is a pathology in which the development of the muscular and ligamentous component of the joint, its bone-cartilaginous structure, is disturbed.
This problem occurs in children quite often (approximately 0.6%). The peculiarity of this disease is that if there is no appropriate treatment, in most cases the child in the future can become an invalid. In newborns, dysplasia of the hip joint is most often found.
There are the following reasons for the development of dysplasia:
- Heredity - the presence of dysplastic diseases in the mother or other close relatives.
- An inadequate diet of a woman during pregnancy. The formation of the osteochondral cartilage occurs throughout the entire pregnancy. If the fetal organism does not receive sufficient nutrients from the mother in sufficient quantity, the growth of his musculoskeletal system is impaired.
- Pathological course of pregnancy (toxicosis, improper placement of the fetus in the uterine cavity, low water, etc.). As a result, the formation of articular surfaces is disrupted and the development of the cartilaginous basis of the joint is underdeveloped.
- Having a mother's bad habits (drinking alcohol, smoking) can lead to the fact that the growth of bones is broken, and the wrong zones of ossification form.
- The process of joint formation, in particular of its bone-cartilaginous structures, as a result of the transferred viral diseases during pregnancy is disrupted.
The components of the hip joint are:
- The acetabulum is a structural formation of the iliac bone, round in shape, and it is lined with cartilaginous tissue. This is the joint bed.
- In the cavity of the acetabulum is located the head of the femur, the shape of which is the same as the shape of the bed.
- A capsule is formed around the joint with the help of ligaments, which keeps the head of the femur in the acetabulum.
- Helps to keep in the correct position the head of the femur and promotes active movements in the joint of the muscular apparatus.
In the event that any structures that enter the hip joint are underdeveloped, the head of the femur is displaced relative to the acetabulum, then subluxation develops and the child can show signs of dysplasia. The extreme degree of dysplasia is a dislocation of the hip, in which the femoral head leaves the acetabulum.
The development of dysplastic changes is possible both in one and in both joints. The disease is most often in girls.
Symptoms of hip dysplasia
It is best to identify the main manifestations of dysplasia in children under the age of seven days. It is during this period that muscle tone is lowered, which makes it possible to conduct a survey without hindrance. With age, muscle tone rises and this makes it difficult to diagnose this pathology. In an older child, it is possible to assume the presence of dysplasia on the basis of specific signs.
Dysplasia проявляется тем, что разведение ног в тазобедренном суставе ограничено. Чтобы выявить этот симптом, необходимо согнутые в коленных суставах ножки развести в горизонтальной плоскости. При этом ребенок должен лежать на спине. При таком обследовании можно обнаружить подвывих сустава, а проявляется это разным разведением ножек. Когда у малыша мышечный тонус повышен, не всегда можно достичь результата. О дисплазии тазобедренного сустава может также свидетельствовать асимметричное расположение кожных складок, которые определяют на задней и передней поверхностях бедра. В положении малыша на спине не паредней поверхности видно три складки, которые в норме должны зеркально отражать друг друга. В положении на животе видно ягодичные складки, которые тоже обязательно должны быть симметричными друг другу. Но не нужно забывать, что это не является абсолютным показателем, так как иногда незначительная асимметрия складок может быть у здоровых детей.
In addition, when you bend legs bent at the knees in the position of the child on the back in the hip joint, you can hear a click (the so-called "click symptom"). This is due to the alignment of the dislocation.
The "click symptom" is the most informative symptom of dysplasia, as it can be determined regardless of the muscle tone and age of the child. With dysplasia of the hip joint, the limb is shortened on the side of the lesion. This occurs as a result of the displacement of the head of the femur with respect to the acetabulum. Since it is impossible to check the length of the limb in children using a centimeter tape, the study is carried out as follows: in the position of the child on the back and knees bent at the knees (the soles are located on a changing table), evaluate how the knee joint of one limb is located relative to the joint of the other. The knee joint on the side of the lesion is located below.
A clear clinical picture of dysplastic changes in the hip joint in a child is noticeable after it begins to walk. Most often this happens later than in healthy babies (about one and a half years). This is characteristic of the so-called "duck walk", which is often accompanied by pain in the lumbar region. This is due to the fact that the attachment of muscles changes and the lumbar spine is bent. When unilateral position, lameness occurs.
In the event that the child has a dislocation of the hip there for a long time, the shape of the joint capsule changes. At its center, a constriction is formed, giving the form of an hourglass. Because of this, hip dislocation is difficult to correct.
To confirm the presence of a dysplasia of the hip joint in a child is assisted by radiographic examination. Sometimes this method makes it difficult that in small children the bones are represented only by cartilages that are not clearly visible on the radiograph. Therefore, radiological research is mainly prescribed to children from six months of age. For visual evaluation of ligaments, cartilage structures and the structure of the capsule of the joint, an X-ray contrast agent (iodamine, veropain) is sometimes injected into its cavity, which colors all these structures and makes them well visible in the image.
Children from birth to one year also undergo ultrasound examination of the hip joint. This method is more accurate than X-ray examination.
In newborn children, a wide swaddling is used to treat hip dysplasia. At the same time, a diaper is folded into the perineal region of the child, folded three times and fixed by another diaper. Thanks to this, the legs of the baby remain constantly diluted. With pronounced dysplastic changes, the legs are fixed using a plaster bandage.
A good effect for children under one year is the use of a stripping tire. If the child is diagnosed with a hip dislocation, the legs in the diluted position on the spacer bar should be fixed for a long time.
This helps to return to the acetabular head of the femur and fix it. The tire is removed only when bathing and requires constant wearing. The process takes at least two to three months, and in neglected and severe cases - even 10-12 months. In the presence of dysplastic changes in children older than 2 years, surgical intervention is indicated. A good effect is provided by a constant massage, which stimulates the muscles and helps strengthen the joint bag. It is possible to carry out a massage at home. The child for this is placed on his back, on a flat surface, the legs are gripped in a bent position in the knees and lead to the stomach, and after that they are bred in such a way as to try to touch the knees of the table surface. Then straighten one and the other leg alternately. This exercise is preferably performed before feeding 6-8 times a day, repeating 8-10 times.
Consequences of untreated dysplasia
In time, untreated and untreated dysplastic changes can lead to serious consequences. In case of unilateral dislocation of the femur in children after the year, slight or pronounced limping, skewness of the pelvic bones, soreness of the knee and hip joints, moderately expressed atrophy of the muscles of the limb are possible. A bilateral dislocation of the hip is manifested by a "duck" gait, a hyperlordosis of the spine (lumbar region), severe soreness in the waist and hip joint, as well as a decrease in the volume of movements in it, impairment of pelvic organs and muscle atrophy of the extremities.
As a result of untreated dysplasia of the hip joint, dysplastic coxarthrosis develops. Most often, pathology occurs in 25-55 years as a result of hormonal changes during pregnancy, deterioration of the muscular apparatus of the joint and a decrease in physical activity.
The disease manifests discomfort and pain in the joint region and ends with its complete immobility. In this case, the treatment consists in endoprosthetics (replacement of the joint with an artificial one). Less often, in the place where the femur rest on the pelvic bone, a false joint is formed. This is considered self-healing, but functionally and anatomically the hip is shortened.
At a dysplasia of a hip joint at children the forecast favorable. With timely treatment in 100% of cases, recovery is observed. In the case of late treatment (after two years of age), the prognosis is less favorable, because changes occur both in the hip joint and in the spine. But even in this case, more than half of the patients can fully recover.