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Erschienen in: Der Orthopäde 6/2019

28.05.2019 | Leitthema

Morbus Perthes – Neuigkeiten in der Diagnostik und Behandlung

verfasst von: Prof. Dr. B. Westhoff, C. Lederer, R. Krauspe

Erschienen in: Die Orthopädie | Ausgabe 6/2019

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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.
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Metadaten
Titel
Morbus Perthes – Neuigkeiten in der Diagnostik und Behandlung
verfasst von
Prof. Dr. B. Westhoff
C. Lederer
R. Krauspe
Publikationsdatum
28.05.2019
Verlag
Springer Medizin
Erschienen in
Die Orthopädie / Ausgabe 6/2019
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI
https://doi.org/10.1007/s00132-019-03737-2