El síndrome de Perthes

El síndrome de Perthes afecta mayormente a niños de entre 3 y 12 años de edad. Suele no dejar secuelas, pero es necesario seguir un tratamiento adecuado.
El síndrome de Perthes

Escrito por Fernando Clementin, 17 marzo, 2018

Última actualización: 18 marzo, 2018

El síndrome de Perthes, también denominada enfermedad de Perthes o Legg-Calvé-Perthes, es una patología que afecta a la articulación de la cadera de los niños.

Precisamente, lo que hace es perjudicar su desarrollo mediante una necrosis; es decir, se mueren las células del hueso por una disminución en el flujo sanguíneo hacia ellas.

El síndrome de Perthes puede aparecer entre los 3 y los 12 años de edad y es mucho más frecuente en niños. De hecho, el 80% de los casos estudiados son en el sexo masculino. Además, en 1 de cada 10 casos la lesión se produce en ambos lados de la cadera, mas nunca en forma simultánea.

Precisamente, la parte afectada es la cabeza del fémur, también llamada ‘bola’. Según el momento en el que se manifieste y, por supuesto, la respuesta de cada organismo, es una enfermedad que puede o no dejar secuelas. Si se da después de los 8 años, es muy posible que aparezcan malformaciones o que se genere artrosis.

¿Cuáles son las causas del síndrome de Perthes?

No se ha logrado concluir cuáles son los orígenes de esta afección. Sin embargo, se lo ha ligado a ciertos factores que podrían contribuir en su formación:

  • Padecimiento de una sinovitis previa. Muchos afirman que es el desencadenante más frecuente, dado el aumento de la presión intraarticular que ocasiona. Sin embargo, esto no está confirmado. A diferencia de la sinovitis transitoria de cadera, esta permanece por más tiempo.
  • Pequeños traumatismos repetidos en la zona: el nivel de violencia de algunos juegos podría explicar por qué se da más frecuentemente en varones que en mujeres.
  • Factores constitucionales. Están relacionados a la estatura, el peso y la maduración en cuanto a la densidad ósea. Es una de las teorías más fuertes en cuanto a las causas del síndrome de Perthes.
  • Factores genéticos. La falta de evidencias para comprobar este punto hace que su consideración sea relativamente baja.
  • Factores ambientales. Se han detectado más casos en niños con deficiencias nutricionales. Asimismo, aparece más a menudo en familias de fumadores.

Todo esto hace que la enfermedad de Perthes sea prácticamente imposible de prevenir. Solo se procede a tratarla una vez es detectada.

La fisioterapia contribuye a mejorar la movilidad tras el síndrome de Perthes.

Síntomas del síndrome de Perthes

El diagnóstico de esta enfermedad puede darse a partir de las siguientes señales:

  • Inflamación de la zona afectada.
  • Dolor, que por lo general no es mucho y se localiza en la ingle, la rodilla o el muslo.
  • Leve cojera en momentos de cansancio, sobre todo por las noches.
  • Disminución de la movilidad en la cadera.

Sin embargo, no se trata de una patología con síntomas claros y contundentes. Por lo general, una vez que se diagnostica, el síndrome de Perthes ya se ha desarrollado y su avance y el período de regeneración necesarios ya están determinados.

¿Cómo se trata?

El tratamiento del síndrome de Perthes tiene, como tantas otras patologías, objetivos específicos. Estos son la mitigación del dolor, la conservación de la movilidad, la protección del hueso y el tratamiento de posibles secuelas.

Luego de pedir una examinación por imágenes a través de placas radiográficas o de una resonancia magnética, lo más probable es que el doctor solicite algunas precauciones.

La primera suele ser la suspensión de la actividad física intensa. Esto tiene la finalidad de evitar golpes o movimientos bruscos que puedan agravar el cuadro.

“Según el momento en el que se manifieste y la respuesta de cada organismo, es una enfermedad que puede o no dejar secuelas”.

Seguidamente, lo que se buscará será calmar el dolor. Esto se puede lograr a través de medicamentos analgésicos y antinflamatorios.

En aquellos casos en los que el dolor sea tan intenso que se produzca una contracción muscular en la zona de los músculos aductores, se tomarán otras medidas.

En ocasiones se llega hasta el ingreso hospitalario, para colocar un sistema de tracción que mantenga las piernas separadas y para aplicar relajantes musculares. Esto puede complementarse con trabajos fisioterapéuticos.

Se requiere tratamiento fisioterapéutico para curar el síndrome de Perthes.

 ¿Es necesario una intervención quirúrgica?

En algunos casos se procede a operar al paciente. Esto dependerá de dos factores:

  • La zona de la cadera afectada.
  • La capacidad regenerativa de la persona.

Si la enfermedad afecta al tercio lateral de la cabeza femoral, los médicos pueden realizar una operación para reparar las deficiencias mecánicas y permitir una mejor recuperación.

El motivo de ello es que esta parte de la cadera es la que soporta gran parte del peso corporal. Si se deforma, las consecuencias pueden ser importantes.

Pese a las incomodidades que genera, el síndrome de Perthes es una enfermedad que tiene cura. Por lo tanto, es primordial centrarse en el tratamiento correspondientes para que la movilidad del niño no quede en riesgo a futuro.

La recomendación más oportuna es consultar al médico ante la aparición de cualquier síntoma poco común en el andar del pequeño.

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