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Pertes's illness (aseptic necrosis of a head of a femur)
Pertes's illness (completely this illness is called an illness of Legga-Kalve-Pertesa) is rather often found pathology of a hip joint at children's age. The aseptic necrosis of a head of a femur which is observed at this disease is mainly shown at patients whose age — from 3 to 15 years. However and this disease also occurs at adults. In the course of its progressing supply with blood of cartilaginous tissue of a joint is broken. Manifestation of a necrosis has the aseptic nature and is not connected with impact of infections on a human body in any way. Disturbance of blood supply is temporary. However under its influence femur head fabrics gradually die off. As a result, the irritation and inflammatory process is observed. At Pertes's illness one joint most often is surprised, but also bilateral damage of joints is in certain cases possible.
Approximately five times more often the illness of Legga-Kalve-Pertesa is diagnosed for boys. At the same time this illness at girls has heavier current. The first time the description of this disease appeared about one hundred years ago. Then it was defined as a specific form of arthritis of a hip joint at children.
Peters's illness develops at the child if he notes some inborn and acquired factors having. As a background on which the femur head necrosis is shown often serves the underdevelopment of lumbar department of a spinal cord (myelodisplasia). This part of a spinal cord provides an innervation of hip joints. Such pathology can be inborn in view of hereditary conditionality. It is observed at many children, several its severity is defined.
Easy degree of a myelodisplasia can and remain not diagnosed during human life. But heavier disturbances in development of a spinal cord become afterwards the reason of orthopedic diseases including Pertes's diseases.
At a myelodisplasia the structure of hip joints differs from normal option a little. This pathology is expressed at children by smaller quantity and caliber of nerves and vessels that causes decrease in a blood-groove in joint tissues. A consequence of such phenomenon — insufficient intake of nutrients, and also decrease in a tone of a vascular wall.
But Pertes's illness at the child begins to develop only on condition of complete cessation of supply with hip head blood. It can occur owing to influence of a number of factors. It is the injury leading to crossclamping of vessels, inflammatory process in a hip joint which develops under the influence of an infection. The infection gets into a joint sometimes even at catarrhal diseases or at other infectious illnesses.
As a result, blood supply is completely blocked, and in a head of a hip the necrosis centers are formed.
The aseptic necrosis of a head of a femur at children develops stadiyno. Five stages of a disease are allocated. At the first stage the aseptic necrosis develops, on the second there is a secondary compression change. The third stage of an illness of Pertes represents process of fragmentation and a rassasyvaniye of sites of the died-off spongy takna. At the fourth stage there is a recovery, and on the fifth secondary changes are observed.
Therefore, symptoms depend on a stage of an illness, level of distribution of a necrosis and its degree. At the first stage of an illness of Pertes of noticeable symptoms of a disease it can not be noted at all, or they are insignificant. The child can speak about periodically shown moderate pain in a hip or a knee joint. Sometimes at children changes in gait are noted: it begins to privolakivat a leg a little.
If the disease develops further, then the hip head is gradually deformed that, in turn, leads to biomechanical changes in a joint. As a result, the child begins to limp, suffers from joint pain or in a leg. Both pain, and lameness is shown from time to time, sometimes the period when nothing disturbs the patient, can proceed for weeks and months. Often pain develops owing to the spasm of muscles arising because of irritation in a joint. Pain becomes more intensive at the movement, sometimes it moves to the area of a groin, buttocks. After the child will have a rest at rest, pain becomes less expressed.
If treatment of an aseptic necrosis of a head of a femur is not carried out, then afterwards there are impression changes in a necrosis zone. Then the affected extremity at the child becomes shorter that is noticeable even during visual survey. The child is tired in the course of walking, he has an expressed lameness.
At the same time at the first stage the osteochondropathy of a head of a femur is reversible, and on condition of rather small center of a necrosis and fast recovery of normal blood circulation the illness recovers, without having passed into a stage of deformation of a head of a hip. Therefore at the slightest suspicions on similar pathology it is necessary to pass careful inspection.
Carrying out X-ray inspection allows to define Pertes course of a disease already in an initial stage. If necessary the specialist also appoints carrying out a magnetic and resonant tomography and ultrasonography of hip joints. Such methods allow to obtain additional information.
In certain cases for the purpose of differentiation with other diseases carrying out laboratory researches is appointed. In the course of treatment X-ray analyses are conducted several times to track dynamics of improvement.
Pertes's illness revealed in the course of diagnosis demands specific treatment. Treatment at children assumes the periods of an immobilization or restriction of a physical activity. After the illness is diagnosed for the child, he at once needs to adhere to a bed rest not to allow loads of the affected joint. Therefore, the patient can go only with crutches. To provide centration, different orthopedic devices are used. Also massage sessions, physiotherapeutic treatment practice. As a rule, Pertes's illness at children recovers, and approximately in 2 years the child can conduct completely normal life, without having the reason to undertake any motive restrictions.
More intensive process of treatment at girls practices, however at boys the forecast of recovery and an effect of a disease is worse.
If at children in an age group from 2 to 6 years results of inspection testify to poorly expressed symptoms of a disease, then treatment of an illness of Pertes consists only in supervision. If symptoms of an illness are noted at children at advanced age, a certain therapy depending on specific features of disease is carried out.
Pertes's illness at adults is treated taking into account all specific features — age, associated diseases, severity. However at adults this disease leads to irreversible changes which consequence even disability can sometimes be. At adults surgical treatment practices most often. At the first stages of an illness the femur head tunnelization is carried out, and in hard cases carrying out endoprosthesis replacement is possible.
Doctors try to carry out treatment of an illness of Pertes at children by means of nonsurgical methods. To reduce inflammatory process in a hip joint, the course of treatment non-steroidal anti-inflammatory drugs is appointed. The child can sometimes take such medicine on an extent even of several months. At the same time the doctor periodically conducts research, tracing, fabrics are how intensively recovered. In the course of recovery performance of simple exercises from a special complex of physiotherapy exercises is shown to the child.
Sometimes the doctor makes the decision on use of a plaster bandage by means of which it is possible to hold a femur head in an acetabular hollow. The so-called bandage of Petri is applied. It is a bilateral bandage from gypsum which is applied both legs. In the middle of a bandage there is a wooden crossbeam which gives the chance to keep legs in a divorced position. Such bandage the first time is applied to the patient in the operating room.
Surgical treatment allows to recover a normal arrangement of bones in a hip joint. For this purpose the surgeon carries out necessary manipulations. After operation to the patient impose a bandage corset from gypsum which it is necessary to carry about two months. After a cast removal the complex of physiotherapy exercises with the minimum load of a hip joint is appointed.
The measures of prevention directed to avoidance of prevention of an illness of Pertes at children and adults do not exist. But it is very important to diagnose this disease as soon as possible and to provide the correct treatment. In this case therapy will be the most effective.
Section: Orthopedics and traumatology