APOPHYSITIS

From Big Medical Encyclopedia

APOPHYSITIS (apophysitis; grech, apophysis a shoot + - itis) — an osteochondropathy of apophyses, the podostrovospalitelny process which is shown in a growth period of a skeleton. Most often suffer tuberosity of a tibial bone (see. Osgood-Shlattera disease ), a hillock of a calcaneus (see. Haglunda-Shintsa disease ), apophyses of bodies of vertebrae (see. Sheyermanna-Mau disease ), apophyses of a crest of an ileal bone and pubic bone.

Fig. 1. An apophysitis of tuberosity of the right tibial bone at the boy of 9 years. Fragmentation of an apophysis is expressed (the roentgenogram at the left); normal X-ray pattern of ossification of the left tibial bone (roentgenogram on the right).
Fig. 2. Apophysitis of a hillock of a calcaneus. Fragmentation of an apophysis (roentgenogram) is expressed.

And. it was for the first time described by Haglund (R. Haglund) as an aseptic necrosis of apophyses. It is established that And. results from the vascular frustration caused by action of various factors (endocrine, exchange, infectious, traumatic). And. more often happens at males at the age of 8 — 15 years. And. can be both bilateral, and unilateral.

Clinical picture it consists of the various functional disturbances caused by pains. There are no local inflammatory phenomena, but the swelling sometimes appears. At a palpation of the respective area morbidity is noted, the movements in a joint can be limited.

Radiological changes (fig. 1 and 2) at And. have several stages: in the beginning shadows of apophyses lose the homogeneity, contours of apophyses become uneven, the drawing gains spotty character, the centers of an enlightenment against a dark background appear. Further fragmentation of an apophysis is characteristic. At And. bodies of vertebrae the greatest changes arise in vertebrae at top of a kyphosis: bodies of vertebrae get a wedge-shaped form, in their apophyses the same changes are observed, as at And. other localization. At correctly carried out treatment the fragmented sites or resolve, or gradually merge with each other, are reconstructed and acquire structure of a normal bone.

Differential diagnosis it is carried out with tuberculosis, a fracture and tumoral process. Course of a disease slow: from several months to 2 — 3 years.

Forecast favorable.

Treatment: vitamin therapy, radiation by quartz, balneofizioterapevtichesky procedures. At strongly expressed pain syndrome — a bed rest, restriction of an exercise stress; at And. a calcaneus — foot baths, paraffin, carrying instep supports. After the termination of the acute phenomena — short-wave therapy. See also Osteochondropathy.


Bibliography: Reynberg S.A. Radiodiagnosis of diseases of bones and joints, t. 2, page 252, M., 1964; Rokhlin D. G. Radiodiagnosis of diseases of joints, p. 3, page 159, D., 1941; R e-dulesku A. Osteokhondropatiya, Mno-gotomn. guide to the orthoitem and travmat., under the editorship of Η. P. Novachenko, t. 1, page 516, M., 1967.

H. N. Nefedyeva.

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