DOENÇA DE LEGG-CALVÉ-PERTHES: FATORES DEMOGRÁFICOS, DIAGNÓSTICO PRECOCE, ABORDAGENS TERAPÊUTICAS E IMPACTO DA REABILITAÇÃO

• DOI: https://doi.org/10.22533/at.ed.767142518036

• Palavras-chave: "Legg-Calvé-Perthes Disease", "Early Diagnosis", "Hip Osteonecrosis", "Treatment Strategies" e "Rehabilitation".

• Keywords: "Legg-Calvé-Perthes Disease", "Early Diagnosis", "Hip Osteonecrosis", "Treatment Strategies" e "Rehabilitation".

• Abstract: Legg-Calvé-Perthes Disease (LCPD) is a rare pediatric condition with an incidence ranging from 0.2 to 19.1 per 100,000 children under 15 years of age. The peak incidence occurs around the age of 5, particularly among Caucasian children. The disease predominantly affects boys, with a male-to-female ratio of 5:1. Although most cases are unilateral, approximately 10-15% are bilateral. The occurrence of LCPD exhibits significant geographic and racial variation, being less common in Asian and Black children compared to Caucasians. Additionally, incidence is influenced by latitude, being higher in Northern Europe and lower in equatorial regions. In some countries, such as the United Kingdom, regional disparities in disease prevalence have been observed. Environmental and socioeconomic factors also play a crucial role in the development of LCPD. The disease is more common in children from lower socioeconomic backgrounds, indicating a strong environmental influence. Exposure to tobacco smoke, both prenatal and postnatal, has been linked to an increased risk of developing LCPD. Maternal smoking during pregnancy, in particular, has a detrimental effect on coagulation and fibrinolysis systems, contributing to disease development. Furthermore, children living in households with smokers show a higher prevalence of LCPD. The disease is also associated with growth factors and birth weight, especially in children born weighing less than 1,500 grams. A notable feature of LCPD is altered growth, particularly in distal regions such as the hands and feet, while cranial growth remains unaffected. Coagulopathies, including mutations in the factor V Leiden gene, have been linked to LCPD, leading to hypercoagulability. However, the relationship between LCPD and other coagulation disorders remains controversial. Malformations such as genitourinary anomalies and occult spina bifida are also commonly observed in children with LCPD. Psychological and behavioral disorders are frequently associated with LCPD. Children with the disease tend to exhibit hyperactivity and attention deficits, with some studies suggesting a higher risk of attention-deficit/hyperactivity disorder (ADHD). These children are often more active and prone to injuries, which may worsen their condition. Adults who had LCPD in childhood are at higher risk of early retirement. The genetic component of LCPD remains a controversial topic, with some studies indicating a familial tendency, particularly in cases with a positive family history. Genetic mutations, such as those in the COL2A1 gene, have been identified in specific family studies, although further research is needed to confirm these findings. Additionally, trauma plays a significant role in the disease’s etiology, with recurrent trauma contributing to vascular disruption, making it a relevant factor in LCPD development.