#Перцийн #өвчин, #Perthes #disease PPT хэрэгтэй бол btk1092@gmail.com хаягаар холбогдоно уу

1. Perthes өвчин
б

2. Түүх
• Анх 1909 ОНД LEGG
болон
WALDENSTORM
ба 1910 онд PERTHES
CALVE
тодорхойлогдсон.

3. Тодорхойлолт
• Perthes өвчин (LCPD)
нь хүүхдэд тохиолддог
шалтгаан тодорхойгүй
дунд чөмөгний толгой
хайлдаг өвчин

4. Тархалт
• Бага насны хүүхдэд
• Нас 4-8yo
• хүү:охин= 4-5:1
• 2 талдаа 10-12%
• Удамшилийн онош нотолгоогүй

5. • Тархалт :
77.4%
6.0%2.8%5.3%
8.5%
Transient
synovitis
SCFE
Infection
Perthes'
disease
Other

6. Этиологи
• Тодорхойгүй
• Хуучны онол: халдвар, үрэвсэл, гэмтэл,
төрөлхийн
• Судасны эмгэг гэж үзсэн
▫ Sanches 1973: “second infarction theory”

7. Шалтгаан
• Таамагласан онол.
▫ Excessive femoral antiversion.
▫ Synovitis.
▫ Generalized skeletal disorder.
▫ Arterial anomalies.

9. Эмгэг жам
• 1913 онд гистологийн өөрчлөлт тодорхологдсон
• Ясжилтийн хоёрдогч бүс = 3 давхар мөгөөрсөөр
хучигддаг :
▫ Өнгөц
▫ Эпифиз
▫ Нарийн мөгөөрсөн бүс
• Капилляр нь нарийн мөгөөрөн нэвтэлж дор
оршдог.

10. • Эпифизийн мөгөөрс in LCP disease:
▫ Superficial zone is normal but thickened
▫ Middle zone has
1) areas of extreme hypercellularity in clusters and
2) areas of loose fibrocartilaginous matrix
• Superficial and middle layers nourished by synovial
fluid
• Deep layer relies on blood supply

11. • Physeal хавтгай: завсар хагархай бүрдэл,
amorphis debris, blood extravasation
• Metaphyseal бүс: normal bone separated by
cartilaginous сав
• Epiphyseal changes can be seen also in greater
trochanter, acetabulum

12. Цусан хангамж

13. • Waldenstrom 4 үе шат
▫ 1) анхдагч үе
▫ 2) задрах үе
▫ 3) дахин ясжих үе
▫ 4) эдгэх үе

14. Анхдагч үе
• Early radiographic signs:
▫ Failure of femoral ossific nucleus to grow
▫ Widening of medial joint space
▫ “Crescent sign”
▫ Irregular physeal plate
▫ Blurry/ radiolucent metaphysis

15. • хавирган сарны
шинж шинж

16. Задрах үе
• Bony epiphysis begins to fragment
• Areas of increased lucency and density
• Evidence of repair aspects of disease

17. Дахин ясжих үе
• Normal bone density returns
• Alterations in shape of femoral head and neck
evident

18. Эдгэх үе
• Left with residual deformity from disease and repair
process
• Differs from AVN following Fx or dislocation

19. Group I

20. Group II

21. Group III

22. Group IV

23. Lateral Pillar Classification
• 3 groups:
▫ A) no lateral pillar
involvment
▫ B) >50% lat height
intact
▫ C) <50% lat height
intact

24. Salter-Thompso-ний ангилал
• Simplification of Catterall
• Based on status of lateral margin of capital femoral
epiphysis
• Group A (Catterall I & II equivalent)
• Group B (Catterall III & IV equivalent)

25. Эмнэлзүй
• Stature usually shorter than peers
• Quadriceps and gluteal muscle wasting is common,
Trandelenburg test positive (drop of the hip on the
unsupported side)
• Acute phase; range of motion at the hip joint is
limited due to muscle spasms
• Progressively; limited internal rotation and
abduction is likely due to impingement lesions
(hence the Roll test, guarding on affected side)
• Later stage; global reduction in all ranges of motion
assoc. with pain, indicating joint arthritis

26. • Age- 4 to 10 years, with peak incidence at 7
• Gender- Boys (5:1 ratio) but it tends to be more severe
in girls
• Height
• Passive smoking or maternal smoking at pregnancy
• ADHD? Increased physical activity
• Family Hx of; skeletal dysplasias or thrombotic
disease
• Ethnicity; more common in Whites, Eskimos,
Japanese
• Social Hx- associated with low socio-economic status
Эрсдэлт хүчин зүйл

27. Ялгах онош
• Unilateral
1. Septic hip
2. Toxic synovitis
3. Slipped femoral capital
epiphysis
4. Lymphoma
• Bilateral
1. Hypothyroidism
2. Sickle cell
3. Multiple epiphyseal
dysplasia
4. Spondyloepiphyseal
dysplasia

28. Workup
• Technetium 99 bone scan -
Helpful in delineating the
extent of avascular changes
before they are evident on
plain radiographs.
▫ The sensitivity of radionuclide scanning in the
diagnosis of LPD is 98%, and the specificity is
95%.
• Dynamic arthrography - Assesses sphericity of the
head of the femur.

29. • Ultrasonography may provide significant diagnostic
clues to differentiate early Perthes' from transient
synovitis.
T Futami, Y Kasahara, S Suzuki, S Ushikubo and T Tsuchiya
Journal of Bone and Joint Surgery - British Volume, Vol 73-B, Issue 4, 635-639
Хэт авиа

30. CT шинжилгээ
• Staging determined by
using plain radiographic
findings is upgraded in
30% of patients.
• Not as sensitive as nuclear
medicine or MRI.
• CT may be used for follow-
up imaging in patients with
LPD.

31. MRI
• It allows more precise
localization of involvement
than conventional
radiography.
• MRI is preferred for
evaluating the position, form,
and size of the femoral head
and surrounding soft tissues.
• MRI is as sensitive as isotopic
bone scanning.

32. Эмчилгээ
Эмчилгээний зорилго
1. Reduce hip irritability and pain
2. Restore/maintain hip mobility
3. Prevent femoral head from extruding or collapsing
“CONTAINMENT”
4. Regain spherical shape of femoral head

33. Below 6 years and Herring A/B
• Mainstay of treatment would be to OBSERVE with
6-12 month reassessment.
• Patients in this age group need bed rest and anti
inflammatory medication at most. NO evidence that
abduction splints or surgery beneficial
• Prognosis is good for the majority

34. Non Surgical treatment
1. NSAIDS
2. Traction
3. Casts and braces
(Scottish Rite Orthosis)

36. Above 6 and Herring class B
• Containment of the head within the acetabulum is
warranted
This is achieved by;
• Abduction bracing
• Femoral varus osteotomy
• Pelvic ostotomy

37. Age between 6-8 and Herring class C
• Results of intervention have been equivocal.
• Above 9 years
1. Often have Herring class B or C
2. Prognosis is poor
3. Early containment is key, by pelvic osteotomy and
internal fixation

38. Osteotomies

39. Хүндрэл
Femoral
▫ Shortening
богиносолт
▫ Stiffness хөшилт
▫ Malrotation
▫ Limp доголох
▫ Positive
trendelenburg
Pelvic
▫ Lenghtening
▫ Stiffness
▫ Chondrolysis
▫ Failure of
containment

40. Тавилан
• The younger the age of onset of LCPD, the better the
prognosis.
• Children older than 10 years have a very high risk of
developing osteoarthritis.
• Most patients have a favorable outcome.
• Prognosis is proportional to the degree of radiologic
involvement.