Diseases of the hip joint and their treatment
Structure of the pelvic joint
All organs of the human body are important and unique. Its frame is the musculoskeletal system. The hip joint is one of the largest and most mobile parts of this system, which largely determines the mobility of the whole body.
Motion is the symbol of life itself. The hip joint connects the upper part of the trunk and lower limbs, ensuring their movement. The joint itself is able to move in several directions and carries out various types of motion, so the damage or disease of it leads to serious consequences.
Hip Joint: General Anatomy
This joint connects the pelvic and femur. It is a cup-shaped joint, which is a kind of globular shape. With the help of numerous ligaments and cartilaginous joints, the joint articulates the acetabulum of the pelvic bone with the femoral head.
At the junction site, the surface of the femoral head is almost completely covered with hyaline cartilage, except for the fossa where the ligament is fixed. The cartilage covering of the pelvic bone is located only on the round portion of the acetabulum. The remaining bone surface in the joint region is covered with fiber in the form of loose joint tissue and synovial membrane( membrane).On the free edge of the acetabulum, the acetabular fibrous-cartilaginous lip is grown, having a height of up to 6 mm and formed by collagen fibers.
Lip provides full and dense coverage of the acetabulum of the femoral head. The volume under the transverse ligament formed by the acetabulum is filled with a loose articular tissue, through which blood vessels and nerve channels are laid.
Anatomy of the capsuleThe capsule of the hip joint is a strong formation. It is fixed on the hip bone in the back of the acetabulum;and on the femur is attached in two places: in front - on the intertwining line, behind - slightly away from the intertwining crest.
Fixing on the bones in this way, the articular bag is on the circumference of the acetabulum and encloses two thirds of the neck of the femur and the acetabulum.
In front of the surface of the articular capsule lie the fibers of the ilio-lumbar muscle. The thickness of the capsule in this zone decreases.
In some cases, this formation generates a synovial bag.
Bundles of the hip joint
The hip joint contains five main ligaments. In the anterior part, the ileal-femoral ligament is located on the surface of the joint, connecting the pelvic and femoral bones between the lower iliac region and the intervertebral line. This bundle fan of its fibers covers the hip joint. The ileum-femoral ligament is the most solid ligament of the entire human musculoskeletal system. The thickness of the bundle is due to the fact that it largely determines the vertical arrangement of the entire human body and must provide certain inhibition during extension.
The pubic-femoral ligament consists of fairly thin fibers assembled in a bundle, and placed in the lower part on the surface of the joint. The ligament begins from the pubic part of the hip bone, is directed downwards and is attached to the femur in the area of the small trochanter, right up to the vertex. Passing from the outside of the joint, part of the fibers of this ligament are weaved into the tissues of the joint capsule. The main function of the ligament is the inhibition of the transverse movement of the thigh.
Joint and its ligaments
The sciatic-femoral ligament is located behind the coxofemoral joint. The beginning of this ligament is fastened in front on the surface of the ischium of the pelvis. Fibers of the sciatic-femoral ligament encircle the femoral neck, some of them intertwine into the joint capsule. The remaining fibers are fixed on the femur in the zone of the large trochanter up to the pit. The main task of this ligament is the inhibition of the movement of the thigh in the inner direction.
The bundle of the head of the femur is a fairly loose structure of the tissue, covered with the synovial membrane. Inside the ligament are the vessels that are directed to the head of the femur. The beginning of the ligament is fixed in the pit of the acetabulum of the hip bone, and the end is fixed in the fossa of the head of the femur. A bundle of the femoral head is inside the capsule of the hip joint. The strength of the ligament is not very great, and it can easily stretch. When the joint moves inside, a space is formed that is filled with a bundle of the femoral head and synovial fluid, which ensures the lining between the surfaces of the bones and increases the strength. A bundle of the femoral head prevents excessive rotation of the thigh in the outer direction.
The circular zone of the ligaments is located inside the capsule of the hip joint. It has the appearance of a loop that runs around the femur in the middle part of the cervix. This zone is a mixture of different collagen fibers collected by thin beams. Ligaments are attached in the ileum.
Hip joint:motor functions The anatomy of the hip joint makes it possible to ensure its high freedom of movement in different planes and directions. The maximum amplitude of the movement of the joint is allowed relative to the frontal axis. This axis passes through the head of the femur. Such movements of the joint ensure flexion and extension of the person. Flexion is almost not limited to ligaments and can reach 122º( a restriction on flexion is made by the abdominal muscles).Extension is possible only at angles up to 13º.The inhibition of the joint to unbend is provided by the iliac-femoral ligament, as when this extension is stretched, this ligament is stretched. Further movement of the body backward is possible only due to the lumbar region.
The second type of motion is transverse movement of the thigh relative to the sagittal axis, i.e.removal and reduction of the thigh relative to the trunk. The travel angle is limited to 45 °.A large spit is inhibited by a large spit when it comes into contact with the ilium. If the thigh is in a bent state, then the large spit is pointed back and does not create obstacles for the hip.
The movement of the hip joint relative to the vertical axis provides external and internal rotation of the thigh. The amplitude of the rotation amplitude is 40-50º.Both femoral ligaments actively participate in inhibition of this type of movement.
Finally, the globular design of the joint allows for another movement - pelvic rotation relative to the lower extremities. The amplitude of such movements is determined by the size of the wings of the ilium and the large trochanter, and also by the magnitude of the angle between the vertical axis and the longitudinal axis of the femur. A noticeable effect is exerted by the angle of the neck of the femur, which changes in a person with age, which explains the changes in the amplitude of these movements and, accordingly, in the gait of a person with age.
For example, this angle for newborns is up to 150º, and for a 30-year-old man - up to 125º, for a woman - to 118º.
Features of the circulatory system in the hip joint
The circulatory system of the knee joint consists of a variety of blood vessels. The blood supply is provided by the external and internal arteries, enveloping the hip bone and departing from its deep artery, as well as branches of the acetabular artery and gluteal arteries. Blood flow is carried out through the veins, which are located on the surface and inside the hip joint. Through the venous system of the joint, blood enters the femoral vein, and bypassing the veins of the venous vessels, the outflow reaches the iliac vein. Below the outflow system is associated with the system of lower extremities, which originates from the finger veins entering the venous arch of the foot. In turn, the inner and outer marginal veins, which pass into the large and small saphenous veins of the leg, feed from the arc.
The lymphatic system includes lymph nodes and transfer vessels. Lymphatic drainage is performed in the lymph nodes that are located( outside and inside) around the iliac vessels. The nervous system of the hip joint is included in the general nervous system of the person through the femoral, sciatic, blocking and gluteal nerves.
Age features of theHip joints change during the growing up of the body, which is associated with structural changes in the bones that are connected in the joint. Thus, in the newborn the head of the femur has a cartilaginous structure, and the nucleus of ossification becomes noticeable only by the age of six months. In a child of six years of age, ossification increases by an average of 10 times.
The size of the neck of the femur increases for a long time, its growth stops only by 20 years. Complete formation of the pelvic bones and cartilage structure in the acetabulum zone is completed only by the age of 14-17.
Defects in the development of the hip joint
In the process of age development of the hip joint, defects( defects) can occur, manifested by insufficient development of the joint elements or their deformation.
A dangerous defect is hip dysplasia, which is the inadequate formation of the acetabulum of the pelvic bone and the proximal femur. Most often, the primary cause of this vice is congenital. At the same time in a child at an early age, dysplasia can develop into a shift in the head of the femur.
Joint dysplasia can be classified into three degrees of joint damage: preluxation, subluxation and dislocation. Dysplasia in a child can manifest itself in the first months of life in the form of restriction of the hip, skin folds on the thigh, reduced length of the leg, turning the leg outward at rest. At the age of 3-5 years in a child, the subluxation may manifest as an instability or limping, and dislocation - through a swinging gait.
Important pathological abnormalities indicative of dysplasia are the elevation of the acetabular roof slope, the displacement of the femur end in the outward and upward directions, and later the ossification of the head. The most common reason is the displacement of the head of the femur, which is divided into five degrees.
Vervous deformation of the femoral neck is characterized by a decrease in the cervico-diaphysial angle and displacement of the trochanter. The main symptoms of the defect: limping, a slight change in the length of the foot, turning the leg outward, the motion of the joint is limited.
Damage from injuries
The hip joint is frequently traumatized. The most common contusions are manifested in the form of pain in the joint area or as a slight restriction of movement, bruising in the tissues or knocking in the joint area. Traumatic dislocation is determined by the displacement of the femoral head relative to the pelvic bone.
Depending on the direction of deformation, the front, back and central dislocations are distinguished. With central dislocations at the bottom of the acetabulum, cracks are often observed. The bone fractures have the strongest effect.
In fractures, in addition to the destruction of bone tissue, as a rule, ligaments and muscles are damaged.
Diseases of the hip jointSignificant destruction of the joint tissues occurs with osteochondrosis, which is a dystrophy of the bone structure and cartilage. The most characteristic form of the disease is osteoporosis( coxarthrosis).In this disease, cartilage gradually lose its elasticity and cease to fully perform its function, because of which the bones are deformed. Deterioration of blood circulation leads to the fact that the muscles begin to atrophy. The main symptoms of the disease: pain in the thigh and groin, limited mobility of the joint, lameness, muscles weaken.
The causes of inflammatory processes in the hip joint often lie in a disease such as a coke that is usually infectious. With such a disease, the synovial membrane, articulated bone sites are affected. The first symptoms are manifested in the form of pain in the pelvic region, stiffness of movement, increased temperature in the joint area. If the coxite has developed into a purulent form, then symptoms appear in the form of an unnatural position of the limb, pulling the leg upwards.
Tumors of a different nature can develop on the capsule of the joint or articular tissues( cartilage and bones).The reason - the development of diseases such as synovioma, osteoma, chondroblastoma, chondroma, etc. Such diseases, as a rule, require surgical intervention.
Hip pain may be caused by diseases that occur in the muscles adjacent to the joint. Hypertension of the muscles is one of the diseases. In mild forms, hypertonus causes discomfort and a feeling of stiffness, but in the future can lead to muscle spasms, limited movement, tightening of the limb. In severe form, hypertonicity can cause significant muscle tightening and pain in them under stress.
Treatment of the hip jointTreatment of the hip joint primarily requires a therapeutic and preventive approach. Good results show different methods of physiotherapy. So, ozocerite has become a valuable material for health procedures. It is especially noticeable how ozocerite helps in the treatment of arthrosis( coxarthrosis), osteochondrosis, myositis, traumatic consequences. Ozokerite, because of its low thermal conductivity and natural basis, has become the source of the creation of such a kind of physiotherapy as ozoceritherapy.
Therapeutic techniques in the treatment of hip joints can be based on manual therapy. In particular, post-isometric relaxation is recommended, which is especially good for hypertension of muscles. This method of manual therapy is based on the combination of passive stretching of muscles and impulse isometric work of minimum intensity. The affected joint is sensitive to vibrational loads, which causes widespread use of therapeutic massage. The use of ointments and creams is recommended for all patients. Damaged( susceptible) place can be smeared with warming compounds of different types.
With severe pain and serious inflammation, it is difficult to do without a drug treatment. Dexamethasone is a glucocorticoid drug. When treating various diseases of the musculoskeletal system, dexamethasone proved to be reliable and effective. Dexamethasone has an anti-inflammatory and analgesic effect, there are no contraindications for allergies. The dosage should be specified by a specialist.
The use of a complex of therapeutic physical exercises is necessary for any diseases of the hip joint. From how we strengthen the hip joint, the speed of recovery and recovery of mobility depends. The complex of exercises improves blood circulation, stabilizes muscular activity, restores the elasticity of ligaments.
Surgery is the last resort and is only used for severe injuries when there is no alternative. Redirection of the bone element or replacement of the articular tissue can be the goal of the operation. Recently, transplantation( replacement) of the articular tissue has become quite an ordinary event in the treatment of complex cases of disease or trauma. Especially important is the availability of such a method as the replacement of joint formation, in the treatment of tuberculosis cocksites and tumors.
The hip joint is a complex organ in the human body. If it hurts, grows numb or knocks, then immediate action should be taken. This joint largely determines the motor abilities and stabilization of the whole body: any pain, knocking can cause big problems.
Hip joint: Anatomy, structure, muscles
The very place where these two components come in contact is covered with special cartilages on both sides. In the very center of the deepening of the articular cavity is the connective tissue of a very loose structure. It is covered with the synovial membrane. From the edges of the cavity there is a so-called lip. It has a height of up to 6 mm and is formed from collagen fibers. This allows you to make the head of the thigh completely immersed and very tightly connected, even turned out to be covered by the acetabulum. At the same time over her lip does not end and does not stop. On the contrary, it forms a transverse ligament. Below it is a small space filled with connective tissue. This loose substance is necessary in order for nerves and blood vessels to pass through it into the head of the femur, and into the ligaments of the thigh.to table of contents ↑
Cartilages of the hip joint
The articular cartilage with which the surface of the head of the femur and acetabulum are covered is a strong, smooth and very elastic "lining".It is functional. With its help:
- Good gliding of bones occurs among themselves;
- The bone load is distributed with any movement of the joint.
This cartilage has a unique and special physiology. Anatomy implies that it works like a sponge. So, during its compression from the cartilage articular fluid is released. When the pressure does not act on it, the liquid again fills all of its pores. The purpose of this "water" is to lubricate surfaces. It forms a special protective film, the thickness of which largely depends on the load that the joint feels.
Cartilage has the following important features:
- it is elastic;
- it has great rigidity;
- , he is pretty pliable.
All these qualities provide cartilage anatomy. Collagen fibers give the cartilage a special stiffness. They are intertwined, and among them are unique molecules, which are called proteoglycans. These molecules, together with water and chondrocytes( special cells) are the basis of cartilage. Thanks to them, it acquires suppleness and the ability to retain liquid in its composition.
Water is more than 70% of the total cartilage mass. With age, a person becomes less and less. Therefore, the cartilage loses its functionality and becomes not as "springy" as it should be.
Anatomy of the hip jointto the table of contents ↑
The entire hip joint is enclosed in a special strong capsule. To the pelvic bone, it is attached from behind with the joint lip, and in front - directly to the femur. It turns out that almost the entire neck of the thigh is enclosed in this capsule.
The ilio-lumbar muscle is attached to the front surface of this capsule. In that very place, it has a small thickness. In some cases a synovial bag develops here.to table of contents ↑
In the articular cavity a bundle of the femoral head is located. Its main component is a connecting, very loose tissue. In the very thick of this ligament of the hip joint are the vessels that pass to the head of the femur. Its main purpose is to ensure the strength of the connection of bones during the movement of a person.
The most sturdy ligament of the hip joint is the anus-femoral. Its thickness can reach 10 mm. The purpose of this ligament is the inhibition of turning inside and extending the thigh. The fact that Taz along with the whole body, constantly "balancing", moving on the head of the femur, expresses the desire to turn around all the time. In this regard, there is a need to keep the trunk strictly vertical. In this regard, the hip joint is equipped with an anus-femoral ligament. In addition to everything a person should have well developed muscles that are on the front surface of the joint.
Another important link in this joint is the sciatic-femoral. It is located behind. Its origin is on the ischium, which takes an active part in the formation of the acetabulum. Then this bunch goes up. Some of its fibers are woven directly into the joint bag, while the other components are attached to the trochanter of the femur. Thanks to this bunch, the hip does not move inward.
A small bundle of fibers is located at the bottom of the hip joint. It is a pubic-femoral ligament. Its main task is to inhibit the withdrawal of the entire thigh. Especially in the case when the joint is in the unfolded state.
There are also important links - it's a circular zone. They are located in the capsule of the joint and cover the middle part of the neck of the thigh.to table of contents ↑
Anatomical features of
The shape of the hip joint is similar to a ball. Exactly 2/3 of it is immersed in the acetabulum. Anatomy refers this joint to a nutlike type. Accordingly, its movements are very diverse. The maximum swing of the thigh is then possible up to 122 degrees along the head of the femur or the frontal axis of the joint, if the knee is bent. Even more bending in this direction is impossible, becauseis limited by the wall of the abdomen.
Extension in the joint reaches a maximum of 13 degrees. The restriction in this case is the tension of the ileum-femoral ligament. In the movement of the leg, the hip joints do not take part. This is only the result of a bend in the lower back.
Around and around the sagittal axis, the hip is withdrawn and withdrawn. Maximum - 45 degrees with a straight leg. If it is bent at the knee, then the lead is carried out and 100 degrees.
The structure of the hip joint implies not only the movement of the hip, but also the movement of the entire trunk, as well as the pelvis itself. Such movements of a person occur constantly, especially during walking, and even when the leg is in a free position.
The volume of all movements of the hip joint is determined by:
- the angle of the femoral neck;
- the size of the wings directly to the ilium;
- in the form of a large spit.
Muscles play an important role in the functioning of the hip joint. They are very massive and surround it from all sides. Muscles in the human body ensure the normal movement of all joints. Without them, correct coordination is simply impossible.
In addition, it is on the muscles have the most basic load, when a person is walking or running. They are active shock absorbers when driving. The major muscles that surround the hip are gluteal and femoral. They should be trained and developed.
Those people whose buttocks and hips muscles are best developed are less prone to injury. BecauseJoints no longer suffer from unsuccessful jumps, prolonged walking or traumatic stress. All troubles are experienced by the muscles, protecting the bones, ligaments and cartilages of the hip joint from problems.to table of contents ↑
Blood supply and lymph flow
Blood to the hip comes through the blocking and gluteal arteries. And the outflow occurs through the iliac and deep vein of the thigh.
Lymph in the pelvis falls through the lymphatic vessels( the blockage channel).And then goes on the internal iliac lymph nodes.
Anatomy and structure of the human hip
- 7 Clinical role of the joint
The hip joint is the articulation of the femur with the joint cavity of the bone pelvis. It is one of the largest in the human body. Performs an important role in the movements, carries the load of the upper half of the body.
Unfortunately, the pathology of the hip joint is very common, especially in the elderly. Injuries lead to prolonged immobilization of a person and the development of severe complications.
A prerequisite for trauma is a special pattern of joint structure, unusual blood supply, and an abundance of vulnerable elements.
Bone structures of
Which bones form the joint? In the creation of the joint, important entities are involved: the femoral head and the acetabulum of the bone pelvis.
The head of the hip is a globular structure that connects to the main bone by the neck. Under these formations there are two outgrowths( trochanter).These are the protuberances of bone tissue, to which are attached the large muscles that provide traction to the articulation.
The acetabulum of the pelvis is an element that repeats the outline of the femoral head, but with a larger diameter. Inside this fossa is an articular surface that connects bone tissue with intraarticular cartilage.
The incomplete coincidence of the dimensions of the pelvic cavity and the head causes the presence of auxiliary elements, which give the structure strength, and movements smoothness.
Cartilage elements of
Anatomy of the human hip is designed in such a way that intraarticular cartilages play a significant role in movements. It is these structures that provide an ideally smooth glide of bones.
Cartilages provide trophic( nutrition), amortize, smooth out the strength of movement, preventing the load on the bone.
Semilunar surface on the pelvic bone and fossa of the femoral head are covered with cartilaginous layers.
Another joint structure complements the articular cavity - the acetabulum. This element is fixed around the acetabular fossa and makes it deeper, turning a half-moon cavity into a large cavity enclosing the head of the thigh.
To retain the components of the joint, to limit excessive mobility, fibrous connective tissue components - ligaments - help to create a physiological correspondence between the bone formations.
A large fiber bundle that extends from the cartilaginous lip forms a transverse ligament of the acetabulum. To this structure and surrounding bone tissue is attached another fibrous element - a bundle of the head of the femur.
These fibrous structures on the outside are covered with synovial tissue, which nourishes the surrounding formations and ensures smoothness of sliding.
Articulations surround several connective tissue strands that make up the fibrous membrane.
- Circular zone is a fibrous element with a transverse direction. Surrounds the neck of the hip in the form of a loop, fixed on the bone pelvis under the acetabulum.
- The ileum-femoral ligament is a wide structure 0.8-0.9 cm thick. It performs the most important function - it hinders the re-opening of the hip, which means that it keeps the trunk from falling on the back.
- The sciatic-femoral ligament is a much smaller fibrous element that limits the excessive reduction of the extremity to the inside.
- The pubic-femoral ligament is a thin connective tissue cord on the inner part of the fibrous membrane. Prevents mobility outside.
This arrangement of fibrous fibers is necessary to perform the articulation functions.
A special fibrous structure that forms the junction of the articulation is the joint capsule. This broad stitch originates from the pelvic bone along the circumference of the cavity, and on the femur below the head so that half of the cervix remains under the capsule.
The structure of a capsule made of strong fibers is designed to retain elements of the anatomical region between each other. The space inside the cavity is filled with synovial fluid, which fulfills the nutritional function, helps maintain smoothness.
Features of movements
The hip joint is a bones joint, shaped like a bowl or bowl. This structure allows you to make movements in the following axes: frontal, vertical and sagittal. Mobility is physiologically limited to large fibrous structures forming a thick membrane.
- In the front axle, bending( at 120 ° in the bent knee) of the leg is performed, as well as extension, which is severely limited to 14 °.
- In the sagittal plane, the leg is withdrawn and brought to an amplitude of up to 90 °.
- Around the vertical axis, the articulation can rotate up to 50 ° due to the anatomy of the femoral head. The volume is limited by intraarticular ligaments and large muscle elements of the femoral region.
Scheme of blood supply to the joint
The structure of the vessels of the hip joint of a man explains the development of pathological mechanisms that arise in trauma. Therefore, it is worthwhile examining the sources from which the joint feeds:
From the deep thigh artery( a large formation that feeds all the subcutaneous structures of this region), the inner and outer arteries that are around the femur go away toward the joint.
From an important vessel feeding the pelvic organs - the occlusion artery - the acetabular branch carrying oxygen and nutrients of the pelvic part of the joint is directed to the joint. The gluteal branches branch out from the system of the internal iliac artery - the upper and lower branches. These vessels through the anastomoses( joints) are involved in feeding the articulation.
The feeding circuit of the femoral head includes vessels from the periarticular plexus that run around and inside the neck, providing a blood supply to this structure. Therefore, with fractures of this anatomical region, fasting of the head of the femur develops, leading to a disease such as avascular necrosis.
Clinical role of joint
The hip joint of a person performs the functions of moving in space, forming posture, holding the body in the right position and others. His whole anatomical scheme is aimed at creating a stable foundation for the trunk on one side, and ensuring limb movements on the other.
These important functions can be affected by the development of diseases such as:
- Fractures of the cervix, acetabulum.
- Arthrosis - degeneration of bone and cartilaginous tissue.
- Cartilage trauma.
Hip joint - structure, healing and treatmentFebruary 13, 2014
Hip jointThe hip joint has a nutlike shape and belongs to the lower extremity belt. He connects the pelvic bone by articulating her articular cavity, which has cartilaginous lips, with the femur head. The articular surfaces of the bones are covered with a layer of smooth cartilage. The hip joint is deeper in comparison with the shoulder joint. It is more durable, but has less freedom of movement when walking. A healthy joint provides movement in 3 planes. Retraction and reduction of the femur are made around the sagittal axis. Extension and flexion in the hip joint are performed around the frontal axis. Rotation of the hip outside or inside is a movement around the vertical axis. The fibrous capsule is attached to the hip bone along the edge of the articular( acetabular ) cavity, and the cartilaginous lip is located in the joint cavity. The upper part of the capsule is attached to 3/4 of the length of the neck of the thigh. On the front surface of the neck, the bag is fixed on the interstitial line, along the bottom surface - near the base of the small spit. Behind the joint capsule does not reach the intervertebral crest, it can be fixed at any distance - from half the length of the neck and less, to 2/3 of its length. The non-articular and intraarticular ligaments strengthen the strength of the hip joint. The intra-articular triangular ligament begins from the edge of the acetabular incision, then goes to the bottom of the pit on the head of the thigh. Outside, it is covered with a synovial membrane, and is thus isolated from the true cavity of the joint. The triangular ligament is a shock absorber when walking, preventing fracture of the bottom of the articular cavity. The transverse ligament is stretched over the notch of the acetabulum. Deep layers of the capsule of the joint contain a bundle, called the circular zone. It covers the neck of the hip and forms the fibrous base of the joint bag. Its fibers are attached to the inferior anterior iliac spine. The sciatic-femoral and pubic-femoral ligaments connect the circular zone with the adjacent sections of the pelvic bones. The functions of the sciatic-femoral ligament are strengthening the joint capsule from the rear, fixing it on the ischium and limiting the turning of the thigh to the inside. The function of the pubic-femoral ligament is restriction of the hip rotation. It passes along the upper branch of the pubic bone and is attached to the small spit. The most powerful ligament of the human skeleton is the ileum-femoral ligament. Its thickness is normally 7 mm, and width - 7-8 cm. This ligament is from the anterior lower iliac to the large trochanter of the thigh, attaching closer to the middle, reaching the intertwining line to a small skewer. Its function is to restrict the movement of the hip backwards, that is, overextension in the joint.
Embryonic development ofTissue and hip joint structures develop from the mesoderm, the middle germinal leaf. The laying of the structures of the hip joint of the embryo occurs at the 6th week of pregnancy. The greatest value in the proper maturation of the joint belongs to the intrauterine period and the first year of the child's life. Hip joints of newborns are still immature and quite unstable. The marginal parts of the acetabulum, the head and neck of the femur, retain a partially cartilaginous structure at the time of the birth of the child. The acetabulum in the newborn has an oval shape, shallow and contains only 1/3 of the femoral head( in adults - 2/3 ).In infants, the angle of vertical tilt of the cavity is 60 °, and in adults - 40 °.The head of the hip of infants is held in the flat joint cavity due to the tension of the ligamentous apparatus and the joint capsule. The displacement of the head upwards and dislocation is prevented only by the cartilaginous plate along the edge of the acetabulum. The weakness of the ligaments, characteristic of newborn children, contributes to the instability of the joint. During the first year of the child's life, the hip joint stabilizes. The angle of inclination of the articular cavity and the slope of its roof are reduced, the centralization of the femoral head is normalized, the ossification of its neck is normal, the capsule and ligamentous apparatus are strengthened.
Congenital dysplasiaIn newborns, there is a disruption in the maturation of the hip joints - congenital dysplasia or congenital dislocation of the hip. An anomaly of development in infants can be suspected by the apparent asymmetry of the gluteal folds. To clarify the diagnosis, X-rays are performed. X-ray symptoms of hip dysplasia of newborns:
- nuclei of ossification of the femoral head are arranged asymmetrically;
- on the side of the lesion, the ossification nucleus is smaller;
- contours of cores are uneven, fuzzy, can be fragmented;
- on the affected side, the nucleus of the femoral head ossification is not projected into the center of the joint cavity. Another X-ray symptom of dysplasia is an increase in the so-called neck-diaphysial angle> 22 °.Neck-diaphyseal is the angle between the neck of the femur and the main part of the femur - its diaphysis. Normally it is 22 °.An increase in this parameter indicates the presence of joint dysplasia in the child. Treatment of dysplasia is conservative: a set of exercise exercises for infants and "wide" swaddling are used. Interesting facts:
- , people born with hip dysplasia, are more likely to have osteoarthritis in adulthood;
- in those peoples, whose women wear babies on their hips with widely divergent legs, congenital dislocation of the femur in children is almost never found.
Methods of investigation ofThe state of internal structures of the hip joints is assessed using radiotherapy methods. The X-ray reveals the condition of the bones, with the help of ultrasound, they study the condition of the articular cartilage. The most modern way of informative and safe research of any joints is magnetic resonance imaging( MRI ).
Acquired diseasesDiseases and hip joint damage in the final stages cause disability of patients. The leading symptom of hip joint lesions is pains that increase dramatically when walking. The main difference between articular pain and the symptoms of pinching of the nerve root is the absence of irradiation along the posterior surface of the leg along the sciatic nerve. Common hip diseases:
- traumatic dislocations and subluxations in the hip joint;
- fracture of the femoral neck due to trauma or osteoporosis( bone loss );
- non-infectious necrosis( necrosis ) of the femoral head;
- arthritis is an inflammation of the joint, which has various causes.
CoxarthrosisOsteoarthritis( osteoarthrosis ) of the hip has its specific name - coxarthrosis. All three terms denote a degenerative-dystrophic process in the articular cartilage. Arthrosis can be suspected when the joint hurts badly when walking. Treatment of coxarthrosis can be conservative and operative. In the initial stages of the disease, many people try to treat coxarthrosis by folk methods, using rubbing, ointments, compresses. These measures improve blood circulation in the joint, reduce jet inflammation, slow down the destruction of cartilage. For medicinal treatment, anesthetics and chondroprotectors are used - cartilage protectors that improve nutrition. Non-drug treatment of arthrosis - rehabilitation for people with joint damage. Rehabilitation of patients with coxarthrosis includes:
- training of patients for exercise physical therapy;
- massage courses;
- compliance with the diet;
- courses of physiotherapy and sanatorium treatment. In case of inefficiency of conservative tactics, a substitute( " prosthesis ") of the synovial fluid is inserted into the joint. It is a preparation of hyaluronic acid, which facilitates the gliding of cartilage of articular surfaces and facilitates its restoration.
ProstheticsIn the final stages of osteoarthritis and other diseases, with the threat of complete immobility, as well as massive damage, the operation of replacing a worn joint with an artificial prosthesis is performed - endoprosthetics. In many countries around the world, doctors have accumulated extensive experience in successful hip replacement. This operation allows the attending person to return to a full-fledged life. The cost of hip replacement in Russian clinics ranges from 80 thousand rubles and more. Until recently, there were also free programs of prosthetics of large joints financed by the state. But it was really possible to implement free prosthetics patients only after a few years waiting in line.