Treatment and prevention of coxarthrosis of the hip jointCoxarthrosis is a destructive degenerative disease of the joints, which occupies a leading position among diseases of the musculoskeletal system in its prevalence. Most often the lesion affects the large joints of the human skeleton - knee and hip. Treatment of coxarthrosis of the hip joint is a rather lengthy process and largely depends on how patient is informed about the disease itself and is ready to cooperate with the attending physician.
The exact cause of this pathology is a topic of lively discussions in the scientific community. There are many theories, and many of them are not unfounded, but to date, scientists have been able to establish only a number of predisposing factors that can affect the onset of this pathological process. Among others, we can distinguish the following:
- physiological aging of the organism;
- various hormonal changes, including menopause in women;
- genetic predisposition;
- congenital abnormalities of the hip joints;
- overweight of the patient;
- a sedentary lifestyle;
- metabolic disorders;
- some infectious and autoimmune diseases;
- various pathologies of the spine or feet( kyphosis, flat feet);
- dysplasia of the hip joint of various genesis, etc.
In the aching joint the connective cartilaginous tissue is depleted and the bones are injured
The insidiousness of the disease lies in the fact that during the debut of the disease a person experiences only minor discomfort, the symptoms are not pronounced, and therefore patients rarely consult a doctor. In the clinical course of the disease, it is common to distinguish 3 stages:
- The first stage is characterized by changes in the structure of the synovial fluid, which changes its consistency and becomes more viscous. The joint can not function normally, and the cartilaginous tissue begins to slowly degenerate. Appear single bone growths, which are called osteophytes. At this stage of the disease, the patient does not experience intense pain or restricted mobility in the joints. There may be only some stiffness and discomfort with prolonged loads.
- The second stage can not go unnoticed. The patient experiences severe pain that appears even when the joint is at rest. Pain gives into the groin or thigh, and the amount of movement in the joint is severely limited.
- The third stage is characterized by severe destructive lesions of the joint. There is atrophy of the muscles of the thigh, lower leg and buttocks, which leads to a shortening of the leg on the affected side, a change in the center of gravity and lameness. All this leads to the fact that the load on the joint is further increased, and the process of its destruction becomes even more intense. The painful syndrome reaches the maximum intensity and torments the patient even at night, at rest. This stage, in the absence of proper treatment, ends for the patient with a disability.
Thus, it can be concluded that the earlier the patient, having noticed the first signs of coxarthrosis, will seek the help of qualified specialists, the more effective the treatment will be and the more favorable the medical forecast.
It is accepted to isolate primary and secondary coxarthrosis of the hip joint. The most common form of primary coxarthrosis is one- or two-sided dysplastic coxarthrosis.Dysplastic coxarthrosis develops against a background of dysplasia of the hip joint, which can be both congenital and acquired. Of great importance is the early diagnosis of dysplasia and timely treatment. In children, dysplasia is treated by correcting the dislocation and applying a special coke bandage. This allows you to avoid developing a deforming coxarthrosis in your baby.
The diagnosis of "dysplastic coxarthrosis" is based on radiographic examination and functional diagnostics. In adult patients coxarthrosis of the hip joint is more often secondary, while dysplastic arthrosis of the hip joint in children is more often a consequence of congenital dysplasia.
Coxarthrosis of the hip joint in the ICD 10
There are certain international regulations that systematize all existing diseases and conditions that affect human health. This approach ensures the unity of methodological approaches in the treatment of various diseases. The international classification of diseases and health-related problems is the statistical and classification basis for health. Once in 10 years, the World Health Organization reviews and reaffirms this document. Today there is 10 edition of this document( ICD 10).This classification helps to convert various diagnoses into a special notation system( alphanumeric code), which greatly facilitates the systematization and storage of data.
ICD 10 includes 22 classes of diseases, among which diseases of the musculoskeletal system and connective tissue occupy the 13th place. Codes for the ICD-10 from M-15 to M-19 designate arthrosis of various genesis. Among them, the M-16 code belongs to coxarthrosis( or arthrosis of the hip joint).There is a definite classification of coxarthrosis of the hip according to the etiology of the disease, which is also reflected in the ICD 10. This information is also displayed when the disease is coded. According to the ICD 10, there are 9 forms of coxarthrosis of the hip joint:
- M 16.0 Coxarthrosis bilateral primary.
- M 16.1 Other primary coxarthrosis.
- M 16.2 Coxarthrosis as a result of dysplasia is bilateral.
- M 16.3 Other dysplastic coxarthrosis.
- M 16.4 Posttraumatic bilateral coxarthrosis.
- M 16.5 Other posttraumatic cosatthrosis.
- M 16.6 Other secondary coxarthrosis bilateral.
- M 16.7 Other secondary coxarthrosis.
- M 16.8 Coxarthrosis, unspecified.
This knowledge is very important for patients. Possessing such information, they can independently decipher the code of the disease according to the ICD 10 and find out the cause of the pathology.
Methods of differential diagnostics
The most accessible( but no less effective) method for diagnosing this pathology was and still is radiography. On the X-ray, structural changes in bone tissue can be clearly seen, which allows us not only to establish the degree of the disease, but also to identify the cause of the pathology with great accuracy.
Tomogram of a patient with coxarthrosis, which clearly shows the deformation of the femur
If possible, the patient is given computer or magnetic resonance imaging. These advanced research methods allow visualizing, among other things, the underlying tissue and synovial fluid, which allows a more accurate picture of the clinical course of the disease.
Differential diagnosis with gonarthrosis, Bechterew's disease, reactive arthritis and bursitis is required. To determine the exact etiology of the disease, a number of laboratory tests are prescribed. Sometimes dysplastic coxarthrosis is mistaken for coxarthrosis of the knee joint, as the pain irradiates to the knee. Based on the above-mentioned studies and a patient's questioning, an experienced orthopedic doctor can make a fairly accurate picture of the course of the disease and choose the most rational treatment tactics.
How to treat coxarthrosis of the hip joint
There are a number of techniques that are successfully used to treat this pathology. Conservative methods are very effective in the debut of a disease, when destructive processes are still reversible. Conservative therapy includes a number of measures aimed at reducing the pain syndrome, improving mobility in the joint and inhibiting destructive processes. For this purpose, medicamental treatment and physiotherapeutic procedures are used. Drug therapy is the use of non-steroidal anti-inflammatory drugs of prolonged action. These drugs effectively eliminate pain syndrome and contribute to the removal of the inflammatory process.
Local therapy( various ointments, gels and creams) is possible. Such therapy is ineffective in terms of bioavailability, but it has some advantages. Massage with coxarthrosis is used to improve blood circulation and metabolic processes. By rubbing ointments and gels, you achieve similar results. Massage with coxarthrosis can be used only in the stage of stable remission.
The doctor can also prescribe physical therapy and sanatorium treatment. Specially designed sets of exercises help to improve the mobility of the affected joint and restore its other functions. Such exercises can be performed both in special offices at outpatient clinics, and at home.
If the disease continues to progress, the symptoms of coxarthrosis do not go away and become more intense, and drug therapy does not bring the desired relief, the patient is prescribed intraarticular injections of analgesics and nonsteroidal anti-inflammatory drugs. Such injections can be done only in the conditions of a specialized hospital.
In no event should such manipulations be carried out at home, as the consequences of improper administration of the drug can be fatal to the patient.
When an operation is indicated for coxarthrosis
When critical bone fracture has to resort to the installation of an artificial joint
If the disease can not be cured conservatively and the disease progresses, decide on a surgical intervention( complete or partial replacement of the hip joint for the implant).There are several methods for surgical intervention in coxarthrosis:
- hip joint replacement( indication - bilateral coxarthrosis) the operation is a complete replacement of the damaged joint for the implant;
- arthroplasty - this operation allows you to replace some damaged parts of the joint;
- osteotomy is an operation for the destruction of bone, its partial replacement with an implant and fastening of joints in the most favorable position;
- arthrodesis is an operation in which bones are fastened with special bolts and plates.
Endoprosthetics and arthroplasty are the most progressive methods of surgical treatment of coxarthrosis of the hip joint. This intervention allows you to save not only the supporting function of the injured limb, but also its motor function. Any operation is a rather complicated process, requiring constant postoperative control of specialists and a long course of rehabilitation. In most cases, such operations are carried out successfully and patients return to the usual way of life.
Often carry out similar operations with coxarthrosis in children. However, parents should be aware that in 40% of cases after surgery, children still developed coxarthrosis, and often the disease takes even more menacing forms. In such children, there was a significant narrowing of the joint gap, gait disturbance and pain during movement.
Early diagnosis is important in the treatment of children, since the most effective treatment for the disease is conservative therapy.
Prevention and treatment at home
Every patient should understand that treating such a serious pathology at home with folk remedies is a waste of precious time. Another thing is when the methods of traditional medicine are used in conjunction with traditional therapy.
After consultation with the attending physician, you can use various auxiliary therapies. But self-medication can not only not bring you the desired relief, but also cause irreparable harm to your health. Coxarthrosis and self-medication are incompatible concepts.
A great value in coxarthrosis of the hip joint is a diet. It is important to adhere to the principles of fractional and healthy eating. Take food better 5-6 times a day in small portions. Diet should be aimed at correcting body weight and improving metabolism. It is necessary to exclude fat and fried foods, bakery products, sugar and whole milk. Preference should be given to vegetables and fruits, as well as products containing iron and calcium. Nutrition for coxarthrosis of the hip joint should be balanced so that the patient receives all the necessary nutrients in the right quantities.
The water-salt balance plays an important role. It is necessary to completely exclude alcohol, strong tea and coffee and carbonated drinks. As a drink suitable non-carbonated mineral water, green tea without sugar and various herbal medicinal herbs. Tea from chamomile, calendula, currant leaves or other herbs with anti-inflammatory properties is suitable.
With a comprehensive approach to the treatment of coxarthrosis of the hip joint, the prognosis is
What is joint dysplasia?
The human musculoskeletal system begins to form during the intrauterine period, during the fourth week of fetal development, and the end of this process occurs after the birth, when the baby takes the first steps. But the process of formation is not always successful: at any stage, various disruptions in the growth and development of tissues are possible. It is these disorders that are dysplasia.
Joint dysplasia is a phenomenon when certain disorders occur in the formation and development of connective tissue, as a result of which it becomes weak, and this, in turn, leads to pathological mobility of the joints( hypermobility).
Causes of joint dysplasia
Disturbances in the development of connective tissue are possible at any stage, but joint dysplasia is predominantly a genetic pathology and is often found in several representatives of different generations of the same genus. Incorrect formation of bones, ligaments and muscles can occur also in the unfavorable course of pregnancy - toxicosis, gestosis, infectious diseases and disorders of the endocrine system. Factors that negatively affect fetal fetal formation are also a bad ecological environment, occupational hazards, an unhealthy lifestyle of a pregnant woman( smoking, drinking alcohol and drugs), eating disorders and so on. The diet should contain enough vitamins, minerals and proteins. Especially important is calcium, which is directly involved in the development and formation of connective tissue. The cause of dysplasia of the joints of the newborn can also be the elderly age of the parents.
Types of joint dysplasia
In the vast majority of cases, joint dysplasia affects the hip joint. This pathology belongs to 3 percent of all orthopedic diseases. It is noteworthy that it is found mainly in girls born in breech presentation. In this case, the head of the femur is not located in the acetabulum of the pelvic bones, where it, it is worth noting, is the place itself.
However, this is not the only type of joint dysplasia. Common are subluxations and preluxations of the joints, dislocations of the femoral head, shortening the limb and disrupting the walking function. Another type of joint dysplasia is a false joint that develops in the place where the head of the femur has been dislocated.
The dysplasia of the joints can be recognized by the asymmetry of the gluteal and inguinal folds, different lengths of the legs, gait disturbances, flicking of the joint with certain movements.
Treatment of joint dysplasia
A timely diagnosis and correct treatment can almost completely restore the functions of the hip joints. For this, the child needs a systematic examination of the orthopedist. Examinations take place in the first, third, sixth, ninth and twelfth months of life. Otherwise, the disease will lead to violations of gait and posture, curvature of the spine, pain syndrome and so on.
The treatment consists in fixing the legs in a dilated position, so that the head of the femur can enter the articular cavity. Important in the treatment are also massage and physiotherapy, physiotherapy and drug therapy. But such conservative methods of treatment are effective only for children under one year. The older the age, the more likely that the patient will be recommended for surgery. But even a few operations do not guarantee the restoration of the functions of the hip joints. Disorders of gait often remain a consequence of dysplasia for life.
Author of the article: Muravitsky Igor Valerievich, rheumatologist
Hip dysplasia in adults and children
Dysplasia from the ancient Greek language is translated as a violation of education. Simply put, it is a vice of development. Dysplasia can be noted in any stavah. But dysplasia of the hip joints is most often observed.
Apparently, this is due to the peculiarities of the anatomical structure and the development of the hip joint in children. Our hip joint is formed by the articular acetabulum of the pelvis and the head of the femur, or simply - the head of the hip. The head is connected to the rest of the bone by the neck of the thigh. To increase the area of contact between the articular surfaces of the head and the acetabulum, the latter is surrounded by a cartilaginous plate - the limbus.
The hip joint begins its formation at about 5-6 weeks of intrauterine development. At the embryo at 2-month in it movements are possible. However, the complete formation of the hip joint ends only when the child begins to walk - without adequate load the joint remains immature in anatomical and functional terms.
In most cases, congenital dysplasia occurs, which is diagnosed for the first time in childhood. This fact is reflected in ICD-10, the international classification of diseases of the 10th revision. In this classification, hip dysplasia is located in the XVII rubric - congenital anomalies( malformations), deformations and chromosomal abnormalities, in the congenital anomaly( malformations) of the musculoskeletal system. According to this classification, this pathology has an innate character. Among the causes of hip dysplasia:
- Genetic disorders leading to inferiority of connective tissue structures - bones, cartilage, ligaments;
- Damage to the hip and hip joint due to birth injuries caused by increased tone of the uterus, pelvic presentation of the fetus;
- Influence of external negative factors on the organism of a pregnant woman - stresses, industrial, household toxins, infections;
- Hormonal imbalance is an increase in the synthesis of progesterone during pregnancy, which relaxes muscles and ligaments;
- Drinking alcohol, drugs, smoking during pregnancy.
A lasting role in the development of hip dysplasia due to congenital immaturity is played by a tight swaddling, at which the hip axis shifts, and the femoral head extends beyond the acetabulum of the .In some cases, hip dysplasia in adults is observed. It is believed that this pathology in the adult period predisposes to increased stress on the joint - exercise, dance, gymnastics. Apparently, in adults this pathology also has an innate character. Simply, the anatomical changes in the joint and in the ligaments are minimally expressed, and up to a certain time they are not diagnosed. And physical activities are not causes, but provoking factors.
Types and degrees
Depending on the nature of the anatomical disorders, the following types of hip dysplasia are distinguished:
- Acetabular. The articular cavity has been altered - it is flattened, the limbus is thinned or displaced.
- Changed the head of the hip. When the femoral head is changed, the anatomical correspondence( congruence) of the joint hip surfaces is also violated. Along with the head, the neck of the hip often suffers, which leads to a decrease or increase in the angle between the neck and the femur.
- Rotary. It is caused by pathology of the femur and often - the knee joint, shin. In this case, the entire lower limb is rotated( rotated) inwards.
Structural changes in the hip joint are not the same, and therefore the following degrees of hip dysplasia are distinguished:You can also read: Why does the hip joint hurt?
- Prevail - articular surfaces have been altered, but the head is located within the acetabular joint cavity.
- Subluxation - further displacement of the head relative to the articular surface. The head partially extends beyond the articular cavity.
- Dislocation - the head of the femur completely extends beyond the articular cavity.
All these degrees with the appearance of the corresponding symptoms of hip dysplasia develop against the background of the so-called.immaturity of the joint. This immaturity is characterized by weakness of muscles, ligaments and the above signs of joint disorders.
Congenital dysplasia is most often noted in the female first-born. This is due to the fact that girls react more to maternal progesterone than boys, as well as a more increased tone of the uterine musculature during the first pregnancy. Although, in male toddlers, dysplasia is sometimes diagnosed. According to statistical data, this pathology is observed in 2-3% of newborns of both sexes.
Among the main signs of hip dysplasia:
- Different length of lower limbs. On the side of dysplasia the leg is shortened.
- Rotation of the entire lower limb inside.
- Limitation of lead. The child lies on the back, and clasps the legs, bent at the knee and hip joints. In this position, the legs are bred. With normal development of the hip joint, the leg is removed under a straight( or close to a straight) angle. With dysplasia, the angle of lead is significantly less.
- Click symptom. In some cases, with the hip in the above position, you can hear the click of the femoral head, which indicates a dislocation. When the thighs are brought together, the click is heard again - the dislocation is corrected.
- Asymmetrical arrangement of skin folds. In the position on the abdomen, 3 creases are defined on the surface of the hips. On the side of the dislocation, these folds are higher than on the healthy one.
Asymmetry of skin folds
According to statistical data, all the above symptoms are more often noted on the left lower limb.
Diagnosis of hip dysplasia is performed during external examination and instrumental research. Suspect pathology can be based on the characteristic symptoms mentioned above. Roentgen confirms the diagnosis. Radiographic photographs clearly show structural disorders of the joint elements. In children up to 6 months. For diagnosis, ultrasound of the hip joint can be used.
This is how dysplasia on the radiographic image of
The earlier the diagnosis is made, the more effective the treatment that should be done literally from diapers. Otherwise, such consequences of hip dysplasia as lameness, persistent limitation of movements in the hip joint, atrophy of the muscles of the thigh and lower leg are possible.
In adults, these factors lead to arthrosis changes in the hip joint, to disability. The problem is that in the anatomically altered acetabular joint cavity the connective tissue develops over time, and it is almost impossible to achieve complete anatomical matching of the articular surfaces.
Currently, various types of fixation bandages
are used with hip dysplasia Fortunately, in most cases, in young children, congenital dislocations and subluxations of the hip are spontaneous. For this lower limb, the position of the abduction in the hip joint should be given. To this end, use special fixing orthopedic devices - Pavlik's stirrups, Freik's pillow. These devices are used up to six months of age. At the same time, one should abandon the tight swaddling, which provokes hip dislocation and subluxation.
Parallel to the orthopedic correction, we perform health gymnastics - flexing and unbending the legs in the knee and hip joints, the legs in the position on the abdomen. During exercise, soft stroking movements massage the legs, buttocks of the child. In the presence of dislocation of the femur, the latter is closed in a closed manner, after which the hip joint is fixed with a plaster bandage. However, closed direction can be carried out only in early childhood. After 5-6 years, this can not be done, and the dislocation is only corrected by the open method, during the operation. Other types of surgical interventions to eliminate hip dysplasia suggest different types of acetabulum, limbus and articular ligament plasty.
Such a disease, as hip dysplasia in adults, is extremely rare, because this ailment is revealed even in infancy. But everything happens in life. Why is the congenital disease sometimes found in adults? And in what form? To understand this, you need to understand everything in detail.
What does the dysplasiamean?
Dysplasia refers to the formation of tissues, which differs from their usual( true) development. When, for example, cartilage or bone is formed in a person incorrectly during fetal development or after birth, then it is claimed that there is dysplasia of this tissue. Accordingly, this concept is common to any type of living tissue.
Hip dysplasia is otherwise referred to as congenital hip dislocation. Such an ailment is very difficult. It is characterized by a violation of the formation of all the components of the joint and a change in the location of the epiphysis of the femur( head) in relation to the acetabulum.
Of all the congenital ailments of the musculoskeletal system, dysplasia of the hip joint is one of the first places, and the female sex is twice as likely to suffer from this disease. It is known that obstetric aspects of pregnancy also matter. Gluteal presentation of the fetus increases the likelihood of dysplasia in the femoral joint. In women with this pathology, the likelihood of having a baby with dysplasia is also high.
Causes and classic symptoms of
The true causes of hip dysplasia are still unknown. Predisposing factors are the following:
- underdevelopment of the acetabulum;
- incorporating new mechanisms in the movement of the joint during the onset of walking.
Approximately 2-3% of cases of dislocation are formed already in utero.
As mentioned above, dysplasia of the hip joints is detected already in early childhood during scheduled visits to an orthopedic physician. Suspicion can cause the following symptoms:
- excess hip rotation;
- shortening of lower limbs, one or two at a time;
- when moving in the region of the hip joint, it is as if slipping or clicking;
- if you bend your legs at an angle of 90º in the hip and knee joints and try to dilute them, there is incomplete abduction of the limbs;
- asymmetrical arrangement of skin folds.
How to cure the pathology of
Treatment of hip dysplasia should be performed from the moment of detection of this disease. Usually used as a massage therapy. Massage is performed only by a specialist, in order to avoid injury to the child. The course of treatment depends on the degree of dysplasia, in some cases, ten days. In other situations, in addition to massage, you will need to wear a special corset to complete cure.
But there are cases when pathology is missed, not detected for one reason or another in childhood. Then serious consequences are waiting for an adult. Because dysplasia of the hip joints in adults in such cases is the result of an untreated or not completely cured disease in childhood. Therefore, it is necessary to start treatment on time, to work only with qualified specialists to avoid serious consequences.
Consequences of childhood dysplasia can be expressed in the development of diseases such as neoarthrosis or coxarthrosis in adults.Back to the Table of Contents
Neoarthrosis as a consequence of
One of the consequences of childhood dysplasia in adults is neoarthrosis. Neoarthrosis, or pseudoarthrosis, is the formation of a new joint in the place where it should not be. It appears when the femoral head is displaced to the posterior surface of the iliac wing. People may not know about such a disease for many years. It is detected only during radiography.
Symptoms of neoarthrosis:
- good mobility in the place of the former injury;
- limb stiffness;
- overlap of the medullary canal with a closing plate;
- formation of cartilage and false capsule of the joint;
- shortening of the diseased limb to 10 centimeters.
This consequence of dysplasia can only be cured surgically. The new joint is removed, gomotransplants are inserted for rapid healing. After the operation, rehabilitation is mandatory: physical therapy, massage, therapeutic physical training.Back to the Table of Contents
Coxarthrosis as a consequence of
Coxarthrosis is another consequence of advanced dysplasia. Symptoms of this disease are muscle atrophy in combination with a limb shortening. Like neoarthritis, it develops for several years.
- discomfort in the pelvic area, especially in the morning;
- strengthening of pain during physical exertion;
- lack of mobility;
- is an inflammation;
- growth of osteophytes.
In coxarthrosis, a multi-stage, complex and rather long-term treatment is required. The most important thing is an emergency start of treatment, regardless of the stage of the disease.
During the initial stage of development of coxarthrosis, it is only necessary to regulate the patient's lifestyle, adjust nutrition, solve metabolic and circulatory problems. Other stages of this pathology require more serious actions, which consist in drug treatment and surgical intervention.
Drugs are used to anesthetize, eliminate swelling and inflammation. Use in the treatment of the following groups of medicines:
- Non-steroidal anti-inflammatory drugs( used to relieve swelling, inflammation and anesthetize the damaged area): Piroxicam, Diclofenac, Indomethacin, Ketoprofen.
- Muscle relaxants( used to relieve muscle spasm and improve blood circulation, apply with caution): "Sirdalud", "Midokalm".
- Vasodilators( used to relieve spasms and improve blood circulation): xanthinal nicotinate, "Cinaresin", "Pentoxifylline".
- Hormonal preparations( injection): triamcinolone acetamide, metipred, hydrocortisone.
- Chondroprotectors( used to restore the structure of cartilage): Rumalon, Arteeoparon, glucosamine, Dona, and Arthrochondroitin.
- Drugs for topical use.
Drug use is not the main treatment. A positive effect helps to achieve the process of rubbing some of the medications, this helps improve blood circulation.
Hip dysplasia in children: photo, treatment, consequences ofWhat 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)., in one way or another, all of its elements can be exposed:
- the head of the thigh and capsule;
- underdevelopment of surrounding muscles and ligaments.
Brief description ofThe role of the hip joints is very great, they experience the main load 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 the correct 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 shape 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 limbus;
- by shortening the neck of the femur with changing its antiversion and diaphyseal angle;
- ossification of articular cartilage elements;
- pathologies of the ligamentous apparatus of the head, manifested hypertrophy or aplasia
Classification of DTSThree main types characterize the pathology of DTS.1) To acetabular dysplasia, a disorder in the structure and pathology in the acetabulum itself, mainly abnormalities 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 facilitates the stretching of the capsule, the development of ossification of the articular cartilage and an increase in the displacement of the femoral head. 2) Mayer's dysplasia or epiphyseal is characterized by a pointlike ossification of the cartilaginous tissues that causes 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, manifested by obvious violations 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 acetabular roof. The position of the femoral head located in the joint cavity is slightly shifted.
- 2nd degree - subluxation - in the articular 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 cavity direction up.
Causes of hip dysplasiaThe causes of articular pathology in the hip joints are caused by several theories: 1) Theories of heredity - presupposing inheritance at the gene level, 2) Hormonal - the increase in the level of progesterone in the late stages of pregnancy leads to functional and structuralchanges in the muscular-ligament structures of the fetus, marked by instability in the development of the hip apparatus. 3) According to the multifactorialThere are several factors influencing the development of TPA: •
- • gluteal position of the fetus;
- 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 become dysplastic.
Symptoms of hip dysplasia in childrenA 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) Asymmetry of the location of wrinkles on the hips. There must 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 the slide of the head 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 searching)
Diagnosis of hip dysplasiaThe diagnosis of dysplasia of the hip joints is determined during examination by an orthopedic surgeon during a profile survey, often at the age of up to six months. The diagnosis is based on physical examination of the baby, certain tests and concomitant symptoms are used. In confirmation in polyclinic conditions, ultrasound is used, less often roentgenography.
- 1) SPL has the advantage of many other research methods, 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.
Treatment of hip dysplasia in newbornsIn pediatric orthopedics, there are many methods of treating hip dysplasia in a child. Each doctor chooses an individual treatment program for his small patient, based on the severity of the disease. These are methods, from elementary broad swaddling to gipsovaniya malysha. I 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 shirts 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.
- general massage with an emphasis on TBS;
- gymnastics of newborns;
- physiotherapy( using vitamin, with lidase, with calcium);
- paraffinotherapy, applications on the TBS region;
- dry heat, mud treatment.