Dysplasia of a hip joint

Description:

Congenital dislocation of a hip (Xing. The dysplasia of a hip joint) is the inborn inferiority of a joint caused by its maldevelopment which can lead (or brought) to an incomplete dislocation or dislocation of a head of a femur — to "congenital dislocation of a hip" (English congenital dislocation of the hip). The modern name of this pathology — a dysplasia of a hip joint  (English developmental dysplasia of the hip).

Symptoms of the Dysplasia of a hip joint:

The research of the child has features depending on age of the child and from extent of disturbance of a functional condition of a hip joint. Inspection of the child is performed in a quiet and peaceful situation, in heat the room, after feeding, in a condition of the maximum relaxation of muscles. It is possible to allocate 4 groups of clinical tests which can indicate a dysplasia of a hip joint at children of the first year of life:

  1. asymmetry of skin folds
  2. shortening of a hip
  3. symptom of sliding of Marx-Marksa-Ortolani
  4. restriction of assignment of a hip

First of all pay attention to symmetry of skin folds of a hip, meaning that at bilateral pathology this sign can be and is not visible. Asymmetry of skin folds is more informative at children is more senior than 2-3-month age. Skin folds at congenital dislocation of a hip are located at the different levels, differ in depth and a form. Have diagnostic value: buttock, subnodal and inguinal folds. On the party of an incomplete dislocation or dislocation they are deeper also than them more. This symptom is observed at a half of sick children and "in itself" has no diagnostic value.

Often observed asymmetry of skin folds on a hip, especially at newborns, has no diagnostic value, it occurs at absolutely healthy babies.

Rentgendiagnostika.
Reliable diagnostic criterion is the phenomenon of shortening of a hip at the expense of the back shift of a head of a femur of rather acetabular hollow. He points to the most severe form of a dysplasia of a hip joint — on congenital dislocation of a hip. The test is considered positive if at the child lying on spin with the legs bent in knee and hip joints, the knee on the sick party is located below.
However, the fact of a positive symptom in itself of Marx-Ortolani at children of the first two weeks of life, does not testify to a disease of a hip joint at all. This symptom can occur also at absolutely healthy newborns. The ratio of sick and healthy newborns at whom the sliding symptom was revealed makes respectively 60 and 40% of cases. 60% of newborns "recover" in the first week of life, and 88% in the first 2 months. The remained 12% actually also make various stages of a true dysplasia of a hip joint. This symptom loses the value of the sick child with age, it comes to light only at 25% of children 2-3 weeks are more senior. Restriction of assignment of a hip on the party of a dysplasia is a characteristic symptom of a dysplasia of hip joints.
The most part of a head of a hip and acetabular hollow at children of early age consists of cartilages which are invisible on a x-ray film therefore they apply various schemes to reading roentgenograms. First of all draw a vertical midline, it passes through the middle of a sacrum. Draw a horizontal line through At-shaped cartilages, through the lower points of an ileal bone (Hilgenreyner's line). Through outwardly upper edge, perpendicular to the horizontal line, draw Perkin's line. Often happens that on the party of defeat it is impossible to define the upper edge of an acetabular hollow. In these cases use Reynberg's method: symmetrically, at the same distance from a midline, draw a vertical line (perpendicular to horizontal). It will also designate verkhnelateralny edge of a hollow, invisible on the roentgenogram. Through edges of an acetabular hollow draw a tangent line before crossing with the horizontal line of Hilgenreyner. The educated corner is called "an atsetabulyarny corner" or a tilt angle of a roof of an acetabular hollow.

To auxiliary lines carry Shenton's line and Kalva. Shenton's line (a locking and femoral arch) is normal "represents mental continuation of cranial edge of a locking opening on a medial regional contour of a neck of a hip" (V. O. Marx, 1978). At pathology (hip shift lateralno and up) this line is broken off.

At a dysplasia of a kernel of ossification appear later, their sizes it is less, they develop more slowly. Normal the kernel of ossification of a head of a femur is located with a bigger part medialny Perkin's lines and Hilgenreyner's lines are lower. At an incomplete dislocation and dislocation it is displaced up and lateralno. Kernels of ossification of a head of a hip appear at girls in 4 monthly, at boys at the 6th monthly age.

Reasons of the Dysplasia of a hip joint:

There is a development dysplasia (about disturbance of development of all structures of a joint in process pre-and post-natal ontogenesis).

Treatment of the Dysplasia of a hip joint:

The basic principles of treatment are: the early beginning, use of orthopedic means for long deduction of legs in the provision of assignment and bending, the active movements in a hip joint within legal range.

"For treatment of a dysplasia of a hip joint without shift and with the shift of a head of a hip different types of pillows, panties, stirrups, tires, devices and other devices are offered. All of them are expected holding in the provision of cultivation of a leg of the child and to provide them function. Radiological confirmation of the diagnosis because anyway it is necessary to apply the same treatment-and-prophylactic measures — cultivation of legs by means of soft laying (broad swaddling, Freyk's pillow, etc.), gymnastics using otvodyashche-roundabouts in a joint, massage of gluteuses is not required from children of the first 2 — 3 months at suspicion of a dysplasia of a hip joint or existence of clinical symptoms of dislocation. With a dysplasia in the way of cultivation of legs diapers, Becker's "panties", Freyk's pillows, Pavlik's stirrups, elastic tires are suitable for treatment of children. At this age use of rigid designs, that is the tires obstructing the traffic of extremities made by the baby is absolutely inadmissible"

Most often apply to treatment of congenital dislocation of a hip: Pavlik's stirrups, Freyk's pillow, Vilensky's tire, Volkov's tire. In hard cases single-step reposition of dislocation and a koksitny bandage is applied. At inefficiency of conservative treatment apply different types of corrective operations. One of methods of treatment of easy displaziya and prevention is broad swaddling.

In 1946 in Prague the Czech orthopedist Arnold Pavlik reported about successful treatment of congenital dislocation of a hip with use new as he called it, "a functional method of treatment". Those years the rigid designs limiting the movements in hip joints were applied to giving of bending and assignment of hips. The serious illness "an aseptic necrosis of a head of a femur" (30% of children which carried out treatment) was a frequent complication of such treatment.

Broad swaddling is applied at children of "risk group", at newborns from BONDS signs of "an unripe joint", and also in those cases, full treatment for any reasons cannot be carried out. It is the main method of prevention of a dysplasia of a hip joint. Technology of swaddling is simple: two diapers lay between legs of the baby, giving the provision of bending and assignment in hip joints, and the third fix legs. Broad swaddling allows to keep the provision of cultivation and bending 60 — 80 °.