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Morbus Perthes

Legg-Calvé-Perthes disease

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Zusammenfassung

Hintergrund

Der Morbus Perthes ist eine wichtige Ursache für das Hinken und/oder Hüftschmerz bei präadoleszenten Kindern.

Fragestellung

Pathogenese und Epidemiologie des M. Perthes, Klassifikationen der Krankheitsstadien, des quantitativen Hüftkopfbefalls und der Prognose anhand von Röntgenbildern und Magnetresonanztomographie (MRT).

Material und Methoden

Synopse und Diskussion von Grundlagenarbeiten und Empfehlungen.

Ergebnisse

Meist sind Jungen zwischen 3 und 10 Jahren betroffen. Die Ätiologie der Hüftkopfischämie ist ungeklärt. Gängige Klassifikationen sind die Krankheitsstadien nach Waldenström und das Ausmaß des Hüftkopfbefalls nach Catterall. Zur Frühprognose dienen die „head-at-risk signs“ und nach Wachstumsabschluss die Endstadien nach Stulberg für die Langzeitprognose.

Schlussfolgerungen

Anhand von Röntgen- und MRT-Bildern ist durch verschiedene Klassifikationen eine gezielte Beurteilung von Krankheitsverlauf und Prognose des M. Perthes möglich. Die systematische Befundung ist essenziell, um Fälle mit operativem Behandlungsbedarf als solche zu identifizieren und Komplikationen wie eine frühzeitige Koxarthrose zu vermeiden.

Abstract

Background

Legg-Calvé-Perthes disease (LCPD) is an important cause of limping and/or hip pain in preadolescent children.

Objective

Pathogenesis and epidemiology of LCPD, classification of disease stages, quantitative femoral head involvement and prognosis based on X‑ray images and magnetic resonance imaging (MRI).

Material and methods

Summary and discussion of the basic research and recommendations.

Results

Boys between 3 and 10 years of age are mostly affected. The etiology of the femoral head ischemia is still unknown. Commonly used classifications are the stages of disease according to Waldenström and the extent of the femoral head involvement according to Catterall. Head at risk signs are used for early prognosis, and after completion of growth Stulberg’s end stages are applied for long-term prognosis.

Conclusion

Based on X‑ray images and MRI, different classifications can be used for an assessment of progression and prognosis of LCPD. This systematic approach is essential to identify cases that require surgical treatment and to avoid complications such as early onset osteoarthritis of the hip.

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Literatur

  1. Balasa VV, Gruppo RA, Glueck CJ et al (2004) Legg-Calve-Perthes disease and thrombophilia. J Bone Joint Surg Am 86:2642–2647. https://doi.org/10.2106/00004623-200412000-00009

    Article  PubMed  Google Scholar 

  2. Barker DJ, Hall AJ (1986) The epidemiology of Perthes’ disease. Clin Orthop Relat Res (209):89–94. PMID: 3731620

  3. Catterall A (1971) The natural history of Perthes’ disease. J Bone Joint Surg Br 53:37–53

    Article  CAS  PubMed  Google Scholar 

  4. Catterall A, Pringle J, Byers PD et al (1982) A review of the morphology of Perthes’ disease. J Bone Joint Surg Br 64:269–275. https://doi.org/10.1302/0301-620X.64B3.6807991

    Article  CAS  PubMed  Google Scholar 

  5. Cotta H, Puhl W (1971) Aseptische Knochennekrosen im Bereich der Hüfte. In: Cotta H (Hrsg) Orthopädie für die Praxis. Springer, Berlin, Heidelberg, S 61–77

    Chapter  Google Scholar 

  6. Dillman JR, Hernandez RJ (2009) MRI of Legg-Calvé-Perthes disease. AJR Am J Roentgenol 193:1394–1407. https://doi.org/10.2214/AJR.09.2444

    Article  PubMed  Google Scholar 

  7. Gill AB (1940) Legg-Perthes disease of the hip: its early roentgenographic manifestations and its cyclical course. JBJS 22:1013

    Google Scholar 

  8. Glueck CJ, Glueck HI, Greenfield D et al (1994) Protein C and S deficiency, thrombophilia, and hypofibrinolysis: Pathophysiologic causes of Legg-Perthes disease. Pediatr Res 35:383–388. https://doi.org/10.1203/00006450-199404000-00001

    Article  CAS  PubMed  Google Scholar 

  9. Grzegorzewski A, Synder M, Szymczak W et al (2004) Bilateral Perthes’ disease. Ortop Traumatol Rehabil 6:567–574

    PubMed  Google Scholar 

  10. Ha AS, Wells L, Jaramillo D (2008) Importance of sagittal MR imaging in nontraumatic femoral head osteonecrosis in children. Pediatr Radiol 38:1195–1200. https://doi.org/10.1007/s00247-008-0979-6

    Article  PubMed  Google Scholar 

  11. Hernández-Zamora E, Rodríguez-Olivas AO, Rosales-Cruz E et al (2023) Prothrombin time and coagulation factor IX as hemostatic risk markers for Legg– Calvé–Perthes disease. Clin Appl Thromb Hemost 29:10760296221151166. https://doi.org/10.1177/10760296221151166

    Article  PubMed  PubMed Central  Google Scholar 

  12. Herring JA, Neustadt JB, Williams JJ et al (1992) The lateral pillar classification of Legg-Calvé-Perthes disease. J Pediatr Orthop 12:143–150. https://doi.org/10.1097/01241398-199203000-00001

    Article  CAS  PubMed  Google Scholar 

  13. Hochbergs P, Eckervall G, Wingstrand H et al (1997) Epiphyseal bone-marrow abnormalities and restitution in Legg-Calvé-Perthes disease. Evaluation by MR imaging in 86 cases. Acta Radiol 38:855–862. https://doi.org/10.1080/02841859709172424

    Article  CAS  PubMed  Google Scholar 

  14. Jaramillo D, Kasser JR, Villegas-Medina OL et al (1995) Cartilaginous abnormalities and growth disturbances in Legg-Calvé-Perthes disease: evaluation with MR imaging. Radiology 197:767–773. https://doi.org/10.1148/radiology.197.3.7480754

    Article  CAS  PubMed  Google Scholar 

  15. Kim HKW, Skelton DN, Quigley EJ (2004) Pathogenesis of metaphyseal radiolucent changes following ischemic necrosis of the capital femoral epiphysis in immature pigs. A preliminary report. J Bone Joint Surg Am 86:129–135. https://doi.org/10.2106/00004623-200401000-00019

    Article  PubMed  Google Scholar 

  16. Loder RT, Skopelja EN (2011) The epidemiology and demographics of legg-calvé-perthes’ disease. ISRN Orthop 2011:504393. https://doi.org/10.5402/2011/504393

    Article  PubMed  PubMed Central  Google Scholar 

  17. Mcnutt W (1962) Inherited vascular pattern of the femoral head and neck as a predisposing factor to Legg-Calve-Perthes disease. Tex Rep Biol Med 20:525–531

    CAS  PubMed  Google Scholar 

  18. Mendelsohn NJ, Wood T, Olson RA et al (2013) Spondyloepiphyseal dysplasias and bilateral legg-calvé-perthes disease: diagnostic considerations for mucopolysaccharidoses. JIMD Rep 11:125–132. https://doi.org/10.1007/8904_2013_231

    Article  PubMed  PubMed Central  Google Scholar 

  19. Miyamoto Y, Matsuda T, Kitoh H et al (2007) A recurrent mutation in type II collagen gene causes Legg-Calvé-Perthes disease in a Japanese family. Hum Genet 121:625–629. https://doi.org/10.1007/s00439-007-0354-y

    Article  CAS  PubMed  Google Scholar 

  20. Nevelös AB (1986) Perthes’ disease. The family tree. Clin Orthop Relat Res (209):13–22. PMID: 3524941

  21. Purry NA (1982) The incidence of Perthes’ disease in three population groups in the Eastern Cape region of South Africa. J Bone Joint Surg Br 64-B:286–288. https://doi.org/10.1302/0301-620X.64B3.7096393

    Article  Google Scholar 

  22. Ratliff AH (1962) Avascular necrosis of the head of the femur, after fractures of the femoral neck in children, and Perthes’ disease. Proc R Soc Med 55:504–505

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Salter RB, Thompson GH (1984) Legg-Calvé-Perthes disease. The prognostic significance of the subchondral fracture and a two-group classification of the femoral head involvement. J Bone Joint Surg Am 66:479–489

    Article  CAS  PubMed  Google Scholar 

  24. Stulberg SD, Cooperman DR, Wallensten R (1981) The natural history of Legg-Calvé-Perthes disease. J Bone Joint Surg Am 63:1095–1108

    Article  CAS  PubMed  Google Scholar 

  25. Tanaka H, Tamura K, Takano K et al (1984) Serum somatomedin a in Perthes’ disease. Acta Orthop Scand 55:135–140. https://doi.org/10.3109/17453678408992324

    Article  CAS  PubMed  Google Scholar 

  26. Trueta J (1957) The normal vascular anatomy of the human femoral head during growth. J Bone Joint Surg Br 39-B:358–394. https://doi.org/10.1302/0301-620x.39b2.358

    Article  CAS  PubMed  Google Scholar 

  27. Waldenstrom H (1934) The first stages of Coxa Plana. Acta Orthop Scand 5:1–34. https://doi.org/10.3109/17453673408991314

    Article  Google Scholar 

  28. Waldenström H (2016) The definite form of the Coxa Plana. Acta Radiol 57:e79–e94. https://doi.org/10.1177/0284185116642923

    Article  PubMed  Google Scholar 

  29. Wamoscher Z, Farhi A (1963) Hereditary Legg-Calvé-Perthes disease. Am J Dis Child 106:97–100. https://doi.org/10.1001/archpedi.1963.02080050099016

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Diagnostische und Interventionelle Radiologie, Sektion Kinderradiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland

    Alina Schwert MBA

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  1. Alina Schwert MBA
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Correspondence to Alina Schwert MBA.

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A. Schwert gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von der Autorin keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Schwert, A. Morbus Perthes. Radiologie 63, 736–744 (2023). https://doi.org/10.1007/s00117-023-01182-z

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