Die Entwicklung der Epiphysen und Knochenkerne bei der hämophilen Arthropathie des Ellenbogens

Zusammenfassung

Destruktive und reparative Verläufe bei der hämophilen Arthropathie können besonders gut am Ellbogengelenk verfolgt werden, weil Gelenkblutungen bei Hämophilen meist im Kindesalter während der zeitlich abgestuften Entwicklung der Knochenkerne und Epiphysen auftreten. Unter der floriden hämophilen Arthropathie des Ellenbogens entwickeln sich Knochenkerne vorzeitig. Knochenkerne und Epiphysen sind vergrößert und in ihrer Struktur verändert. Wegen ihrer verminderten Festigkeit entstehen in Belastungszonen typische Impressionsdeformationen und an Stellen, die ein Ausweichen gestatten, Expressionsdeformationen. Weil ausgeprägte Deformationen irreversibel sind und in der Regel zu erheblichen Funktionseinbußen führen, ist es von therapeutischem Interesse, die Belastbarkeit der chronischen hämophilen Arthropathie röntgenologisch abzuklären.

Summary

Destructive and reparative changes in haemophiliac arthropathy can be observed particularly well in the elbow, since bleeding occures usually in childhood during development of the epipyses. These appear prematurely as a result of florid heamophiliac changes. They are enlarged and their structure is altered. Stress areas show typical impression deformations and in other areas the bone becomes expanded. Extensive deformities are irreversible and usually lead to severe functional impairment. It is, however, of thereapeutic importance to evaluate these changes radiologically. The literature contains various special features of heamophiliac arthropathy of the elbow. As early as 1897, two years after the discovery of x-rays, Shaw described enlargement of the head of the radius. Increased depth of the groove of the trochlea, of the incisura radialis ulnae and of the olecranon fossa are regarded as typical. Deformities of the tip of the olecranon and of the coronoid process are also described (De Palma 1956, Jordan 1958, Ahlberg 1965, Weseloh 1973). At the rehabilitation centre for children and adolescents at Neckargemünd, 100 heamophiliacs have been examined systematically. Development of the arthropathy has been followed for a period of five years. Three typical heamophiliac arthropathies of the elbow are described and discussed. Classification is proposed according to a system published in 1980.