Osteochondropathy

Osteochondropathy (synonym: aseptic necrosis of the bones, apofiza) is a disease of the epiphyses and epifizov bones, occurring in childhood and adolescence. Are affected most often the head of the femur (see Perthes disease), tuberosity of the tibia, head of the metatarsal bones of the body vertebrae and rarely other bones. Osteochondropathy is manifested by pain and often by swelling in the affected area. The diagnosis is usually set by x-ray. Forecast by osteochondropathy favorable, but an incorrect treatment of the disease can cause the development of osteoarthritis (see).

Osteochondropathy (osteochondropathia; from the Greek. osteon - bone, chondros - cartilage and pathos - suffering, illness; synonym: aseptic necrosis of the bones, epiphyseolysis, apofiza) - a group of pathological processes, characterized by a kind of change in cancellous short and epiphyses of the long bones, often associated with changes in the articular cartilage and ending with the deformation of the affected bones.
The etiology and pathogenesis. Osteochondropathy occurs as a result of local eating disorders of bone, the causes of which, apparently, different at different locations process (overload, microtrauma and other).
Osteochondropathy differs certain phase current. The process is based upon an automatically arising aseptic Podhradie necrosis of bone tissue (I phase), complicating secondary pathological depressed fracture nekrotizirovannah area (phase II, impressionis fracture). Adjacent connective tissue (joint and germ cartilage, joint bag, periosteum, ligaments) is involved in the resolution of necrosis and the replacement of the elements of his osteogeny substance (III phase, phase resorption, fragmentation), then Kosteniuk. In the bone structure of the affected Department is restored (IV phase, recovery phase) and Acting spontaneously ends, however, with various degrees of deformation of the affected Department (V phase, end). When significance of this deformation respectively and gradually modeled, warping, articular end of the adjacent bone of this joint; so gradually may occur deforming process (osteoarthritis) is a common complication of O. Practically distinct phases partially complemented by the time one another.
There are certain bones of the skeleton and typical places in those bones (covered with cartilage) for localization of osteochondropathy. In the literature of different localization O. often (not always accurately) indicate the names of the first reported their authors. So, O. pubic-sciatic connection called the disease of the van Nacka, the vertebral body - disease Calvet, scaphoid foot disease Keller I, heads metatarsal bone disease Keller II-moon wrist bone disease of Kinbaku, the femoral head - Perthes disease or Legge - calve - Perthes disease (see Perthes disease), the tibial tuberosity - disease Osgood (Tibia) (see (Tibia) disease), scaphoid wrist - illness of Preiser, sesamoides bones I metatarsophalangeal joint disease of Renander - Muller, sternal end of the clavicle disease Friedrich, the nucleus of ossification heel bone - Haglund disease - Shintsa, epifizov of the vertebral bodies disease of Leiermann-May, medial condyle of the femur and capitate elevation of the shoulder bone disease Koenig. Some authors refer to osteochondropathy and change the shape of vertebrae - disease Nummela. Limited diagnostic conclusion a short phrase such as "disease Keller II"; it should identify and phase of the disease depend on those or other therapeutic and labour purposes and limitations.
Pathologic anatomy studied Acting on the drugs derived from the operations. The essence of pathological changes are the same in all diseases belonging to the group of O.
The initial stage of the disease has not been studied as the operations regarding osteochondropathy produced in the late stages. At the height of the disease macroscopically is expressed deformation of the affected Department bone or all of the bones in the localization process in small bones. When illness calve vertebra flattened, sometimes more in the back office. When of Perthes disease is flattened, the head of the femur; along the edges of it are formed bone thickening in the form of rollers. When illness Keller I scaphoid bone flattened foot (Fig. 1). When illness Keller II flattened head struck metatarsal bones. In the case of Nummela the affected vertebrae decrease in height, take a tapered tarifitsiruyutsya. The disease Osgood (Tibia) deformed region tuberosity of the tibia. When illness Koenig (osteochondritis dissecans) part of the medial condyle of the femur over time rejected, and is in joint cavity in the form of free articular body - site spongy bone covered with articular cartilage. Along the line of separation from the bones is the narrow area of fibrous tissue. In the bone fragment parts you can see mikromotory, spinaudio broken balocchi. In the long bones and small bones of the hands and feet major changes are localized in the subchondral areas. Microscopically visible here randomly located small bone fragments, represent fragments of bone beams; osteocytes are not painted. There are also fragments of cartilage and degenerative changes, and sometimes with the proliferation of cartilage cells. Also in this area are unstructured protein weight (Fig. 2). Part of them formed, apparently, pletnevskiy fibrin, part represents the main substance of the cartilage. In these unstructured mass fall grainy precipitation of lime, which is sometimes incorrectly accept the collapse of the bones (bone meal). In bone beams can detect traces of the former once fractures: a separate bulochki soldered between micromacrame, there are areas of newly formed bone substance, which is soldered old bone bulochki deprived of osteocytes. Sometimes the newly formed bone substance has the character of osteoid.

Fig. 1. Deformation of the scaphoid.
Fig. 2. The protein mass in the interosseous spaces.

The sequence of pathological changes in osteochondropathy interpreted in two ways. Some believe that the basis O. lies primary aseptic necrosis of bone beams with their subsequent fractures and sometimes broken all the bones. Others include Acting to microtransactions diseases: primary arise microfractures bone beams, the accretion of them occurs in the context of the ongoing functional load, so healing is defective and is accompanied by the development of deformations. Cm. the Bone (pathologic anatomy). T. Vinogradova.
The clinical picture and symptoms. Osteochondropathy is a disease of the growing organism and occurs mainly in children, adolescents and young men, less often in infants and only at certain locations in the flourishing age. The onset of the disease in most imperceptible and gradual. Leading clinical signs are strictly localized pain, aggravated by stress and cause sparing of this division, restriction of movement, as well as pain at the pressure on the affected Department and along the long axis of the bone; including local swelling and even hyperemia. Fever, peripheral blood changes, wandering abscesses and fistulas are missing.
A confident diagnosis and differential diagnosis is possible only on the basis of x-ray data. To differentiate the osteochondropathy depending on localization needs with TB, fracture area of perestroika, nonspecific arthritis, rickets, caisson disease, etc. Should be taken into account that the number of bone disease (tuberculosis, eosinophilic granuloma etc) may be complicated O.
The prognosis for osteochondropathy favorable for the disease spontaneously ends. To prevent the increase of necrosis and degree of pathological depressing bone advisable to relieve the affected Department at 1-II-III stages of the disease; this facilitates the reparation and more perfect shape recovery bones in the fourth phase O.
In the study of the skeleton on other occasions sometimes the x-ray can detect changes typical of the consequences once transferred and not seen patients osteochondropathy. There are also cases of recourse people only with complaints about osteoarthritis, resulting moved imperceptibly of osteochondropathy.
Osteochondropathy of the vertebral body (illness Calvet, flat, osteopaticheskii vertebra) occurs in infants, children and adolescents in thoracic, lumbar or cervical spine; on the level of minor angular kyphosis radiographically detected progressive losing body of one vertebra to 1/2 - 1/4 and more normal height, more front, with a small vastanie his anterior. Shadow intensity of the affected vertebra due to necrosis and pathological compression strengthened. The height of the adjacent intervertebral crevices often increased. For several years the height of the affected vertebra (often imperfectly) and normal figure, his shadow on radiographs are restored.
Osteochondropathy scaphoid foot disease Koehler I) sick infants, children and adolescents, more often boys. The x-ray shadow of the kernel of ossification of the scaphoid in phase II, thinner and obscured, and both allied joint gaps are widening. In phase III the shadow kernel segmented, and then recovered without treatment.
Osteochondropathy head II, rarely III - IV metatarsal bone disease Koehler II) is associated with increased load metatarsus (flat). There is solitary, less often multiple, defeat in adolescents and young adults, mostly women. In phase II, struck the head is flattened and compacted, allied joint gap is widening. In phase III head looks as if consisting of separate fragments. Dimming and irregularity shadow head disappear in the fourth phase, which typically ends spontaneously, not later than the third year of the disease. The gap related to the metatarsophalangeal joint remains extended forever; the base is adjacent phalanx is modeled by the head of the metatarsal bones. In the fifth phase, there are various degrees of deformation head from the subtle and very rough with osteophytes.


Osteochondropathy moon wrist bone disease Kinbaku) are characteristic of people aged 15-30 years really strain on the wrist. The peculiarity of this localization Acting in duration (up to 2 years or more) of the I phase of the disease, i.e., the phase of the negative x-ray data that insufficient account of local clinical phenomena and profession often causes undue suspicion in the simulation. Flattening, deformation and seal bones in the phase II is replaced by the irregularity of its shadow in phase III and homogenization in the fourth phase, but without the restoration of the initial form and size of the bone by the end of the disease.
For very rare Acting one, often medial, from sesamoid bones I metatarsophalangeal joint disease Renander - Muller) typical rentgenologicsky picture of disease dynamics, but without the restoration of normal form and size of the affected bones to the end of the disease.
Osteochondropathy kernel () of ossification of the calcaneal bone (disease Haglund - Shintsa) is very rare and histologically not proven. Characteristic of children and adolescents. Convincing arguments in favor of the existence of this disease are distinct shift I fragments of the nucleus of ossification of the hill and thickening of the cartilage that is transparent for x-rays, a layer between the core and the array heel bone.
Chairman and May (N. Scheuermann, S. May) described the disease of the thoracic spine bone in adolescence and early youth ages, most men, Acting as epifizov vertebral disease Leiermann-May)as the cause of the so-called juvenile kyphosis. Based x-ray picture of the changes in apofiza vertebrae, similar to osteochondropathy, but histologically not proven. Some authors changes in juvenile kyphosis attributed to chronic injury epifizov at overload of the spine with the development of the front cartilage hernias and subsequent deformation. Local pain rare and not intensive. Radiographically observed in the dynamics of single or multiple irregularities sites of bodies of the affected breast, rare upper lumbar vertebrae (due to the cartilage of hernias of intervertebral disks), behind them in the growth in height, forming here kyphosis, later thinning disks. Further at this level usually develop irreversible deformation-degenerative diseases (osteochondrosis).
Occasionally in adulthood motivated injuries, usually in the head of the femur, occurs late in Acting, which dynamics is characterized by the absence of the recovery phase and a repetition of the first three phases. The prognosis is poor due to progressive destruction of the femoral head.
One of the varieties avascular osteonecrosis - disease Koenig [synonym: partial wedge osteochondropathy articular surface, cutting the osteochondrosis dissecans)] - is the gradual delimitation nekrotizirovannah fragment from the surrounding living bone granulations, and then in his exclusion through the articular cartilage in the joint cavity, where it becomes a "joint mouse, sometimes uselease. Classical and the most frequent sites of this type are Acting articular surface of the medial condyle of the femur, capitate upland shoulder and block talus, more rarely, other parts of skeleton.