Osteochondropathy – group cyclic, it is long the current diseases which cornerstone violation of food of a bone tissue with its subsequent aseptic necrosis is. Secondary clinical and radiological manifestations of osteokhondropatiya are connected with a rassasyvaniye and replacement of the destroyed sites of a bone. The disease of Legga-Kalve-Pertesa, Ostgud-Shlatter's disease, Köhler's Disease, Sheyermana-Mau's disease, Shints's disease, etc. belong to osteokhondropatiya. Diagnosis of an osteochondropathy is based on ultrasonography, radiological and tomographic data. Treatment includes an immobilization, physical therapy, vitamin therapy, LFK. According to indications surgical treatment is carried out.
Osteochondropathy develop at patients of children's and youthful age, affect bones of the lower extremities more often, are characterized by a good-quality chronic current and rather favorable outcome. The confirmed data on prevalence of osteokhondropatiya in medical literature are not available.
In traumatology allocate four groups of osteokhondropatiya:
- Osteochondropathy of metafiz and epifiz of long tubular bones. The osteochondropathy of the grudinny end of a clavicle, phalanxes of fingers of hands, a coxofemoral joint, a proximal metafiz of a tibial bone, heads II and III plusnevy bones enters into this group of osteokhondropatiya.
- Osteochondropathy of short spongy bones. Treats this group of osteokhondropatiya an osteochondropathy of bodies of vertebras, a semi-lunar bone of a brush, a boatshaped bone of foot, and also a sesamovidny bone of the I plusnefalangovy joint.
- Osteochondropathy of apofiz. Include an osteochondropathy of a lonny bone, apofizarny disks of vertebras, a hillock of a calcaneal bone and a bugristost of a tibial bone in this group of osteokhondropatiya.
- Wedge-shaped (partial) an osteochondropathy, the striking articulate surfaces elbow, knee and other joints.
Taking into account features of a course of pathological process distinguish four stages of a disease:
- The first. Necrosis of a bone tissue. Proceeds up to several months. The patient is disturbed by the mild or moderate pains in the struck area which are followed by dysfunction of an extremity. The palpation is painful. Regionarny lymph nodes are usually not increased. Radiological changes during this period can be absent.
- The second. "A compression change". From 2-3 to 6 and more months proceed. The bone "sinks", the damaged bone beams put each other. On roentgenograms homogeneous blackout of the struck departments of a bone and disappearance of its structural drawing comes to light. At defeat of an epifiz its height decreases, expansion of an articulate crack comes to light.
- The third. Fragmentation. Lasts from 6 months to 2-3 years. At this stage there is a rassasyvaniye of the become lifeless sites of a bone, their replacement with granulyatsionny fabric and osteoklasta. Is followed by reduction of height of a bone. On roentgenograms reduction of height of a bone, fragmentation of the struck departments of a bone with chaotic alternation of dark and light sites comes to light.
- The fourth. Restoration. Proceeds from several months to 1,5 years. There is a restoration of a form and, a bit later – and structures of a bone.
The full cycle of an osteochondropathy takes 2-4 years. Without treatment the bone is restored with more or less expressed residual deformation further leading to development of the deforming arthrosis.
The full name – a disease of Legga-Kalve-Pertesa. Osteochondropathy of a coxofemoral joint. Strikes a head of a coxofemoral bone. Develops at boys at the age of 4-9 years more often. The trauma of area of a coxofemoral joint can precede developing of an osteochondropathy (not necessarily).
Pertes's disease begins with slight lameness which the pains in the field of damage which are quite often giving to the area of a knee joint join later. Gradually symptoms of an osteochondropathy amplify, the movements in a joint become limited. At survey unsharply expressed atrophy of muscles of a hip and shin, restriction of internal rotation and assignment of a hip comes to light. Morbidity at load of a big spit is possible. Quite often the shortening of the affected extremity on 1-2 cm caused by a hip incomplete dislocation up is defined.
The osteochondropathy lasts 4-4,5 years and comes to the end with restoration of structure of a head of a hip. Without treatment the head gets a fungoid form. As the form of a head does not correspond to a form of a vertluzhny hollow, the deforming arthrosis develops over time. With the diagnostic purpose carry out ultrasonography and MRT of a coxofemoral joint.
To provide restoration of a form of a head, it is necessary to unload completely affected joint. Treatment of an osteochondropathy is carried out in a hospital with observance of a bed rest within 2-3 years. Imposing of skeletal extension is possible. To the patient appoint fizio-vitamin and klimatolecheny. The regular jobs by remedial gymnastics allowing to keep the volume of movements in a joint have huge value. At violation of a form of a head of a hip bone plastic surgeries are carried out.
Osteochondropathy of a bugristost of a tibial bone. The disease develops at the age of 12-15 years, boys are ill more often. Gradually there is a swelling in the field of defeat. Patients complain of the pains amplifying when standing on a lap and walking on a ladder. Function of a joint is not broken or broken slightly.
Treatment of an osteochondropathy conservative, is carried out in out-patient conditions. To the patient appoint restriction of load of an extremity (at severe pain impose the plaster tire for 6-8 weeks), physiotreatment (an electrophoresis with phosphorus and calcium, paraffin applications), vitamin therapy. The osteochondropathy proceeds favorably and comes to an end with recovery within 1-1,5 years.
Osteochondropathy of heads II or III plusnevy bones. Strikes girls more often, develops at the age of 10-15 years. Köhler's disease begins gradually. In the field of defeat there are periodic pains, the lameness passing at disappearance of pains develops. At survey insignificant hypostasis, sometimes – skin hyperaemia on the back of foot comes to light. In the subsequent shortening II or III fingers which are followed by sharp restriction of movements develops. The palpation and axial loading are sharply painful.
In comparison with the previous form this osteochondropathy does not pose a considerable threat for the subsequent dysfunction of an extremity and development of disability. Out-patient treatment with the maximum unloading of the struck department of foot is shown. To patients impose a special plaster boot, appoint vitamins and physical therapy.
Osteochondropathy of a boatshaped bone of foot. Develops less often than the previous forms. Strikes boys at the age of 3-7 years more often. In the beginning without the visible reasons pains in foot develop, lameness develops. Then skin of the back of foot reddens and swells.
Treatment of an ostekhondropatiya out-patient. To the patient limit load of an extremity, at severe pains impose a special plaster boot, appoint physiotreatment. After recovery recommend to wear shoes with an instep support.
Osteochondropathy of a hillock of a calcaneal bone. Shints's disease develops seldom, as a rule, affects children at the age of 7-14 years. Is followed by emergence of pains and swellings. Treatment of an osteochondropathy out-patient, includes restriction of loading, an electrophoresis with calcium and thermal procedures.
Osteochondropathy of apofiz of vertebras. Widespread pathology. Sheyermana-Mau's disease arises at teenage age, a thicket at boys. Is followed kifozy average and nizhnegrudny department of a backbone (a round back). Pains can be weak or at all be absent. Sometimes cosmetic defect becomes the only reason for the address to the orthopedist. Diagnostics of this type of an osteochondropathy is performed by means of a X-ray analysis and KT of a backbone. In addition for a research of a condition of a spinal cord and the copular device of a spine column carry out backbone MRT.
The osteochondropathy affects several vertebras and is followed by their expressed deformation remaining for the rest of life. For preservation of a normal form of vertebras the patient needs to provide rest. The most part of day the patient has to be in a bed in situation on a back (at the expressed pain syndrome the immobilization with use of a back plaster bed is carried out). The patient appoint massage of muscles of a stomach and back, remedial gymnastics. At timely, correct treatment the forecast favorable.
Disease to Kalva
Vertebra body osteochondropathy. The disease to Kalva at the age of 4-7 years develops. The child without the visible reasons begins to complain of pain and feeling of exhaustion in a back. At survey local morbidity and a vystoyaniye of an awned shoot of the affected vertebra comes to light. On roentgenograms decrease in height of a vertebra is defined considerable (to ¼ from norm). Usually one vertebra in chest department is surprised. Treatment of this osteochondropathy is carried out only in a hospital. Rest, remedial gymnastics, physiotherapy is shown. The structure and a vertebra is got into condition within 2-3 years.
Usually develop aged from 10 up to 25 years, meet at men more often. About 85% of partial osteokhondropatiya develop in areas of a knee joint. As a rule, the site of a necrosis appears on a convex articulate surface. In the subsequent the damaged area can separate from an articulate surface and turn into "an articulate mouse" (freely lying intra articulate body). Diagnostics is carried out by ultrasonography or MRT of a knee joint. At the first stages of development of an osteochondropathy conservative treatment is carried out: rest, physical therapy, immobilization etc. At formation of "an articulate mouse" and frequent blockade of a joint expeditious removal of a free intra articulate body is shown.