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Orthopädie und Unfallchirurgie up2date 2022; 17(05): 477-493
DOI: 10.1055/a-1770-9740
Pädiatrische Orthopädie und Unfallchirurgie

Morbus Perthes – ein Update

Ralf Stücker
,
Sebastian Stücker
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Eine Prognose über den Verlauf des Morbus Perthes ist schwierig, weil nahezu alle Klassifikationen erst in der späten Fragmentationsphase eingesetzt werden können, wenn eine Hüftkopfdeformierung bereits vorlag. Eine frühe Prognose ist nun durch ein Perfusions-MRT möglich, und es verdichten sich die Anzeichen, dass bei ungünstiger Prognose die Ergebnisse der Behandlung besser sind, wenn Therapiemaßnahmen früh durchgeführt werden können.
Kernaussagen

  • Die Ätiologie des Morbus Perthes ist nach wie vor unklar.

  • Medikamentöse Behandlungsverfahren sind erfolgversprechend, haben sich jedoch in der Therapie noch nicht etabliert.

  • Zur Einschätzung der Prognose der Erkrankung hat sich das Perfusions-MRT bewährt. Bei Perfusionsstörungen > 50% sollten operative Maßnahmen in Erwägung gezogen werden.

  • Kinder unter 6 Jahren haben in der Regel eine gute Prognose. Operative Maßnahmen sind selten erforderlich.

  • Eine Orthesenbehandlung hat sich in der Behandlung des Morbus Perthes nicht bewährt und hat keinen Einfluss auf den natürlichen Verlauf der Erkrankung.

  • Containment-erhaltende operative Maßnahmen sollten in der Frühphase der Erkrankung durchgeführt werden, bevor signifikante Deformierungen des Hüftkopfes eingetreten sind.

  • Die Triple-Osteotomie, Shelf-Azetabuloplastik und Arthrodiastase werden vielfach erfolgreich eingesetzt. Das Indikationsspektrum ist jedoch noch unklar.

Schlüsselwörter

Morbus Perthes - Perfusions-MRT - modifizierte Waldenström-Klassifikation - Containment


Publication History

Article published online:
26 September 2022

© 2022. Thieme. All rights reserved.

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