Dysplasia of hip joints in children: photo, treatment, consequences of DTS
What is it - congenital malformations caused by pathologies of the musculoskeletal system, which is the elements of the hip joint, in medicine is called - hip dysplasia( DTS).
To the devil, in one way or another, all of its elements can be exposed:
The role of the hip joints is very great, they experience basic loads when a person walks, runs or just sits. Perform a huge number of different movements.
The joint is a globular head located in a deep crescent-shaped acetabulum. The neck is connected with the other parts. Normal, complex operation of the hip joint is ensured by the configuration and proper internal structure of all its components.
Any disturbances in the development of at least one of the component parts of the pronounced:
Three main types characterize the pathology of DTS.
1) To acetabular dysplasia is a disorder in the structure and pathology in the very acetabulum, mainly pathology in the limbus cartilage, along the edges of the cavity. Under the influence of the pressure of the head, it is deformed, forced outward or wrapped inside the joint. What helps to stretch the capsule, the development of ossification of the articular cartilage and increase the displacement of the femoral head.
2) Mayer's dysplasia or epiphyseal is characterized by a pointlike ossification of the cartilaginous tissues that causes stiff joint stiffness, pain and deformity of the legs. The defeat of the proximal femur, expressed by pathological changes in the position of the femoral neck of two types - dysplasia due to an increase in the angle of incidence, or dysplasia with a decrease in the diaphysial angle.
3) Rotational dysplasia is characterized by delayed articular development and pathologies, expressed by pronounced disturbances in the relative position of bones relative to the horizontal plane. In itself, such a situation is not considered dysplasia, most likely, it is a borderline condition.
The degree of development of the disease depends on the severity of the pathological process.
The causes that result in articular pathologies in the hip joints are due to several theories:
1) Theories of heredity - presupposing inheritance at the gene level;
2) Hormonal - increasing the level of progesterone at the last stages of pregnancy leads to functional and structural changes in the muscular-ligament structures of the fetus, expressed by the instability in the development of the hip apparatus.
3) According to the multi-factor theory, several factors influence the development of the TPA:
Taking this as a basis, the Japanese broke their centuries-old foundations( dense swaddling under the TTP).The results were struck even by the most incredulous scientists - the growth of the disease was reduced by almost ten times against the usual.
A major role in identifying early symptoms of hip dysplasia belongs to parents if they pay due attention to the characteristic signs of dysplasia in children that are expressed:
The diagnosis of hip dysplasia is determined during examination by an orthopedic surgeon at a profile examination, often at the age of up to six months. The diagnosis is based on a physical examination of the baby, certain tests and concomitant symptoms are used.
In confirmation in polyclinic conditions, ultrasound is used, rarely roentgenography.
In pediatric orthopedics, there are many methods of treating hip dysplasia in a child.
Each doctor selects a treatment program individually for his small patient, based on the severity of the disease. These are methods, from elementary broad swaddling to gypsum baby.
And so. In order for some methods of treating dysplasia.
Additional methods of treating dysplasia, they can also be the main ones, when it comes to the immaturity of the joint elements, or about the prevention of DTS in children with a predisposition:
threaten Children with dysplasia are not threatened with a recumbent lifestyle, but they begin to walk much later than their peers. Their gait is characterized by instability, lameness. Children fall like ducks and clumsy.
The formation of new outlines of joints and cavities begins, the formation of a false joint, which can not be full, since it can not perform the function of support and full retraction of the leg. Develops - neoarthrosis
The most serious complication is the formation of dysplastic coxarthrosis, in which the operation to replace the joint is inevitable. If treatment of early dysplasia takes up to a maximum of up to six months, treatment after twelve years can last for twenty years.
To the devil, in one way or another, all of its elements can be exposed:
- acetabulum;
- the head of the thigh and capsule;
- underdevelopment of surrounding muscles and ligaments.
Brief description of
The role of the hip joints is very great, they experience basic loads when a person walks, runs or just sits. Perform a huge number of different movements.
The joint is a globular head located in a deep crescent-shaped acetabulum. The neck is connected with the other parts. Normal, complex operation of the hip joint is ensured by the configuration and proper internal structure of all its components.
Any disturbances in the development of at least one of the component parts of the pronounced:
- pathology and changes in the outline of the femoral head, mismatch of its dimensions with the size of the cavity;
- by stretching the joint capsule;
- is not the normative depth and structure of the hollow itself, its acquisition of an ellipsoidal, flat form, a thickening of the bottom or sloping "roof";
- pathology of the cartilaginous margin - limbus;
- by shortening the neck of the femur with a change in its antiversion and diaphyseal angle;
- ossification of articular cartilage elements;
- pathologies of the ligamentous apparatus of the head, manifested hypertrophy or aplasia
Classification of DTS
Three main types characterize the pathology of DTS.
1) To acetabular dysplasia is a disorder in the structure and pathology in the very acetabulum, mainly pathology in the limbus cartilage, along the edges of the cavity. Under the influence of the pressure of the head, it is deformed, forced outward or wrapped inside the joint. What helps to stretch the capsule, the development of ossification of the articular cartilage and increase the displacement of the femoral head.
2) Mayer's dysplasia or epiphyseal is characterized by a pointlike ossification of the cartilaginous tissues that causes stiff joint stiffness, pain and deformity of the legs. The defeat of the proximal femur, expressed by pathological changes in the position of the femoral neck of two types - dysplasia due to an increase in the angle of incidence, or dysplasia with a decrease in the diaphysial angle.
3) Rotational dysplasia is characterized by delayed articular development and pathologies, expressed by pronounced disturbances in the relative position of bones relative to the horizontal plane. In itself, such a situation is not considered dysplasia, most likely, it is a borderline condition.
The degree of development of the disease depends on the severity of the pathological process.
- 1st, mild degree of DTS is called pre-forcing - it is characterized by small deviations caused by oblique acetabular angles of the roof of the acetabulum. The position of the femoral head located in the joint cavity is slightly shifted.
- 2nd degree - subluxation - in the joint cavity is only part of the head of the femoral joint. In relation to the cavity, it moves outward and upward.
- 3rd - degree - dislocation, characterized by a complete exit of the head from the depression direction up.
Causes of hip dysplasia
The causes that result in articular pathologies in the hip joints are due to several theories:
1) Theories of heredity - presupposing inheritance at the gene level;
2) Hormonal - increasing the level of progesterone at the last stages of pregnancy leads to functional and structural changes in the muscular-ligament structures of the fetus, expressed by the instability in the development of the hip apparatus.
3) According to the multi-factor theory, several factors influence the development of the TPA:
- gluteal fetal position;
- deficiency of vitamin and microelements;
- limited movement of the baby in the womb of the womb - usually, the mobility of the left leg of the baby is limited by pressing it against the wall of the uterus, so the left hip joint is more likely to dysplasia.
Taking this as a basis, the Japanese broke their centuries-old foundations( dense swaddling under the TTP).The results were struck even by the most incredulous scientists - the growth of the disease was reduced by almost ten times against the usual.
Symptoms of hip dysplasia in children
A major role in identifying early symptoms of hip dysplasia belongs to parents if they pay due attention to the characteristic signs of dysplasia in children that are expressed:
- 1) Asymmetric position of wrinkles on the hips. There should be three in front and behind. When viewed, the legs should be unbent with the feet brought to each other. In pathology, on the affected side additional, deeper creases are added, both in the front and the gluteal side.
- 2) The restriction of leg recession is characteristic for the second and third degree of dysplasia. In the normal state of the baby's legs, in the bent state, it is possible to dilute completely to ninety degrees, with dysplasia not more than sixty.
- 3) The definition of Marx Ortolani is a symptom of a head slip with a characteristic click when breeding and bringing the legs.
- 4) Shortening of the affected leg. You can determine by comparing the height of the knee joints.
- softening of the bones of the skull;
- of the elongated shape of the foot or club foot;
- neck curvature;
- oppression of unconditioned reflexes( sucking and search)
Diagnosis of hip dysplasia
The diagnosis of hip dysplasia is determined during examination by an orthopedic surgeon at a profile examination, often at the age of up to six months. The diagnosis is based on a physical examination of the baby, certain tests and concomitant symptoms are used.
In confirmation in polyclinic conditions, ultrasound is used, rarely roentgenography.
- 1) SPL has the advantage among many other methods of research, since it is used from birth. It is the safest method( not invasive), available, and multiple use is allowed.
- 2) X-ray method is not inferior in reliability, but has a number of features. First, children under one year of age are not recommended to have irradiation( unless the diagnosis of an ultrasound is in doubt or is not possible).Secondly, it is necessary to lay the child under the device with observance of symmetry, which in children is difficult.
- 3) Computer or magnetic resonance imaging is used when there is a question about surgical treatment. Gives a more complete, structured picture.
- 4) Arthrography and arthroscopy are used to complete the complete picture when diagnosing when conditions are triggered. The methods are invasive, performed under anesthesia, and are not widely used.
What to do with dysplasia of the hip joints in children: Dr. Komarovsky.
Treatment of hip dysplasia in newborns
In pediatric orthopedics, there are many methods of treating hip dysplasia in a child.
Each doctor selects a treatment program individually for his small patient, based on the severity of the disease. These are methods, from elementary broad swaddling to gypsum baby.
And so. In order for some methods of treating dysplasia.
- 1) Wide swaddling is the most affordable way, even a young mother can perform, use in uncomplicated forms.
- 2) Becker's pants are the same as the wide swaddling, but are more convenient to use.
- 3) The tire or the pillow of the Freik is functional as well as panties, but it has stiffeners.
- 4) Pavlik's stirrups - came to us from the last century, but still in demand.
- 5) Splinting - use the Vilensk or Volkov bus( refer to the elastic type of splinting), also the grooming bus for walking, and gypsum splinting.
- 6) Surgical treatment - this method is used in severe forms, frequent relapses, in children older than one year of age.
Additional methods of treating dysplasia, they can also be the main ones, when it comes to the immaturity of the joint elements, or about the prevention of DTS in children with a predisposition:
- general massage with an emphasis on TBS;
- newborns gymnastics;
- physiotherapy( using vitamin, with lidase, with calcium);
- paraffinotherapy, applications on the TBS region;
- dry heat, mud treatment.
Than the consequences of dysplasia
threaten Children with dysplasia are not threatened with a recumbent lifestyle, but they begin to walk much later than their peers. Their gait is characterized by instability, lameness. Children fall like ducks and clumsy.
If you do not start early treatment of hip dysplasia, it threatens the development of spine pathologies in the form of lordosis, kyphosis or osteochondrosis. With age, non-eliminated hip arthritic pathologies lead to inability to withstand prolonged loads.
The formation of new outlines of joints and cavities begins, the formation of a false joint, which can not be full, since it can not perform the function of support and full retraction of the leg. Develops - neoarthrosis
The most serious complication is the formation of dysplastic coxarthrosis, in which the operation to replace the joint is inevitable. If treatment of early dysplasia takes up to a maximum of up to six months, treatment after twelve years can last for twenty years.