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Der Orthopäde

, Volume 48, Issue 6, pp 515–522 | Cite as

Morbus Perthes – Neuigkeiten in der Diagnostik und Behandlung

  • B. WesthoffEmail author
  • C. Lederer
  • R. Krauspe
Leitthema

Zusammenfassung

Diagnostik

Der M. Perthes stellt nach wie vor eine Herausforderung für den behandelnden Orthopäden dar. Unverändert ist das Röntgenbild die Methode der Wahl zur Diagnostik und Verlaufskontrolle. Eine weitere Differenzierung der Waldenström-Stadien – insbesondere in frühes und spätes Fragmentationsstadium – ist möglicherweise relevant für die Optimierung des Operationszeitpunkts im Falle eines Containment-Verlusts. Sogenannte „Advanced“-MRT-Untersuchungen können möglicherweise frühzeitiger als konventionelle Röntgenaufnahmen Risikopatienten entdecken und damit diese früher einer operativen Therapie zuführen.

Behandlung

Bezüglich der Therapie sind aktuell keine Verfahren im klinischen Einsatz, die direkt die ossären Veränderungen beim M. Perthes normalisieren könnten. Konservative physiotherapeutische Maßnahmen mit Verbesserung der Gelenkbeweglichkeit und ggf. Entlastung sind die grundlegenden Standardverfahren zur Behandlung. Sie werden ergänzt durch eine analgetische und/oder antiphlogistische Medikation bei entsprechenden Symptomen oder Befunden. Bei Containment-Verlust ist insbesondere bei Kindern, die älter als 6 Jahre sind, ein operativer Eingriff indiziert. Dabei besteht aktuell ein Trend in Richtung azetabulärer Verfahren – insbesondere zur Triple-Osteotomie – um die biomechanischen Verhältnisse am proximalen Femur nicht zusätzlich negativ zu beeinflussen, wie es durch die Varisationsosteotomie erfolgt.

Schlüsselwörter

Kindliche Hüfterkrankung MRT Containment Osteotomie proximales Femur Beckenosteotomie 

Abkürzungen

BMP

„Bone morphogenetic protein“

DWI

„Diffusion-weighted imaging“

EMA

Europäische Arzneimittel-Agentur

FAI

Femoroazetabuläres Impingement

HHS

Harris Hip Score

MRT

Magnetresonanztomographie

SA

Shelf-Arthroplastik

SF-36

Short Form 36

SO

Salter-Osteotomie

TEP

Totalendoprothese

TO

Triple-Osteotomie

VO

Varisationsosteotomie

Perthes disease—news in diagnostics and treatment

Abstract

Diagnostics

Perthes disease remains a challenge for paediatric orthopedic surgeons. X‑ray imaging is still the method of choice for diagnostics and follow-up examination. A more detailed differentiation of Waldenström’s classification, especially in early and late fragmentation stages, might be relevant to optimize timing of containment surgery. So-called “advanced MRI” imaging might help to detect patients at risk earlier than conventional x‑ray imaging, which could lead to earlier surgical intervention.

Treatment

Currently there is no treatment modality available which would improve the bone changes in Perthes disease. Non-operative treatment like improving hip range of motion as well as unloading is still the basic standard of care, with analgesic and/or anti-inflammatory medication, according to symptoms or findings. In the case of loss of containment, especially in children older than 6 years, surgery is indicated. Currently, there is a trend favoring acetabular reorientation techniques—especially the triple osteotomy, since the biomechanical relations would not be additionally impaired as in case of femoral varus osteotomy.

Keywords

Paediatric hip disorder MRI Containment Proximal femur osteotomy Pelvic osteotomy 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

B. Westhoff, C. Lederer und R. Krauspe geben an, dass kein Interessenkonflikt besteht.

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

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Orthopädische KlinikUniversitätsklinikum DüsseldorfDüsseldorfDeutschland

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