible reasons Pain in the foot appears and lameness develops. Then the skin on the back of the foot turns red and swells.

Treatment of osteochondropathy is outpatient. The patient is limited in the load on the limb, with severe pain a special plaster boot is applied and physiotherapy is prescribed. After recovery, it is recommended to wear shoes with arch support.

Schinz's disease

Osteochondropathy of the calcaneal tuberosity. Schinz disease develops rarely, usually affecting children aged 7-14 years. Accompanied by the appearance of pain and swelling. Treatment of osteochondropathy is outpatient and includes exercise limitation, calcium electrophoresis and thermal procedures.

Sherman-Mau disease

Osteochondropathy of the vertebral apophyses. Common pathology. Scheuermann-Mau disease occurs in adolescence, most often in boys. Accompanied by kyphosis of the middle and lower thoracic spine (round back). The pain may be mild or completely absent. Sometimes the only reason to contact an orthopedist is cosmetic defect. Diagnosis of this type of osteochondropathy is carried out using radiography and CT scan of the spine. Additionally for condition research spinal cord And ligamentous apparatus spinal column an MRI of the spine is performed.

Osteochondropathy affects several vertebrae and is accompanied by severe deformation that remains for life. To save normal shape vertebrae, the patient must be kept at rest. The patient should remain in bed in a supine position for most of the day (if severe pain syndrome immobilization is performed using a posterior plaster bed). Patients are prescribed massage of the abdominal and back muscles, therapeutic exercises. With timely proper treatment the prognosis is favorable.

Calvet disease

Osteochondropathy of the vertebral body. Calve's disease develops at the age of 4-7 years. The child, for no apparent reason, begins to complain of pain and a feeling of fatigue in the back. Upon examination, local pain and protrusion of the spinous process of the affected vertebra are revealed. Radiographs reveal a significant (up to ¼ of normal) decrease in vertebral height. Usually one vertebra is affected thoracic region. Treatment of this osteochondropathy is carried out only in a hospital. Rest, therapeutic exercises, and physiotherapy are indicated. The structure and shape of the vertebra is restored within 2-3 years.

Partial osteochondropathy

They usually develop between the ages of 10 and 25 and are more common in men. About 85% of partial osteochondropathy develops in the area knee joint. As a rule, the area of ​​necrosis appears on the convex articular surface. Subsequently, the damaged area can separate from the articular surface and turn into an “articular mouse” (a loose intra-articular body). Diagnosis is made by ultrasound or MRI of the knee joint. In the first stages of the development of osteochondropathy, conservative treatment is carried out: rest, physiotherapy, immobilization, etc. In the case of the formation of a “joint mouse” and frequent joint blockades, it is indicated surgical removal free intra-articular body.

Good day, dear friends! Perthes pathology refers to diseases of the femur. In this case, the nutrition of the femoral head is disrupted and normal blood supply does not occur.

Most often, perthes disease of the hip joint occurs in children of adolescence and older. younger age. The disease develops gradually and therefore the first signs may go unnoticed for a long time.

If not provided quality treatment, then it may develop, and then disability.

The disease often manifests itself in children over two years of age. On early stage the disease is very difficult to define. It all starts with minor pain in the hip joint.

The pathological process is characterized by problems with blood supply. Boys get sick more often than girls, but girls experience more severe course diseases.

The exact causes of the disease have not been fully identified. It is generally accepted that this is a polyethological disease, which is influenced by exposure to external environment, predisposition and metabolic disorders.

Most often, the disease is diagnosed in children with myelodysplasia. In this case, disturbances in the innervation of articular tissues occur, and blood stops flowing to the femoral head.

As a result, part of the tissue dies and an area is formed.
The following factors can provoke the occurrence of the disease:

1. Mechanical injuries. This could be a sprain or bruise.
2. Inflammatory process during viral and microbial infections.
3. Changes in hormonal levels.
4. Problems with metabolic processes.

Signs of illness

On early stage children don't feel painful symptoms. One of the first signs is a decrease in active movements.

The child often gets tired and may be interrupted by less active games.
The following symptoms are worth noting:

1. Mild pain felt in the inner thigh, groin area and in the knees.
2. Pain occurs with prolonged physical activity.
3. Lameness.
4. Gait disturbance and falling on one leg.
5. Weakened buttock muscles.
6. Decreased mobility.
7. Swelling of the affected area.
8. Increased body temperature.
9. Sweating and cold feet.

Stages of development of Perthes disease

In the X-ray photo you can see how the disease manifests itself. This disease occurs in five stages. The first x-ray does not show any changes.

1. At the first stage, the development of articular tissues slows down.
2. At stage 2, a fracture of the femoral head occurs. Children feel heaviness in the hip area and high fatigue. The first changes are already visible on the X-ray.
3. Stage 3 of Perthes disease is characterized by shortening and thinning of the femoral neck, which can also cause a fracture.
4. At stage 4 cartilage tissue is replaced by connecting. In this case, the joint is destroyed, and connective tissue replaces areas affected by aseptic necrosis.
5. At stage 5, the connective tissue becomes hard, which impairs joint mobility.
   As reviews confirm, the disease is perfectly treatable at stages 1-4. At stage 5, it is very difficult to completely get rid of the consequences.

Diagnostic methods

Diagnosis of Perthes disease is primarily done using x-rays. In this case, the stages of deformation of the disease are accurately determined.

The photo is taken in several projections at once so that the orthopedist can examine everything in detail. To confirm the diagnosis, ultrasound, tomography, etc. are prescribed.

Complex treatment is used.

Features of treatment

Treatment depends on the stage of the disease and the age of the child. The most commonly used conservative complex therapy. The sooner diagnosis and treatment are carried out, the faster the process of restoration of the femoral head will take place.
At any stage, the following methods are used to reduce the load:

1. Use of orthopedic insoles.
2. Physiotherapeutic procedures.
3. Walking on crutches.
4. Special gymnastics for children.
5. Healing mud.

Treatment folk remedies used as an addition to the main therapy.

Drug treatment

The doctor prescribes drug therapy using vasodilators– ascorbic and nicotinic acid. Treatment with vitamins is also prescribed.
To reduce inflammatory processes, an anti-inflammatory drug is used - Ibuprofen.

As the disease progresses, a plaster bandage is applied. In this case, the head of the femur bone is located inside the acetabulum.

Orthopedic treatment

Therapy begins with complete unloading of the limb. In this case, traction is applied using a roller or plaster splint. These devices are fixed to ankle joint and on the foot.
On late stages may be needed surgical intervention. In this case, joint disorders are corrected.

The operation helps to restore correct location bones. The required position is fixed using special plates and bolts. After the operation, a special plaster bandage is applied.

In combination with drug therapy massage is applied. Its implementation promotes better blood supply, tissue restoration and protects against muscle atrophy.

You need to massage your thighs hip joints, lower back and lower legs.
Massage manipulations are performed in the following sequence:

1. Stroking with grasping.
2. Spiral rubbing using four fingers.
3. Kneading the limb.
4. Continuous stroking.

Massage should be performed not only on the sore limb, but also on the healthy side. The limb is massaged from all sides.

It is important to massage the sacral area as well.
If you do not start timely treatment, you may experience unpleasant consequences. At the right approach The prognosis for treatment is almost always favorable.

Goodbye friends!