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M. Perthes

Diagnostische und therapeutische Prinzipien

Legg-Calvé-Perthes disease (LCPD)

Principles of diagnosis and treatment

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Zusammenfassung

Hintergrund

Der klinische Verlauf des M. Perthes ist sehr variabel. Diagnostik, operative und nichtoperative Therapie entwickelten sich in den letzten Jahrzehnten weg von abduzierenden und entlastenden Orthesen hin zu aufwendigen Gelenk zentrierenden Umstellungsosteotomien, die heute eine wesentliche Säule der Therapie sind.

Methoden

Die diagnostischen und therapeutischen Prinzipien des M. Perthes wurden anhand einer Literaturrecherche unter Berücksichtigung der geltenden Richtlinien der DGOOC (Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie) erarbeitet.

Ergebnisse

Die wesentlichen Prognosefaktoren sind das Alter bei Erkrankungsbeginn, das Bewegungsausmaß und die Ausdehnung des Nekroseareals. Das Hauptziel sowohl der operativen als auch der nichtoperativen Therapie sind die Vermeidung einer präarthrotischen Deformität, der Erhalt und die Verbesserung der Beweglichkeit, Gelenkzentrierung und -kongruenz des Hüftgelenks.

Schlussfolgerung

Die Variabilität der Verläufe macht eine individuell an das Kind angepasste Therapie mit regelmäßigen Verlaufskontrollen bis zur Ausheilung notwendig.

Abstract

Background

The clinical course of Legg-Calvé-Perthes disease (LCPD) is variable. Diagnosis, nonsurgical and surgical methods of treatment have evolved over many decades, from abduction casts and braces to advanced surgical containment methods which are now the mainstay of treatment.

Methods

This article presents a general view and a critical evaluation of the literature.

Results

The main prognostic factors are patient age at the onset of LCPD, the range of motion and the extent of the necrotic process according to the classification of Herring and Catterall. The main aims of surgical and nonsurgical treatment of LCPD are to prevent prearthrotic deformity of the femoral head, relief of symptoms, containment of the femoral head and restoration of congruence of the hip joint.

Conclusions

Each patient needs to be evaluated individually. Every child must receive an adapted treatment and continued follow-up at regular intervals.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Manig gibt an, dass kein Interessenkonflikt besteht. Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigen oder des gesetzlich bestellten Betreuers vor.

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Authors and Affiliations

  1. Orthopädische Universitätsklinik Friedrichsheim gGmbH, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland

    M. Manig

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  1. M. Manig
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Correspondence to M. Manig.

Additional information

Dieser Beitrag erschien ursprünglich in der Zeitschrift: Der Orthopäde 2013, 42:891–904, DOI 10.1007/s00132-013-2177-y.

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Manig, M. M. Perthes. Monatsschr Kinderheilkd 162, 980–988 (2014). https://doi.org/10.1007/s00112-013-3024-2

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