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Z Orthop Unfall 2014; 152(6): 617-635
DOI: 10.1055/s-0034-1382865
Refresher Orthopädie und Unfallchirurgie
Georg Thieme Verlag KG Stuttgart · New York

Morbus Perthes

B. Westhoff
Orthopädische Klinik, Universitätsklinikum Düsseldorf
,
F. Martiny
Orthopädische Klinik, Universitätsklinikum Düsseldorf
,
R. Krauspe
Orthopädische Klinik, Universitätsklinikum Düsseldorf
› Author Affiliations
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Publication History

Publication Date:
22 December 2014 (online)

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Zusammenfassung

Der Morbus Perthes stellt nach wie vor eine Herausforderung für den behandelnden Orthopäden dar: Die Ätiologie ist ungeklärt und die Therapieprinzipien und deren Umsetzung werden zum Teil widersprüchlich diskutiert. Die Prognose wird wesentlich bestimmt von klinischen (u. a. Alter bei Erkrankungsbeginn, Bewegungseinschränkung, Geschlecht) und radiologischen (u. a. Ausmaß der Nekrose, Containment) Faktoren. Dabei können wir lediglich die Faktoren „Bewegungseinschränkung“ und „Verlust an Containment“ therapeutisch mittels konservativer und/oder operativer Maßnahmen beeinflussen. Es werden zunehmend beckenseitige Osteotomien propagiert, da mit diesen ein größeres Korrekturpotenzial besteht und die biomechanischen Nachteile, wie sie mit der intertrochantären Varisationsosteotomie verbunden sind, eliminiert werden. Die früher angewandte Orthesenbehandlung ist heutzutage als obsolet einzustufen. Non-Containment-Verfahren dienen vorwiegend der symptomatischen Therapie und im Endstadium der Therapie residueller Deformitäten. In Abhängigkeit vom Ausheilungsergebnis besteht ein mehr oder weniger großes Risiko für eine frühzeitige Koxarthrose und die Notwendigkeit einer TEP-Implantation im jungen Erwachsenenalter.

Abstract

Morbus Perthes today still poses a challenge for the orthopaedic surgeon because of the unclear aetiology as well as the controversial discussion about the role and kind of multiple treatment principles. The prognosis depends upon clinical (e.g. age at onset, reduction of range of motion, gender) and radiological (extent of necrosis, containment) parameters. Of these, only the reduced range of motion and a loss of containment can be adressed therapeutically, be it in a conservative and/or operative concept. Pelvic osteotomies have the advantage of a high potential of correction without the biomechanic disadvantages which are associated with intertrochanteric varus osteotomies. Nowadays, the use of orthoses is considered to be obsolete. Non-containment is targeted mainly on the symptomatic treatment and the correction of residual deformities. Based on the outcome after the final stage there is a risk of premature osteoarthritis with the need of early total hip replacement.

Key words

Morbus Perthes - Kinderorthopädie - Hüfte - aseptische Knochennekrose

Key words

Legg-Calvé-Perthes disease - childrenʼs orthopaedics - hip joint - aseptical necrosis of the femoral head
 

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