Features of hip dysplasia and its treatment
Hip dysplasia - a congenital anatomical defect, which hatch in about 2 children out of every thousand newborns. These children are underdeveloped structure of these joints.
It is important to detect pathology at the earliest stage, because if delayed or ineffective treatment of it can cause early degenerative disc disease, curvature of the spine, displacement of the pelvis, subluxation of the symmetrical, even healthy joint. The most severe complication is the hip with the inevitable early disability.
The structure of the hip joint
This joint firmly connects the pelvis with the lower extremities. It is easy to imagine how it works if you know about the principle of the ball joint, which is widely used in various technical mechanisms. At the top of the thigh is narrowed, forming a neck, and ends in a spherical head. It is part of the same spherical Cup in the pelvis - acetabulum.
"Hinged" connection firmly holds the lower extremity and provides their universal movement in almost any direction. Because the hip joint have a huge load, he fortified the capsule and the external and internal ligaments.
For the formation of its structure the most important prenatal period of fetal development and the first year of a child's life. Even in healthy infants the hip joint is very fragile. It consists mainly of cartilage, which is only subsequently replaced by strong bone tissues.
Acetabulum is not round, but oval. She's also pretty flat, and the head of the femur fits in it only 1/3 (instead 2/3). Ligaments are still very weak. The head holds only the shift of the cartilage plate of the trench. But in the first year of the joint much stronger.
If hip dysplasia structural elements are underdeveloped, deformed and can not provide anatomically correct connection. Most often, the head is not suited to the acetabulum, because they have different shapes and sizes.
In addition, the thigh is often deformed, so his neck is shortened. Deformed and cartilage, weakening of ligaments, stretches the joint capsule, affects the adjacent muscles. So formed congenital dislocation of the hip in children. Only prompt treatment can prevent further complications.
Classification and prevalence of the disease
Its types are classified according to the degree of underdevelopment of the joints on the basis of such classification:
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- the immaturity of the joint;
- his previva (dysplasia 1-St degree);
- subluxation (degree 2);
- congenital dislocation (3rd degree).
The immaturity of the joint is typical for premature babies. It's not a pathology, but not the norm. The clinical picture of the dysplasia is not, however, with the help of ultrasound detected abnormalities mild. Often the edge of the acetabulum bevelled and flattened.
If there is a pathology, but the hip is not displaced, diagnosed redviva joint. Such deviation is often observed on the opposite joint is not only neonates but also adolescents, adults with a unilateral dislocation of the hip.
If there is underdevelopment and the acetabulum, and hips in which the head is displaced and located in the cavity only partially, then it is subluxation of the joint.
Congenital dislocation of the hip joint - a condition in which the femoral head is located outside the basin.
Girls exposed to these pathologies is about 6 times more than boys. More pronounced dysplasia of the left hip, as he is usually pressed against the wall of the uterus. Rarely suffer right or both joints. For the disease characterized by seasonality: in winter and early spring, when vitamin deficiency is most pronounced, the problem of children born more.
For a long time, this anomaly was considered a "disease of white people". However, studies have shown that hip dysplasia does not depend on race. In another case. Many European peoples living in the areas with cool and cold climates, for centuries was made tight to swaddle babies. However, a rigid fixation of the body of the child adversely affects development of the hip joints.
In hot countries, mothers usually carry the babies legs which extended "like a frog". Therefore, in these countries, the dysplasia - a very rare phenomenon. After fixing the baby's body in this position contributes to the spontaneous reduction of the joint and accelerates the treatment of the disease.
The causes of the disease
There are several main reasons that have a scientific justification. One of them is that the dysplasia in 12% of cases - a consequence of the pathology in embryonic tissue formation, from which it then develops. Moreover to treat this pathology particularly difficult.
In 25-30% of cases affected by a genetic predisposition to this disease. Mutatedthe gene is passed from mother. Approximately with the same frequency is diagnosed with hip dysplasia with simultaneous underdevelopment of the spine and spinal cord. This pathology is often combined with a clubfoot, Krivoshey and other defects.
Widespread hormonal version of the causes of the disease. At the end of the pregnancy the female organism strenuously produces the hormone progesterone, which relaxes ligaments. Such anomalies are observed in 30-40% of cases, and very easily corrected. In the first months of life of infants, when their body no longer supplied progesterone, the joint often spontaneously stabiliziruemost.
In addition, there are several risk factors. It is primarily the risk that the mobility of the fetus can be constrained. Such adverse conditions often arise when the increased tone of the uterus, especially in nulliparous women, water scarcity, breech of the fetus or if the fetus is large.
Another risk factor is female gender of the child (due to hypersecretion of progesterone in the latter stage of pregnancy). Considerable harm to the developing fetus causes a vitamin deficiency, especially deficiency of phosphorus, calcium, iodine, iron, vitamins E and group B.
Symptoms and diagnosis of the disease
Pediatric orthopedists are guided by classical signs by which it is easy enough to define hip dysplasia in infants. Here they are:
- asymmetry of skin folds;
- effect click;
- limitation of adduction of the femur;
- different length of lower extremities;
- external rotation of the femur.
Skin folds on the legs of the child should be generally symmetrical. In dislocation they are formed is higher than in the healthy joint, and there may be more than three. Gluteal fold by anomalous joint is also higher.
The effect of a click (or a symptom of slipping) more reliable. Only they can be guided in relation to the newborn for about a week - then it usually disappears. The baby's legs, lying on back, bend at the knee and hip joints to form angles of 90 degrees.
With a slow breeding legs and pressed it on the spit, you hear a slight click. This means that the femoral head was included in acetabulum. And when the legs drive, the head comes out of it and again hear the same clicking.
The symptom is limitation of hip abduction is also relevant only in the first 6-7 days of life the newborn. Then he disappears, but after 3 months it appears again and even intensified. Legs healthy childbent at the knee and hip joints, easily apart almost to 90 degrees. If the amplitude of hip abduction is less a sign of dysplasia moderate or severe degree.
About the presence of serious pathology can be judged by the fact that one leg of the baby a little shorter than the other. In this case, his knees are at different heights. In newborns this symptom is observed when severe dislocation, when the femoral head is displaced upwards.
External rotation of the hip indicates the presence of subluxation. When you turn straighten the foot out, the amplitude of rotation determined by the movement of the patella. But this symptom is and some healthy children.
If there are signs of pathology in newborns and babies up to 6 months is prescribed ultrasound and special tables to calculate the degree of impairment. X-ray diagnostics more informative for examination of children older than 6-7 months.
The treatment of the disease
Treatment of hip dysplasia is based on such main principles:
- as early as possible in its beginning;
- giving the joint designated position;
- the active movements of the child;
- the purpose of massage, medical gymnastics, physiotherapy.
When the designated position of the legs of the baby is samoupravlenie dislocation, and centering of the femoral head. For this purpose, use a wide swaddling, pillow frejka, stirrups Pavlik, struts (tires). The child must be sufficient freedom of movement that contributes to its cure.
Treatment is as follows:
- wide swaddling with the first days of life up to 3 months.
- then the frejka pillow or Pavlik's stirrups up to 6 months.
Subsequently, to remove the residual pathology, designate the outlet of the tire. This treatment for a long time, it must hold under periodic ultrasonic or fluoroscopic guidance.
From the first days of therapy connect massage, exercise physical therapy. They strengthen the muscles and ligaments of the diseased joint, it improves blood circulation, beneficial effect on the overall psychophysical development of the child. In the complex treatment includes physiotherapy: mud baths, paraffin baths, underwater massage etc.
Without surgery can not do, if it is clear that conservative treatment will be ineffective. Surgery is inevitable in the following cases:
- when there are gross anatomical defects in the joint and requires plastics;
- when congenital hip dislocation reduce athey cannot, for example, due to contracture of the muscles or due to the fact that the entrance to the acetabulum covered with fabrics etc.
Prevention of the disease
Pregnancy without pathologies - the best prevention of diseases of the hip joint.
The most severe anomalies arise from disorders in the period of early fetal development. They are the hardest to heal. Unbalanced nutrition of the mother, toxemia, increased tone of the uterus, concomitant diseases can indirectly influence the development of dysplastic processes.
It is crucial to identify the disease. The first inspection of the joints of the newborn should be in the hospital. When visiting the pediatrician at home you need to check them again.
Mothers should be informed about possible negative consequences of tight swaddling of the child. It is recommended to put on baby Onesie and cover it with a diaper. Then the freedom of movement he will not be limited, and it is necessary for the final development of the joint.
Residual effects of hip dysplasia in adults can manifest much later and be complicated by dysplastic coxarthrosis. The trigger of its development are: severe pregnancy, hormonal imbalance, a sharp replacement active lifestyle passive.
In the prevention of hip dysplasia such people, increased physical load on the joint, playing athletic sports. But very favorable: swimming, skiing, regular Hiking.