Sometimes young parents came to the next checkup, hear from the doctor that their baby hip dysplasia. Many young parents strongly frightened when he heard about a disease like hip dysplasia in children and begin to panic. Of course, dysplasia - it is very unpleasant and serious disease, but its presence is a reason not to panic, and to treat crumbs.
Unfortunately, doctors often do not consider it necessary to give parents more information about this disease. And parents have only the vaguest idea of what they had to face the same. But, as we know, need to know the enemy's face. It is about what is hip dysplasia, what are its consequences and how to treat it, and will be discussed in this article.
Hip dysplasia is usually a consequence of congenital hip dislocation. This type of congenital deformation of the musculoskeletal - musculoskeletal system is one of the most common. The defeat extends to all parts of the hip joint: the capsule, ligaments and muscles, the femoral head and the acetabulum. All these components have a lack of development.
This complication occurs in about 5% of all newborn babies, the unilateral hip dislocation occurs three times more frequently than bilateral. Most susceptible to this complication of the girls - they have congenital dislocation occurs in about 5 times more often than boys.
The causes of dysplasia
Doctors have not yet been agreed, what exactly is the cause of hip dysplasia. However, most doctors involved in the study of this problem, are inclined to believe that the main cause of congenital hip dislocation is precisely the primary defects of the embryo bookmark, and disruption of the normal process of fetal development.
The causes of such violations, very, very much:
- Vitamin deficiency in a pregnant woman.
- Hormonal disorder in the expectant mother.
- Various infectious diseases carried over the woman during pregnancy.
- The use of the woman during pregnancy alcohol, drugs and smoking.
- Hereditary predisposition.
As shown by studies conducted by the All-Russian Institute of Obstetrics and Gynecology, most babies with hip dysplasia are born to women who suffer:
- Early toxicosis first half of pregnancy.
- Late toxicosis second half of pregnancy - gestosis.
- Violations of water-salt metabolism in the mother.
- Violations of water-salt metabolism in the fetus.
- Disorders of the cardio - vascular system.
- Rheumatic heart disease.
In 50% of all cases of children with the birth of hip dysplasia during pregnancy were crumbs in the breech. That is why all the kids who are in the breech position, after giving birth undergo a thorough examination and follow-up, an orthopedic surgeon.
Among the young parents are very very widespread misconception that sometimes congenital hip dislocation result from improper actions of medical staff during childbirth. But in fact it is not - in children born by Caesarean section, hip dysplasia is found no less than children born naturally.
Congenital dislocation of the hip is always a consequence of the foregoing it predvyviha joint. Predvyvih joint accompanied by hypoplasia of the tissues of the acetabulum, which is flattened, and a decrease in the size of the femoral head, bad undergoing a process of ossification. Thus often the femoral head forward rotation of the upper end. This phenomenon is called antetorseya. In addition, the child is usually accompanied by various anomalies of the normal development of the neuromuscular apparatus of the hip joint.
Over time, the clinical picture changes: in the first few months of life baby femoral head is biased outwardly and slightly upward, then the growth process is a significant displacement upward and inward, causing the joint capsule and stretches considerably increased in size.
However, in some cases, mild dysplasia of the hip displacement of the femoral head is quite small. As a rule, it is observed in the subluxation. When the true displacement of dislocations is much more pronounced. Also, when examining a child can see a significant modification of the structure and shape of the acetabulum and the head of the joint and the joint capsule and cartilage, muscles and ligaments.
On closer inspection you can see that not just the acetabulum is flattened and stretched, and its rear upper edge is almost always virtually undeveloped. As a result, for the head of the femur is not blank, necessary for normal functioning. The acetabulum is a gradual thickening of the cartilage bottom development on it too much connective tissue.
If dysplasia in children under one year was not timely diagnosed, and treatment started as crumbs were not, with age the disease is much heavier. The child continued stable formation of dislocation. Signs of dysplasia in children:
- The upper body of the acetabulum often disappear almost completely.
- Depression itself flattens even more and takes the form of a triangle.
- Due to the fact that there is no emphasis bone, femoral neck develops wrong - it is significantly shortened cervix is stupid - shaft angle.
- In addition, femoral neck, again due to lack of abutment rotated forward.
When a child begins to walk, the load on the leg increases significantly. The result is still a number of pathological changes greatly impair the state of the baby:
- Acetabulum continues to flatten considerably, gradually becoming almost completely flat.
- Substantial modification and is subject to the joint capsule is stretched -one of the displacement head forward.
- Sometimes, the joint capsule can be generally soldered to the joint capsule.
- Due to the fact that the femoral head is constantly slides up on acetabulum sliding groove is formed.
- A joint cavity in most cases, it is divided into three parts, and assumes the form of an hourglass. The upper part of the hip joint surrounds the head, the middle part surrounds the cavity, however, due to the fact that depression is flattened, part of it is hollow. The round ligament in mild cases of the disease is expressed well enough, but sometimes it may be absent altogether.
Diagnosis of hip dysplasia
The success of the treatment of hip dysplasia and the outcome depends on how the disease was diagnosed in a timely manner and appropriate treatment initiated. In that case, if the treatment is not started, complications increase, like a snowball, exponentially elapsed time.
That is why all the children at the hospital are examined by a surgeon - orthopedist still in the hospital. As a rule, for the first time in the hospital diagnosed congenital hip dislocation. However, parents need to remember that, despite the importance of early diagnosis, to recognize it is often very, very difficult, and sometimes even impossible. Hip dysplasia in children often well disguised.
That is why, even if no reason for alarm doctor found a month after the birth of all kids, without exception, should see a doctor - orthopedist, so he could make sure they were all right. Consultations will be necessary to achieve three kids, and then six months. Parents in any case should not ignore these visits to the doctor - they are very important for the health of crumbs - the consequences of dysplasia in children is difficult.
As mentioned earlier, all dysplasia group composed of several diseases:
- Congenital hip predvyvih.
- Congenital subluxation of the hip.
- Congenital dislocation of the hip.
- Radiologically immature hip joint.
In order to correctly assess the state of hip crumbs, a clinical examination of the child shall be carried out on a specific methodology.
There are a number of specific symptoms and signs, which a doctor can diagnose a child's hip dysplasia. These are the basic of these symptoms, but parents in any case should not attempt to make a diagnosis - it can lead to unexpected complications. However, to know about these symptoms is still necessary:
- Dilution legs crumbs towards markedly significant limitation in the hip joints.
- Also, at a dilution of legs toward the presence of hip dysplasia observed symptom of slipping or as it is sometimes called, a symptom of clicks.
- If you put a crumb on his tummy, it is possible to visualize the visual asymmetry of the gluteal folds baby.
- When pronounced hip dysplasia can be noticed with the naked eye shortening of one of the legs crumbs.
Once again, it should be recalled that the diagnosis can only be a doctor surgeon - orthopedist. On their own, without proper medical training to diagnose almost unreal.
Also, the baby, if it is put on the back, there will be a significant restriction in the hip joint when attempting to separate the legs to the side. It is this feature is one of the most constant and the early signs of hip dysplasia. The more time passes, the older the child becomes, the greater the restriction.
And if the rest of the forms of dysplasia, this symptom can be expressed it is not very clearly, that if the baby has formed a dislocation, this feature will be expressed most vividly.
Hip dysplasia must be differentiated from other diseases in which such symptoms are possible:
- Spastic paralysis.
- Muscle contractures.
- Congenital viral strain hip.
All of these diseases should be completely excluded, and only after that a doctor can establish the diagnosis of hip dysplasia. To do this, the child is necessary to conduct a full investigation and careful study of the state of absolutely all the ligaments and muscles of the hips, and just need to ultrasound and X-ray of the hip compositions. Also, when viewed from the doctor the baby must take into account the effect of certain age-related factors, such as physiological muscle stiffness remains. This physiological rigidity often does not allow to separate the legs, even for a healthy crumbs. However, these difficulties arise only sporadically, and sometimes problems with the cultivation of the legs does not happen. But in the case of the baby hip dysplasia, dilute his feet will be possible only after vpravlena will head the joint.
Based on the totality of the symptoms that the doctor will be able to detect by external examination crumbs and data diagnostic testing baby and be a verdict on the presence or absence of the crumbs of such serious diseases such as hip dysplasia.
You also need a little bit more to tell you about a symptom of slipping or clicks. For the first time this symptom has written about the Soviet orthopedic surgeon in 1934. After some time, it is described and an Italian doctor who gave a symptom of another, the third name - a symptom of instability. The essence of the violation that when you try to separate the legs crumbs towards hip dislocation occurs reduction. It is the reduction of dislocation and causes a clicking sound that a doctor hears.
When subluxations sound is a little quieter and perhaps it will not be heard. However, the doctor must feel his hand. When the baby's legs are to the midline, a re-dislocation of the head, which is also accompanied by the sound of clicking and single WinCE legs.
In conducting such a study necessarily be taken into account the fact that the symptom of clicks often almost completely disappear by the end of the first weeks of life remains. But sometimes, if the baby is present hypotonia, it can be stored even several months, typically, the first three - four.
The asymmetry of the inguinal folds, as well as the folds on the hips kid, or a different number on the right and left thigh, is often an indication that there is crumbs hip dysplasia. As a rule, on the side from which the joint amazed the number of folds more, and they are much deeper than the second side. Located proximal to the crease.
However, by itself this symptom in any case can not be the basis for the diagnosis of hip dysplasia. This asymmetry can be observed even in healthy children, while one-third of children suffering from hip dysplasia, this symptom is not observed at all. It is therefore this symptom may be seen as an indication of hip dysplasia in a combination with other symptoms, but does not own.
Also very significant sign of hip dysplasia is the presence of external rotation crumbs crumbs. She always expressed strongly enough. Often it is the mother pay attention to this symptom, and that it serves as a pretext for seeking medical advice - orthopedist. The most well-rotation noticeable when the baby sleeps.
Normally, a marked shortening of the legs, which is noticeable on the eye, is the case of high dislocation of the hip. Contrary to the mistaken belief, rotation is possible not only when dislocation unilaterally, but bilateral and in the event that the thigh arranged at different heights. Some mothers try yourself with a tape, determine whether the shortened one leg. However, in infants it is almost impossible to do - they have a leg length difference is judged by the way located at knee joints. For this baby legs bent at the knees, it is necessary to squeeze the tummy. Once again, please note that all of these manipulations should only be a health worker.
Almost all of the above signs of dysplasia can be expressed in all or only a portion, and sometimes their presence does not indicate hip dysplasia. If a doctor were any doubt, parents in any case should not give up more detailed examination.
If the diagnosis is not confirmed, you and your doctor will know exactly what is in a child with joints all right. And do not resent and blame the doctor's lack of competence - it is absolutely justified precaution, since it is not diagnosed in time hip dysplasia can lead to the fact that the child in the future will be seriously handicapped.
The most successful diagnosis of hip dysplasia in newborns by means of X-ray method of investigation. It is made as follows. The doctor puts crumbs back and pulls his right leg. Taz baby while firmly pressed against the cassette tape. Genitals crumbs must be protected from X-ray radiation specifically for this purpose a lead plate. This plate, with the right of its location, does not interfere with X-ray examination.
The doctor - orthopedist, in assessing the results of the study takes into account age-specific structural features of the newborn hip crumbs:
- In infants almost completely absent ossification heads hips.
- The height of the femoral head in the newborn is the width of the femoral neck.
- Acetabulum in infants has a cartilaginous structure, so the X-ray image does not give a contrasting shade.
If in the normal development of the baby ossification of the femoral head occurs in about six months old, the children suffering from hip dysplasia, ossification occurs no earlier than one year of age.
Diagnosis of congenital hip dislocation in children older years
If you have small children, in some cases, the diagnosis of congenital hip dislocation is difficult from the moment when a child begins to walk, it's much easier to do.