Dysplasia of the hip jointnewborn (baby)

Обновление: Декабрь 2018 Onрушение развития и формирования
hip joints – the main type of congenital abnormalities
musculoskeletal system in children under 1 year.

Dysplasia of the hip joint новорожденных встречается с
частотой 25 случаев на 1000. В регионах,  имеющих
negative environmental conditions, incidence rate
increases several times.

What is dysplasia?

DTS – a disease characterized by underdevelopment in the process
embryogenesis of all elements involved in joint formation:

  • ligaments;
  • cartilage;
  • bone surfaces;
  • muscles;
  • neural structures.

In the medical literature can be found synonym – congenital
hip dislocation. There are three severity of the disease:

  • 1 degree (predislocation) – underdevelopment is observed
    bone and cartilage elements; muscular-ligamentous apparatus is not changed.
    The deviation of the femoral head is absent.
  • Grade 2 (subluxation) – against the background of characteristic manifestations
    pre-dislocation observed displacement (dislocation) of the femoral head
    bones up and out.
  • Grade 3 (dislocation) – severe, femoral head not
    in contact with the acetabulum, the contact of the articular surfaces
    missing.

On рисунке отражены типы ДТС.

Дисплазия тазобедренных суставов у новорожденных

A – hip joint of a newborn is normal, B – dysplasia 1
degree, C – dysplasia 2 degrees, D – dysplasia 3 degrees.

Historical background – Hippocrates described the first symptoms
diseases in newborns. He applied heavy traction
in loads. Only at the beginning of the twentieth century do serious works appear
dedicated to the timely diagnosis and treatment of pathology
hip joint. The term “dysplasia” was first introduced 
Hilgenreiner in 1925.

Withчины формирования ДТС у новорожденных

There are several theories that explain why
congenital dysplasia of the hip joints.

  • Onследственная теория ─ возникновение заболевания связано с
    genetic predisposition.
  • Hormonal theory – the basis of the development of dysplasia is high
    progesterone levels at the end of pregnancy; the result is
    снижение тонуса мышечно-связочного аппарата,  что является
    cause instability in the vehicle.
  • Exogenous theory – exposure to toxic substances, including
    among certain groups of drugs, violates
    bone development processes and leads to pathology
    musculoskeletal system.
  • Multifactorial theory – hip dysplasia in
    infants arises from the combined effects of these
    above factors.

To conditions conducive to the development of congenital hip dislocation,
relate:

  • gluteal presentation of the fetus;
  • lack of vitamins and microelements (calcium, phosphorus, iodine,
    iron, vitamin E);
  • underdevelopment of the acetabulum;
  • restriction of fetal mobility in the uterus.

Established directly proportional dependence increased
incidence of DTS from the characteristics of swaddling a child. In many
Africa and Asia, the incidence is lower because of newborns
do not swaddle, prefer to wear on your back, thereby ensuring
freedom of movement of the child. In this regard, in the early 70s
last century the Japanese in accordance with the national program
abandoned the ancient tradition: it was forbidden tight and durable
swaddling in hip dysplasia in newborns.
The result made even skeptics be surprised: the number of children with
TC pathology decreased approximately 10 times.

Symptoms of dysplasia

With осмотре ребенка обращают внимание на следующие признаки:

  • the position and size of the lower limbs;
  • the position of the skin folds in the thighs (symmetrical or
    asymmetrical);
  • muscle tone;
  • volume of active and passive movements.

DTS in infants manifests characteristic symptoms.

  • The symptom of slipping (synonym: a symptom of a click). Child
    laid on his back, bending his legs in knee and vehicle at an angle
    90 degrees (exploring thumbs have on the inside
    thighs, the rest of the fingers – on the outer surface). With
    The hip is removed by pushing the big spit into
    the result is a reduction of the femoral head.
    The process is accompanied by a characteristic click.
  • Restriction of hip abduction.  Children’s dysplasia
    hip joint is manifested by the presence of limited lead
    up to 80 degrees or less. The most common symptom
    unilateral lesion.
  • Relative shortening of the limb. Symptom occurs at
    newborns rarely occur with high dislocations.
  • Onружная ротация нижней конечности — признак, характеризующийся
    turn the hips on the side of the lesion outwards. Can occur and
    healthy children.
  • Asymmetric position of the femoral and gluteal folds –
    detected during external examination.

Secondary (auxiliary) signs of DTS at
newborn:

  • atrophy of soft tissues (muscles) on the affected side;
  • pulsation of the femoral artery is reduced by dysplastic
    modified joint.

Asymptomatic cases of congenital dislocation are rare.
thighs

Instrumental diagnostic methods

Many mothers interested in the question: how to determine dysplasia in
newborns with one hundred percent authenticity?  With the aim of
diagnosis clarification is necessary to perform the following diagnostic
manipulations.

X-ray – Before taking the picture you need
comply with the following conditions: symmetrical styling of the newborn,
the minimum time to complete the procedure, the use of protective
gaskets. In the production of radiographs necessarily involved
assistants or parents to help fix the baby in
desired posture. TC dysplasia has characteristic X-ray signs:

  • acetabulum roof skewness;
  • removal of the femoral head from the central axis;
  • mismatch of articular cavity sizes
    heads;
  • the displacement of the thigh outwards from the vertical line.

Артрография позволяет  судить о рентгенонегативных
elements – bundles, capsule. Using this method can be
even the first degree hip dysplasia was established. On
the art program can determine the position of the head and its shape,
fibrosis of the capsule, fusion of the acetabulum. Procedure is performed
under general anesthesia. A thin needle pierce the skin,
subcutaneous fatty tissue, capsule, penetrate into the TC cavity. Enter
contrast iodine-containing substance or inert gas. Then
X-rays are performed.

Arthroscopy – A conductor with a camera is inserted into the joint cavity, on
TV screen displays an image of all the elements – bone
surfaces, ligaments, cartilage.

Ultrasound examination of the vehicle. Benefits – opportunity
repeated use to control treatment, lack
radiation exposure compared with radiography. Method
non-invasive, safe for baby. Via
ultrasound study can identify congenital
hip dislocation in early stages. Ultrasound is performed on the following
indications:

  • the presence of clinical manifestations of DTS;
  • severe pregnancy and childbirth;
  • decreased muscle tone in the lower limbs.

Computed tomography allows to evaluate additional
X-ray indices – the degree of atrophy surrounding the joint
soft tissue. The main disadvantage of the method is a high dose of radiation.
even with a single examination. Magnetic resonance imaging
used to determine the indications for surgical treatment.

Differential diagnostics

There are diseases that can manifest the same
symptoms, like congenital hip dislocation. The doctor needs
make some effort to make the correct diagnosis.
TC dysplasia in newborns should be distinguished from those listed below.
diseases: Дисплазия тазобедренных суставов у детей

  • pathological dislocation of the hip;
  • paralytic dislocation;
  • metaphysial fractures;
  • arthrogryposis;
  • rickets in infants (signs, how to treat);
  • epiphyseal osteodysplasia.

DTS in newborns in numbers

  • In the case of starting treatment at the age of 3 months, the percentage
    cure rate is 97%.
  • The treatment prescribed in the second half gives excellent
    results only in 30% of cases.
  • The detectability of the disease before the age of 6 months is
    only 40%.
  • Treatment started at the age of 3 months lasts 2 months, and
    начатое в возрасте 12 месяцев, —  более 20 лет.

The main types of treatment

There are many scientific papers that contain information
on how to treat TC dysplasia. Most authors are guided
following principles:

  • treatment is indicated when clinical signs are detected
    diseases;
  • treatment is prescribed in the presence of radiological signs
    diseases, even in the absence of clinical;
  • combination of asymmetry of the gluteal folds with a severe course
    pregnancy is an indication for treatment.

Консервативное лечение  включает:

  • широкое пеленание:  проводится на протяжении 1 — 2
    months, while maintaining active movements in the joints that
    contributes to the spontaneous reduction of dislocation, correct
    the formation of the acetabulum;
  • spacers in the TPA provide the possibility of retraction of the legs with their
    flexion, free access to the body. Onиболее часто используемая
    dysplasia splint – Pavlik’s stirrups;
  • application of functional plaster dressings with distraction
    system;
  • physiotherapeutic techniques reduce activity
    inflammatory process, improve trophic processes in tissues,
    prevent the occurrence of contractures, reduce pain.
    Apply the following types of physiotherapy:

    • electrophoresis for dysplasia allows the administration of medicinal
      drugs in the hip joint;
    • amplipulse therapy;
    • ultrasound;
    • mud therapy;
    • magnetic laser therapy;
    • hyperbaric oxygenation;
    • massage;
    • acupuncture.

Surgical treatment of DTS is indicated in case of failure
conservative techniques. The following types of operations are used:

  • open reduction of congenital hip dislocation;
  • endoscopic treatment of dysplasia.

Memo for parents

  • Children who have completed hip dysplasia treatment
    суставов, нужно  придерживаться определенного режима.
  • It is recommended to continue performing gymnastic
    exercises.
  • Early learning to walk is prohibited.
  • Walkers and other appliances that are not used
    boost walking.
  • Are applied ankle-fastening shoes.

Rehabilitation for dysplasia

Rehabilitation aims to:

  • strengthening the muscles that form the hip joint;
  • activation of reparative (recovery) processes;
  • adaptation of the joint to the changing conditions of the dynamics and
    statics.

For this purpose, physiotherapy exercises are used.
physiotherapy treatment, drugs.

How to prevent the development of dysplasia in the newborn?

For this purpose it is necessary:

  • regularly visit a neurologist and orthopedist;
  • perform an ultrasound examination of the joints;
  • engage in physical therapy;
  • eliminate tight swaddling.

From the piggy bank orthopedic surgeon – a clinical example

Patient Ira K., age – 8 months. Diagnosed:
�”Dysplasia of the right hip joint of the 2nd degree”. Passed
periodically outpatient courses without positive
dynamics that was the basis for hospitalization in
trauma department of children’s city hospital. With
admission to the hospital the doctor revealed:

  • shortening of the left lower limb by 1 cm;
  • limited lead in the joints to 70 degrees;
  • asymmetrical position of the gluteal and femoral folds.

X-ray examination – the absence of femoral heads
bones, hypoplasia (underdevelopment) of the leading elements of the hip
joint right. The following treatment:

  • surgery under general anesthesia – lengthening of the adductor muscles
    hips;
  • adhesive stretching for 3 weeks followed
    closed reposition of the head of the right femur and overlay
    plaster cast;
  • after 3 months, the cast has been removed;
  • carried out the imposition of tires Vilna;
  • metered load on the affected lower limb.

After treatment, the control radiograph was performed: dislocation
head of the right femur set. From 6 months Ira allowed
crawl. The next stage is rehabilitation treatment (with
once every 3 months), which included:

  • gymnastics exercises to develop
    affected joint;
  • physiotherapeutic treatment (amplipulse therapy, electrophoresis,
    massage of the lower extremities, mud therapy);
  • hypebaric oxygenation;
  • B vitamins;
  • diet therapy;
  • cartilage repair preparations
    structures.

At the age of 1 year 1 month the tire Vilensky removed, allowed
dosed static load. On рентгенограмме, выполненной в
this age – the complete absence of signs of DTS on the right. Volume
movements in the affected joint recovered completely. Painful
the child has no syndrome.

Ira recommended: regular visits to the orthopedist (1 time in 3
month), physical therapy, massage of the lower extremities,
dosed physical load.

From the above we can conclude: hip dysplasia
Joint is curable (treatable) disease. Complete
recovery is possible with the timely treatment of 
orthopedist and full implementation of all recommendations.

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