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Aktuelle Behandlungsstrategie des Morbus Perthes

Current treatment strategies in Legg-Calvé-Perthes disease

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Zusammenfassung

Die Langzeitprognose nach Morbus Perthes wird bestimmt von der Sphärizität des Hüftkopfs und von der Kongruenz des Gelenks nach Ausheilung. Zahlreiche Faktoren, die Auswirkungen auf das Ausheilungsergebnis haben, sind bekannt, aber von diesen können lediglich die „Gelenkbeweglichkeit“ und das Containment therapeutisch beeinflusst werden. Durch unterschiedliche konservative Maßnahmen soll die Gelenkbeweglichkeit erhalten bzw. wiederhergestellt und die auf das Hüftgelenk wirkenden deformierenden Kräfte reduziert werden. Bei Verlust des Containments sind operative Maßnahmen – möglichst im frühen Fragmentationsstadium – indiziert. Dabei sind aus biomechanischen Gründen pfannenkorrigierende Eingriffe zu bevorzugen. Bei einem Alter von < 8,5 Jahren ist zur Prophylaxe eines Trochanterhochstands eine Trochanterapophyseodese zu erwägen. Die Ergebnisse containmentverbessernder Operationen sind ermutigend. Therapeutisch problematisch bleibt jedoch der schwere Morbus Perthes bei älteren Kindern – hier sind die Ergebnisse bislang weniger erfolgversprechend.

Abstract

The long-term prognosis of Legg-Calvé-Perthes disease primarily depends on the spherical form of the femoral head and the congruency of the hip joint after healing. Of the many factors influencing the outcome only the range of mobility and containment can be addressed therapeutically. The mobility of the joint is maintained or restored through various conservative measures thus reducing joint deforming forces. If loss of containment becomes evident operative treatment is indicated, preferably in the early fragmentation stage. For biomechanical reasons correction of the acetabulum is preferred. For children less than 8.5 years old greater trochanteric apophyseodesis is warranted to prevent trochanteric overgrowth. The results of containment ameliorating surgery are promising. In older children with severe Legg-Calvé-Perthes disease the results are less promising.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. R. Krauspe, B. Westhoff, F. Martiny geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Orthopädische Klinik, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    B. Westhoff, F. Martiny &  R. Krauspe

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  1. B. Westhoff
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  2. F. Martiny
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Correspondence to R. Krauspe.

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Westhoff, B., Martiny, F. & Krauspe, R. Aktuelle Behandlungsstrategie des Morbus Perthes. Orthopäde 42, 1008–1017 (2013). https://doi.org/10.1007/s00132-012-2048-y

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