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Klin Padiatr 2017; 229(02): 76-81
DOI: 10.1055/s-0042-116150
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Die Wertigkeit konventioneller Röntgenaufnahmen des Beckens für die Erkennung eines Morbus Perthes 3 Monate nach durchgemachter Coxitis fugax

The Value of Conventional Radiographs of the Pelvis in Detection of Perthes Disease 3 Months After an Episode of Acute Transient Synovitis
U. Lenoir
1   Dept. of Pediatric Surgery, Children’s Hospital, Inselspital, University Hospital Bern, Bern, Switzerland
,
T. Slongo
1   Dept. of Pediatric Surgery, Children’s Hospital, Inselspital, University Hospital Bern, Bern, Switzerland
,
E. Aghayev
2   Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
,
A. Joeris
1   Dept. of Pediatric Surgery, Children’s Hospital, Inselspital, University Hospital Bern, Bern, Switzerland
› Author Affiliations
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Publication History

Publication Date:
12 October 2016 (online)

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Zusammenfassung

Hintergrund: Die häufigste Hüftgelenksaffektion beim Kind ist die Coxitis fugax. Der im ähnlichen Altersspektrum auftretende Morbus Perthes ist unter Umständen im Anfangsstadium nicht von einer Coxitis fugax zu unterscheiden. Aus diesem Grunde bekamen alle Kinder, die in unserer Klinik wegen einer Coxitis fugax behandelt wurden, nach 3 Monaten eine Röntgenkontrolle, um frühzeitig einen Morbus Perthes zu erkennen. Ziel dieser Studie war es, zu prüfen, ob alle Kinder mit einer Coxitis fugax-Episode ein Kontrollröntgen brauchen oder ob die Indikation dafür aufgrund des klinischen Verlaufes gestellt werden kann.

Patienten und Methode: Retrospektive Analyse aller Kinder, die von 2004–2010 mit der Diagnose einer Coxitis fugax in unserer Klinik behandelt wurden. 198 Kinder mit der Diagnose einer Coxitis fugax wurden eingeschlossen. Ausgewertet wurden die radiologischen und klinischen Befunde bei Erstkonsultation und im Verlauf nach mindestens 3 Monaten.

Ergebnisse: Im Intervall zwischen Coxitis fugax und Verlaufskontrolle hatten 20 Kinder erneut Hüftbeschwerden (10,1%). 16 davon hatten eine blande radiologische Verlaufsbildgebung, bei 4 Patienten (2%) wurde ein Morbus Perthes diagnostiziert. Alle Kinder ohne Beschwerden im Verlauf hatten ein negatives Verlaufsröntgenbild (Sensitivität 0,2, Spezifität 1,0).

Schlussfolgerung: Eine Röntgenkontrolle nach Coxitis fugax erscheint nur dann notwendig, wenn im Intervall zwischen Coxitis fugax und Verlaufskontrolle nach 3 Monaten Beschwerden auftreten oder persistieren. Eine gute Anamnese und eine fachkundige klinische Nachkontrolle sind Voraussetzung, um zu entscheiden, ob eine radiologische Verlaufskontrolle nach 3 Monaten notwendig ist.

Abstract

Background: Transient synovitis is the most common hip joint disorder in children. Perthes disease occurs around the same age and may not be distinguishable to an episode of transient synovitis in the early stage. Therefore all children in our clinic with transient synovitis underwent a follow-up X-ray 3 months later to detect Perthes disease at an early stage. The aim of the study was to evaluate, if a follow-up X-ray is necessary for all children with suspected transient synovitis or if the clinical follow-up can lead to the indication for a follow-up X-ray.

Patients and Method: Retrospective study including all children treated with the diagnosis of transient synovitis between 2004 and 2010. 198 patients with the diagnosis of a transient synovitis were included. We analyzed the radiological and clinical findings initially and after at least 3 month follow-up.

Results: In the time between the episode of transient synovitis and follow-up 20 children did not remain symptom-free (10.1%). Of these patients 16 had a normal radiological follow-up and 4 (2%) were diagnosed with Perthes disease. All children which remained symptom-free between the episode of transient synovitis and the follow-up had a negative follow-up X-ray (sensitivity 0.2, specifity 1.0).

Conclusion: A follow-up X-ray in detection of Perthes disease for children with transient synovitis appears to be necessary only if they have recurrent or persisting symptoms in the clinical course between the episode of transient synovitis and the 3-months-follow-up. A good patient history and an expert clinical follow-up examination are mandatory to decide whether a follow-up X-ray is needed.

 

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