Hip dysplasia - a developmental disorder of bone and joint foundations, ligaments and muscles of the hip devices, developing as a result of action unfavorable factors in the embryonic and postnatal periods of life, leading to a deterioration in the quality of life and disability in further.
GENERAL
These modern statistics show that hip dysplasia is the most common disorders of the musculoskeletal system. In different countries, the incidence may range from 0.7 to 20 per thousand live births. This is due to racial and ethnic characteristics, environmental conditions in the region and traditions of care for the child.
Specialists noticed that children dysplasia is more common in girls. For example, one violation of cartilage, bone and muscle tissue in boys falls to 4-5 female newborns with this pathology.
Q65 code assigned in the International Classification of Diseases, Tenth Revision of hip dysplasia.
CAUSES
The causes of the disease are numerous and not completely understood. It is believed that children hip dysplasia can develop under the influence of damaging factors of different nature.
Damaging factors:
- Violation myometrial structure due to benign neoplastic processes in the muscular layer.
- Reducing the volume of amniotic fluid Srokowo below normal.
- Toxic effects, including ongoing medication, alcohol, drugs.
- Various viral diseases occurring during pregnancy.
- Excess ionizing radiation.
- Pathology of the endocrine system of the future mother.
- Severe morning sickness in pregnant women.
In addition to damaging factors, which directly act on the tab and the development of the connective tissue of the child, there are states, which significantly increase the risk of developing chondropathy.
Risk factors for dysplasia:
- Breech - the location of the child, in which he predlezhit to small maternal pelvis buttocks, increases the chance of developing hip joint dysplasia in approximately ten times.
- Gender being female.
- Genetic predisposition. It is proved that the parents with a similar pathology risk of having a child with immature connective tissue is ten times higher than in healthy controls.
When dysplasia in children undergoing changes in all components of the hip joint:
- glenoid cavity in the pelvic region of irregular shape and has a smaller depth;
- femoral head sizes do not match the child's age, the ossification process is delayed;
- joint ligaments are stretched excessively;
- muscle fibers atrophied.
The above changes may have varying degrees of severity, which is taken into account in clinical pathology classification.
CLASSIFICATION
Hip dysplasia is divided into two main characteristics:
- at the time of occurrence;
- on clinical and radiological picture.
By the time of occurrence of dysplasia is:
- congenital, in which changes in the connective tissue and the clinical picture is observed immediately after birth;
- acquired - the first signs of dysplasia and the child begins to grow after the first year of life.
According to the clinical and radiological picture release:
- Predvyvih: the ratio of the femoral head - the surface of the acetabulum remains virtually unchanged. Diagnosed stretched ligaments and muscle fibers.
- Subluxation characterized by flattening of the articular surface of the acetabulum and the femoral head offset within the junction borders.
- Dislocation - most unfavorable shape of pathologies accompanied by profound changes in the cartilage, bone and muscle tissue. The femoral head is leaving the boundaries of the glenoid cavity, develops muscle dysfunction of the lower extremity with the further formation of abnormal bending of the spine in the lumbar spine.
SYMPTOMS
Neonatologists or orthopedic use special tests aimed at detecting connective tissue defect. Complaints from the parents of the child may be missing, however, they sometimes notice:
- a shortening one limb over another;
- a click on dilution and mixing the legs of the child;
- asymmetrical skin folds under the buttocks.
The general condition of the child is not suffering.
While ignoring hip dysplasia progression occurs changes connective joint components. When a child begins to walk, the orthopedic problem manifests itself more clearly.
Signs of hip dysplasia in infants:
- late start walking;
- instability and limping while walking;
- pain in the hip joint on the affected side;
- occurrence of unpleasant sensations in the back because of the development of excessive lumbar lordosis.
DIAGNOSTICS
Diagnosis of hip dysplasia begins immediately after birth by conducting special tests.
Orthopedic tests:
- Symptom slippage manifests snaps, which occurs when the reduction and dislocation of the femoral head. To do this, the doctor makes a careful reduction of child abduction and legs. Clicking shows hip instability. At a time of increased muscle tone (ranging from 7-10 days of life) symptom disappears.
- Symptom limited abduction of the lower limbs - chondropathy when you can not take the baby legs to the horizontal plane. Sign is valid in the first days of life, to increase the tone of the muscle fibers. When unilateral pathological process (dysplasia of the right or left hip) appears the difference in lead leg.
- Symptom asymmetric skinfold - on the affected side, a decrease or increase of the depth of the folds. Normally, in the supine position there are three major folds (groin, adductor and patellar), which are identical in their characteristics at both extremities.
- Symptom limb shortening - in newborns determine the level of location of the knee. On the side of the affected joint is less than healthy.
For early diagnosis of pathological processes use continuous dispensary observation. If you suspect that hip dysplasia is carried ultrasound.
Ultrasound hip
The technique has the following advantages:
- not bear radial load, so it can be reused;
- to evaluate the state of the connective junction structures;
- It assists in the dynamic control of the state;
- It can be used in functional and stress testing.
To evaluate the results of ultrasound examination using the classification of the Count, according to which the patients are divided into four types, where the latter corresponds to the dislocation.
X-ray study of dysplasia
In some cases, performing classic study - X-rays, however, the technique has limitations:
- radiation exposure;
- it is not possible to assess the condition of the connective tissue;
- the need for additional manipulations for visualization of cartilage, ligaments.
To interpret the results of X-ray used Reinberg scheme whereby the position estimate of the femoral head relative to the edge of the acetabulum.
TREATMENT
In the treatment of hip dysplasia using two directions:
- Conservative - with milder forms of pathology;
- operative - with subluxation or dislocation of the joint.
Conservative treatment:
- wide swaddling;
- the use of special orthopedic appliances;
- massage;
- physiotherapy.
Surgery:
- shape correction or the femoral head articular surface with pelvic side;
- Open reduction of dislocation;
- Replacement of the affected joint with artificial.
COMPLICATIONS
The most severe complications:
- gait disturbance;
- rachiocampsis;
- the disposition of the internal organs.
PREVENTION
To prevent the development of disease of the hip joints adhere to the following guidelines:
- plan the pregnancy and the time to give up bad habits;
- during pregnancy is necessary to eat rationally and lead an active life;
- minimize reception of medicines;
- to control the tone of smooth muscles of the uterus;
- undergo regular ultrasound examination in order to identify and further correction breech;
- timely treat somatic pathology.
FORECAST FOR RECOVERY
Accumulating evidence suggests that hip dysplasia in children - is a disease whose prognosis depends entirely on the detection time. With timely diagnosis and adequate therapy is possible the full restoration of damaged structures.
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