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 finally 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. Often, osteochondropathy occurs in children with dyshormonal disorders, in particular, those suffering from adiposogenital dystrophy.

Confirmation important role endocrine system in the pathogenesis of osteochondropathy is 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 subjected to necrosis;
IV - productive with intensive recovery processes(reparative);
V - restoration (reconstruction bone tissue).
A certain value in the pathogenesis of osteochondropathy is played by vascular disorders, among which it is necessary to highlight the neuro-reflex angiospasm caused by trauma or prolonged microtraumatization terminal branches vessels. The development of osteochondropathy is also facilitated by prolonged pressure loads on spongy bones, which leads to impaired microcirculation and obliteration of blood vessels, followed by the development of avascular necrosis. In case of early elimination etiological factor possible proliferation of osteoclasts with subsequent complete or incomplete recovery bone structure.

IN AND. Mazurov

Reasons for the appearance

Osteochondropathy develops when blood circulation is disturbed in some segments of the bone tissue, as a result of which areas of aseptic necrosis (necrosis) of the spongy bone appear at the time of exposure to physical activity.

The reasons for these processes are:

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

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

The full etiology of osteochondropathy is unknown. But there are several factors that can provoke 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 extremities.
• Deforming processes of the legs.
• Deterioration of blood circulation.

To date, the causes of the onset of the disease have not been fully studied, but there are several decisive factors:

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 fragments of bone tissue.

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

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

Types of pathology

Osteochondropathy is conventionally divided into four groups:

1. Osteochondropathy of the epiphyses of tubular bones - humerus(Hass's disease), sternal end of the clavicle, metacarpal bones and phalanges of the fingers (Thiemann's disease), head femur(Legg-Calve-Perthes disease), heads II-III metatarsal bones(Kehler II disease).

2. Osteochondropathy of short spongy bones - vertebral bodies (Calvet's disease), lunate bone of the hand (Kinböck's disease), sesamoid bone of the I metatarsophalangeal joint, navicular bone of the foot (Kohler's disease I).

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

The disease under consideration has several varieties.

Perthes disease

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

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

Osteochondropathy of the head of the pelvic (femoral) bone in adults and children begins with the appearance of a slight lameness. Further movements are accompanied painful sensations. Then the signs become more and more pronounced, 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 fact that the joint is restored. But if you do not engage in treatment, then 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 Eyvihe
are pains in elbow joint and
limitation of limb function due to
severe pain on movement
especially with supination of the forearm.

Usually the forearm is brought to the body
and passively hangs down while in position
pronation. Sometimes there is a performance
heads radius anterior,
pain in the proximal area
forearm section.

Typical
history and presence of characteristic clinical
enough symptoms to
productions correct diagnosis. AT
dubious and difficult cases
X-ray can be done
to rule out fractures.

The pathological process affects:

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

short spongy bones, navicular bone of the foot - Kohler'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 proceed according to the type of primary aseptic necrosis.

The etiology of the disease has not been fully elucidated; the main cause of juvenile kyphosis is believed to be disontogenetic disorders: inferiority of the discs, their fibrosis, and insufficient strength of the endplate of the vertebral body.

In Perthes disease, the basis for the 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 is noted).

There is also differential diagnosis osteochondropathy with heel spur(in older patients), Achilles bursitis.

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

Treatment of clubfoot

Treatment
with congenital clubfoot
start immediately after birth
child. Need to gradually
retrain the leg manually, and then
put on 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
correcting the shape or position of the foot
plaster bandages are removed and applied
special night tires for maintenance
achieved effect.

cure
clubfoot is considered complete,
if it becomes possible
pronation and if the foot has a normal
form. If this by the time of self
getting the child to his feet and trying
walking reach is not possible, it is necessary
variety of shoe inserts.

Starting from the 3-4th year of life, there may be
appointed physiotherapy for
feet. If the indicated
activities are shown operational
intervention on soft tissues before
end of growth and skeletal formation.

Severe cases require intervention
on the bones of the foot, however, they must
be made only after
formation and full development
skeleton.

Treatment
with acquired clubfoot
carry out according to its cause.
If it cannot be eliminated, then
surgery (arthrodesis of the joints of the foot) or
provision of orthopedic
aids(and
orthopedic shoes).

Treatment
always done first
conservatively. It should be checked
is active rectification possible
longitudinal arch (defect of posture).

AT
positive case showing
systematic gymnastic
foot exercises, barefoot walking
on the grass, as well as wearing suitable and
well-fitting shoes.

So-called
early childhood external clubfoot
eliminated in this way. If a
only passive rectification possible
feet, then additionally apply
shoe inserts.

Have children well justified
self detorsion liners according to Hohmann
etc. There are also special
insoles if correct position with
using the means described above
succeeds.

In severe cases it is necessary
wearing orthopedic shoes. Is always
therapeutic exercises should be carried out
and physiotherapy activities.

At
congenital flat feet immediately after
birth should try with
redressal plaster bandages, step
correct defects step by step.

Later
liners, night tires are used,
gymnastics are held regularly
exercises. In the absence of noticeable
improvements or complete fixes
defect shows surgical intervention,
first on soft tissues, and later on
on the bones.

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

Orthopedic
shoes are more often needed
wrong finger position
feet or if along with the transverse
flat feet also occurs external
clubfoot.

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

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

At
fresh paralysis along with the usual
treatment requires application
orthopedic aids fixing
foot position at right angles to the axis
lower legs (night splints for the heel foot).

If correction is not possible
passively should try gradually
eliminate pathological position
feet with redressing plaster
dressings and then apply night splints.

Heel pulls are used for walking.
feet, heel splints, orthopedic
shoes or bandages. Through operational
lengthening of the calcaneal tendon
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
in terms of functionality.

During treatment various kinds 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%, calcium gluconate 5–10% are used.
• Chondroprotectors: Teraflex, Chondroxide (if allowed by age).

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

This requires normalization of blood circulation, stabilization of the metabolic process.

The patient needs to take all measures to unload the diseased joint, to ensure its immobility. This requires strict bed rest and physiotherapy. The latter include the following methods:

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

In addition to physiotherapy procedures, patients are advised to conduct therapeutic exercises for healthy parts of the body. They also help the body cope with osteochondropathy. breathing exercises.

Conservative treatment is carried out with the use of various medicines. They are prescribed to eliminate the symptoms of pathology, namely, to relieve soreness, swelling, inflammatory processes. Also, medicines help in the normalization of metabolism and blood circulation.

• Non-steroidal anti-inflammatory drugs.
• Vitamin and mineral complexes.
• Chondroprotectors.
• Medications to improve blood circulation.
• Painkillers.

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

The indication for surgery is also a detachment of the bone tissue, which must be eliminated.

Therapy for osteochondropathy of the calcaneus consists in prescribing non-steroidal anti-inflammatory drugs (if severe pain is bothering), physiotherapy procedures, and reducing physical exertion. To relieve the load on the calcaneus, special arch support insoles are used.

The device has a cushioning effect on the foot.

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

surgical intervention in childhood carried out very rarely. To relieve pain in osteochondropathy, non-steroidal anti-inflammatory drugs (Ibuprofen, Nurofen) are used in the minimum 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. Physiotherapy procedures have an analgesic and anti-inflammatory effect. For this purpose, apply:

• medical electrophoresis;
• magnetotherapy;
• mud applications;
• phonophoresis.

Prevention

Preventive measures consist in regular classes in therapeutic exercises and swimming to strengthen the muscular corset.

Children during the period of growth are contraindicated in excessive physical activity. To prevent osteochondropathy of the calcaneus, shoes should be comfortable, not tight.

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

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

If therapy is started late or incorrectly, then 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 the measures to prevent this pathology. They are in the management active image life, wearing comfortable shoes, the absence of increased physical exertion.

For the prevention of osteochondropathy of the calcaneus, it is recommended to wear loose shoes.

Preventive measures include regular check-ups with 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 the baby's feet from deformation changes, you need to choose comfortable shoes.

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 of spongy bone. Received
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 of tubular bones:
femoral head (Legg-Calve-Perthes disease);
heads of the II-III metatarsal bones (Kohler's disease II).

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:
tibial tuberosity (Osgood-Schlatter disease);
apophyses of the vertebrae (Scheuermann-Mau disease);
calcaneal tuberosity (Gaglund-Shinz disease).

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

A disease in which degenerative-dystrophic processes occur in the apophyses of bones is called osteochondropathy. The etiology of this disease, which affects children, has not been fully elucidated, and girls get 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); exchange, in which metabolism is disturbed, in particular, the exchange of calcium and vitamins; traumatic, they include heavy loads, as well as an increase in muscle contractions, which leads to compression and obliteration of the vessels of spongy bones; neurotrophic, leading to changes in the skeleton, which, according to M.V. Volkov, are the result of angioneurogenic 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 thickening of the integumentary cartilage as a consequence of its degenerative changes reveals an enlarged joint space and slight osteoporosis.

2. Impression fracture(here you can read about ) or false osteosclerosis. This stage occurs in four to six months. X-ray shows "false sclerosis", which arose from the flattening of bone beams. Violation of the trabecular structure of the bone leads to compaction of the shadow of the epiphysis and its decrease in height, its contours become wavy and scalloped. Under the action of the load, 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 transformed into cells that can produce bone substance, which leads to type 1 osteogenesis. X-ray shows that the apophysis is composed of particles of bone tissue.

Osteochondropathy in children has several types:

Osteochondropathy Legg-Calve-Peters - disease of the femoral head. Children under the age of 12 get sick, the disease lasts a long time: from 2 to 4, sometimes 6 years. Arterial and venous circulation is disturbed in the entire limb, and not just in the hip joint. It develops slowly, the onset is asymptomatic, the first signs are mild lameness and paroxysmal pain in the groin, sometimes it gives to the knee joint.

Osteochondropathy Osgood-Schlatter. Or tibial tuberosity disease, it is also called aseptic necrosis Lanelong-Osgood-Schlatter. Mostly boys are ill at the age of 13-18. Quite often, the process is localized in the bones. Often occurs with trauma. There is swelling and pain, which increases with palpation. Movement is painful sharp pain when kneeling. The apophysis often ossifies as a proboscis-like 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 also required.

Osteochondropathy of Scheuermann-Mau. A very common disease in boys, it is also called juvenile kyphosis. The basis of such a disease of the spine is the inferiority of the discs and the poor strength of the end plates in the vertebral bodies, there is both the influence of hormones and heavy loads on the spine.

Osteochondropathy Kalke. Manifested in aseptic necrosis of the spongy substance in the vertebral body. The disease lasts up to six years, mostly boys from seven to fourteen years old are ill. The first signs are fatigue in the back 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.

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

Osteochondropathy Kohler II occurs in girls between the ages of ten and twenty. The reason could be like wearing high heels, and microtrauma and overload of the foot with flat feet.

Osteochondropathy Koenig, occurs up to 60 years, the knee joint is more often affected. The blood circulation of a part of the epiphysis is disturbed and aseptic necrosis of a small part of the subchondral cancellous bone appears. After that, the fragment with hyaline cartilage is separated into the abdominal region of the joint, which blocks movement in it.

Osteochondropathy of Halgund-Shints. Disease of the apophysis in the calcaneus, 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 destroyed bone areas. Osteochondropathy includes Legg-Calve-Perthes disease, Ostgood-Schlatter disease, Koehler's disease, Scheuermann-Mau disease, Schinz's disease, etc. Diagnosis of osteochondropathy is based on ultrasound, radiological and tomographic data. Treatment includes immobilization, physiotherapy, vitamin therapy, exercise therapy. According to the indications, surgical treatment is carried out.

General information

Osteochondropathy develops in patients of childhood and adolescence, more often affects the bones of the lower extremities, is 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-Calve-Perthes disease. Osteochondropathy of the hip joint. Affects the head of the femur. It often develops in boys aged 4-9 years. The occurrence of osteochondropathy may be preceded (not necessarily) by an injury to the hip joint.

In order to ensure the 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. Perhaps the imposition of skeletal traction. The patient is prescribed physiovitamino- and climatotherapy. Of great importance are constant therapeutic exercises, allowing you to maintain the range of motion in the joint. In case of violation of the shape of the femoral head, osteoplastic operations are performed.

Ostgood-Schlatter disease

Osteochondropathy of the tibial tuberosity. The disease develops at the age of 12-15 years, boys are more often ill. Gradually there is swelling in the affected area. Patients complain of pain aggravated by kneeling and walking up stairs. The function of the joint is not disturbed or only slightly impaired.

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

Kohler-II disease

Osteochondropathy of the heads of the II or III metatarsal bones. Most often affects girls, develops at the age of 10-15 years. Kohler's disease begins gradually. Periodic pain occurs in the affected area, lameness develops, which disappears when the pain disappears. On examination, a slight edema is revealed, sometimes - hyperemia of the skin on the back of the foot. Subsequently, a shortening of the II or III 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 the subsequent dysfunction of the limb 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 physiotherapy are prescribed.

Koehler-I disease

Osteochondropathy of the navicular bone of the foot. It develops less often than the previous forms. Most often affects boys aged 3-7 years. At first without visible reasons there are pains in the foot, lameness develops. Then the skin of the back of the foot turns red and swells.

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

Shinz's disease

Osteochondropathy of the calcaneal tuber. Shinz's disease develops rarely, as a rule, it affects children aged 7-14 years. Accompanied by pain and swelling. Treatment of osteochondropathy is outpatient, includes exercise restriction, calcium electrophoresis, and thermal procedures.

Sherman Mau disease

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

Osteochondropathy affects several vertebrae and is accompanied by their severe deformation, which remains for life. To save normal form vertebrae the patient needs to ensure peace. Most of the day the patient should be in bed in the supine position (with severe pain syndrome immobilization is performed using a posterior plaster bed). Patients are prescribed massage of the muscles of the abdomen and back, therapeutic exercises. With timely proper treatment the prognosis is favorable.

Calve's 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. On examination, local tenderness and protrusion of the spinous process of the affected vertebra are revealed. On radiographs, a significant (up to ¼ of the norm) decrease in the height of the vertebra is determined. Usually only one vertebra is affected thoracic region. Treatment of this osteochondropathy is carried out only in a hospital. Rest, therapeutic exercises, physiotherapy are shown. The structure and shape of the vertebra is restored within 2-3 years.

Partial osteochondropathy

It usually develops between the ages of 10 and 25 and is 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 a “joint mouse” (freely lying intra-articular body). Diagnosis is by ultrasound or MRI of the knee joint. At the first stages of the development of osteochondropathy, conservative treatment is carried out: rest, physiotherapy, immobilization, etc. With the formation of an “articular mouse” and frequent blockades of the joint, prompt removal free intraarticular body.

Good day, dear friends! Pathology Perthes 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 is formed gradually and therefore the first signs can go unnoticed for a long time.

If not ensure quality treatment, then it can develop, and then disability.

The disease often manifests itself in childhood from two years. On the early stage disease is very difficult to define. It all starts with a slight soreness in the hip joint.

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

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 external environment, predisposition and disorders of metabolic processes.

Most often, the disease is diagnosed in children with myelodysplasia. In this case, there are violations of the innervation of the articular tissues, and the blood stops passing to the femoral head.

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

1. mechanical injury. It could be a sprain or bruise.
2. Inflammatory process in viral and microbial infections.
3. Hormonal changes.
4. Problems with metabolic processes.

Signs of illness

On the early stage children do not feel painful symptoms. One of the first signs is a decrease in active movements.

The child is often tired and may be interrupted by less active games.
It is worth noting the following symptoms:

1. Mild pain that is felt in the inner thigh, in inguinal region and in the knees.
2. Pain occurs during prolonged physical activity.
3. Lameness.
4. Gait disturbance and slumping on one leg.
5. Weakened muscles of the buttocks.
6. Decreased mobility.
7. Swelling of the affected area.
8. Increase in 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 ailment occurs in five stages. The first X-ray shows no changes.

1. At the first stage, the development of articular tissues slows down.
2. At the 2nd stage, 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 Perthes disease is characterized by shortening and thinning of the femoral neck, which can also provoke a fracture.
4. At the 4th stage cartilage tissue replaced by a connecting one. In this case, the joint is destroyed, and connective tissue replaces areas affected by aseptic necrosis.
5. At the 5th stage, the connective tissue becomes hard, which impairs the mobility of the joints.
   As the reviews confirm, the disease is excellently treatable at stages 1-4. At the 5th stage, it is very difficult to get rid of the consequences completely.

Diagnostic methods

Diagnosis of Perthes disease is primarily carried out using x-rays. At the same time, the stages of deformation of the disease are precisely 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 and are prescribed.

Complex treatment is applied.

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 the diagnosis and treatment is carried out, the faster the process of restoring the femoral head will be.
At any stage, the following methods are used to reduce the load:

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

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

Medical treatment

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

With the progression of the disease, a plaster bandage is applied. In this case, the head of the femoral bone is located inside the acetabulum.

Orthopedic treatment

Therapy begins with complete unloading of the limb. In this case, traction is applied for roller or plaster splints. These devices are attached to ankle joint and on the foot.
On the late stages may need surgical intervention. In this case, the violation of the joints is corrected.

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

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

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

1. Stroking with girth.
2. Spiral rubbing with four fingers.
3. Stretching of a limb.
4. Continuous strokes.

Massage should be carried out not only on the diseased limb, but also on the healthy side. Massaging the limb is performed from all sides.

It is important to massage the area of ​​the sacrum.
If you do not start timely treatment, you may experience backfire. At right approach The prognosis for treatment is almost always favorable.

Goodbye friends!