Hip dysplasia - symptoms and signs of pathology. Treatment of dysplasia - massage, gymnastics, exercises

The hip joints connect the largest fragments of the human skeleton. They must be flexible and able to withstand heavy loads. Dysplasia hip joint in newborns, disrupts the development of the musculoskeletal system due to wrong position femoral heads. Early detection of pathology and properly selected treatment will lead to the absolute recovery of the child.

Pathology is recorded on average in 3 percent of children. The disease is rare in southern countries, where it is not customary to swaddle babies tightly. So, in Japan, they abandoned the artificial restriction of the mobility of newborns, and the number of children with dysplasia decreased tenfold.

Hip dysplasia in newborns is 4 times more likely to affect girls.

More than half of sick children suffer from a defect in one joint - the left. In other cases, the right or both joints are weakened.

The reasons for the development of hip dysplasia in newborns include a hereditary predisposition - the disease can be transmitted through the maternal line.

In addition to genetics, there are other risk factors:

• Restriction of mobility in the mother's abdomen or in the baby with the help of diapers;
• Excess progesterone in the last trimester of gestation;
• The strongest toxicosis at the beginning of pregnancy and the tone of the uterus throughout its entire length;
• Intoxication, including alcohol, drugs, pharmaceuticals;
• Incorrect position of the fetus (more often - breech presentation) or its large size;
• Deficiency of valuable elements (especially calcium, phosphorus, vitamin E);
• Congenital defect of the acetabulum;
• Diseases of the expectant mother - chronic or infectious.

It is believed that joint problems may arise due to unfavorable environmental conditions in the place of birth.

What types and degrees of the disease exist?

In infants, the ligaments are overly elastic and are not always able to hold the femoral head in articular cavity. Under unfavorable circumstances, she assumes an unnatural position. Depending on this, four main types of hip joints are determined in a child with several subtypes:

1. normal joint
2. There are minor violations.
3. Hip subluxation.
4. Strong dislocation.

Most babies register type 2a. This is a mild degree of illness, predislocation. Muscles and ligaments have not yet been changed, but if treatment is not started, the disease will move into more serious stages. With subluxation, the ligaments lose tension, and the head begins to move upward. A dislocation will cause it to come out of the cavity, and the treatment will be lengthy, possibly even surgical.

The form of the disease also affects the therapeutic course:

• Acetabular, when, due to the incorrect structure of the acetabulum, the joint torsion, cartilaginous ossification and displacement of the femoral head occur.
• Epiphyseal, characterized by poor joint mobility and severe pain;
• Rotational - with incorrect placement of bones in the plane, leading to clubfoot.

Each form can appear on any of the joints or on both.

How to detect pathological changes?

Symptoms of the disease can be seen in maternity hospital during the first days of a baby's life. The neonatologist examines the baby, taking into account risk factors and the severity of the pregnancy. Girls and large boys should be especially carefully examined. But more often, hip dysplasia in children is detected by an orthopedist who conducts the first examination.

Symptoms of hip dysplasia in a newborn

The main signs of the disease, which are easy to detect for parents:

Additional signs are a disorder of the search and sucking reflex, abnormal pulse and flaccid muscles in the area of ​​the hips and pelvis, torticollis. In older children, the disease may be indicated by late getting up on legs, a “duck” gait, problems with coordination of movements. When similar symptoms you should make an appointment with an orthopedist.

hardware research

Based external examination and palpation is never diagnosed. If a disease is suspected, hardware studies are necessary.

The most effective diagnostic methods include:

1. Ultrasound diagnostics. Allows you to identify pathological changes in children in the first months of life.
2. X-ray. It also gives an accurate result: deviations from the norm are visible on x-ray photos. But for children of 1 year of age, such a procedure is not recommended due to harmful radiation.
3. Computed and magnetic resonance imaging. Perform surgeries as necessary to obtain complete picture state of the joints in several projections.

Arthrography and arthroscopy allow you to judge the condition of bone surfaces, ligaments, cartilage. Due to the complexity of their implementation, they are used only in the most incomprehensible cases.

Very important differential diagnosis, because there are diseases with similar symptoms, but requiring different therapeutic methods. These include paralytic dislocation of the hip, arthrogryposis, rickets, metaphyseal fracture, epiphyseal osteodysplasia.

Methods of treatment for the diagnosis of hip dysplasia in infants

Even if the joint defect is not too significant, therapy should be started immediately. A predislocation can turn into a dislocation.

In addition, the treatment of a baby up to six months will be quick and effective, the smallest is enough to undergo therapy for two months. The disease in children after a year is treated much longer.

Therapy

The therapeutic technique depends on the degree of neglect of the dysplastic process.

Methods for curing dysplasia in the first year of life include:

Stirrups Pavlik

In serious cases, fixing splints are used. These can be elastic splints of Vilensky and Volkov or gypsum analogues with a distraction system. This therapy is designed for children up to 3 years. Individual options are also used for older children, but usually as a safety net after surgery.

Closed reduction of dislocation in the pelvic joint is carried out in difficult cases for children under 6 years of age. Those that are older, such therapy will only hurt. Skeletal traction can help with severe pathologies preschoolers up to 7 years old.

The most advanced options, if it is impossible to solve the problem with therapeutic methods, are treated surgically.

Surgery

The operation can be open or endoscopic - it depends on the severity of the disease. Usually, if the treatment of dysplasia is started on time, conservative methods can be dispensed with.

Risks associated with surgical intervention(bleeding, infection, and the risks associated with anesthesia) are minimal. However, at the time of the operation children, podiatrists really need to take extra careto avoid a condition called aseptic necrosis,which head femur(ball of the hip joint) does not get enoughblood condition,which can lead to abnormal bone growth.

Physiotherapy, exercises for hip dysplasia, massage

Gymnastics for hip dysplasia is aimed at flexion-extension, reduction-breeding of the legs. Exercises can be performed at home, but exercise therapy should be recommended by an orthopedist, focusing on the age and severity of the pathology.

Physiotherapy will reduce inflammation and pain, improve cell regeneration in tissues. To the most effective procedures these types include:

• electrophoresis;
• Paraffin applications;
• Amplipulse therapy;
• Ultrasound;
• Magnetotherapy;
• Hyperbaric oxygenation;
• Acupuncture;
• Mud cure.

Massage will strengthen the muscles and joint bags for hip dysplasia in newborns. It must be done regularly six times a day before feeding. The newborn lies on the back, and the adult spreads the legs bent at the knees as much as possible and alternately straightens and bends them eight times.

What is the prognosis for recovery?

With the timely start of orthopedic therapy full recovery absolutely real. But if you ignore the problem, the disease leads to severe complications and disability.

Without treatment, these children face high risk development of osteoarthritis in adulthood, with the corresponding degenerative changes that cause chronic and progressive pain and stiffness in the joints.

While numbers are difficult to pinpoint, some members of the medical community estimate that up to 50% of adults whose health conditions ultimately require hip replacement due to osteoarthritis have the disease as a result of an undiagnosed childhood, problems with the hip joint. In most cases, in adult patients, during the examination, hip dysplasia is also diagnosed.

Consequences of hip dysplasia in newborns:

• Dysplastic coxarthrosis;
• neoarthrosis;
• Musculoskeletal dysfunctions;
• posture problems;
• Scoliosis;
• flat feet;
• Osteochondrosis;
• Necrotic changes in the femoral head.

To prevent this from happening, the disease should be treated as early as possible. Better yet, ensure that the baby is born healthy. The expectant mother should avoid negative effects on the fetus, eat right. You need to swaddle the baby freely, so that nothing interferes with the movement, and the diapers do not put pressure on the pelvic area.

As already noted, the earlier the disease is diagnosed and treatment begins, the higher the chances of a successful outcome: complete reduction of hip dislocation, which is confirmed on x-rays and physical examination. Children who have been treated for hip dysplasia should be seen by an orthopedist on a regular basis (frequency determined by the doctor, but most often once every 3-6 months) until the skeleton is fully strengthened (until the child stops growing) to ensure that normal development of the hip joint continues. In some cases, a dislocated hip that has been successfully corrected may still develop into dysplasia in subsequent years, requiring additional treatment.

A pediatric orthopedist will help identify the problem in the early stages, who should examine the baby up to three months. He will advise what to do with any joint problems.

Remember that only a doctor can make a correct diagnosis, do not self-medicate without consultation and diagnosis by a qualified doctor. Be healthy!

Malformations of the skeleton and connective tissues, if not treated in time, can cause many serious problems and cause significant discomfort to its owner. Congenital dislocation of the hip or hip dysplasia is a common diagnosis. Find out why this disease is dangerous, how to treat congenital pathologies of the pelvic bones and what to do during the rehabilitation period.

What is hip dysplasia

The femoral bed consists of the ilium, which is lined cartilage tissue and is called the acetabulum. In the cavity of the bed is the head of the femur, and ligaments form around it. This is a kind of capsule that helps the femoral head to stay inside the bed with a standard tilt of the acetabulum. Any violation of biomechanics - hypermobility of the joint, insufficient ossification of the heads, violation of the axis of the thigh - is considered dysplasia.

In newborns

Dislocation of the hip in infants is manifested by a violation during the development of one or more of its immature joints. At the same time, the elasticity of the cartilage is lost, the acetabulum is leveled, and the femoral head becomes soft. Over time, the bones become shorter or begin to grow in right direction. Depending on the displacement of the structures, such a pathology is characterized as a dislocation or subluxation.

Hip dysplasia in newborns is much more common than a similar problem in adults. At the same time, late ossification appears more often in girls. In almost half of the cases, underdevelopment of the hip organs suffers from left side body, and the share of bilateral disease accounts for only 20%. Scientists believe that the pathology of pregnancy, the pelvic location of the fetus, heredity, and poor fetal mobility provoke the disease.

In children after a year

Detect disease in one year old baby easy, because by this time the children begin to sit, walk and crawl on their own. In this case, limping may appear on the leg on the side of which the pathology of the pelvis is located. If the hip dislocation is bilateral, the child walks like a duck. In addition, in sick children decreases in size gluteal muscle, and with pressure on the heel in the prone position, mobility of the axis of the leg from the foot to the thigh is observed.

In adults

The geometry of the joint in adults may be impaired due to trauma or be a continuation of a childhood illness. This occurs due to intrauterine disorders, as a consequence of complications during difficult childbirth, with pathologies of the endocrine system of the body. Treatment for adults is longer and more complex. Often standard methods therapy is not enough, then doctors recommend doing joint replacement.

Reasons

Doctors believe that congenital dislocation of the hip can happen by different reasons. For example, scientists have recently found that adverse natural conditions, hereditary factors, frequent stress can contribute to the development of this pathology and exacerbate treatment. The main reasons are:

• pelvic presentation of the fetus;
• too much big weight newborn;
• infectious diseases of the mother;
• tight swaddling;
• joint injuries;
• deviations in the development of the spine;
• foot deformity;
• pathology spinal cord;
• hormonal disorders;
• restriction of intrauterine movements of the fetus;
• the age of the woman in labor is over 35 years.

Species

Hip dislocations are unilateral and bilateral, the latter are very rare. In addition, doctors divide pathology into three main types:

• Acetabular dysplasia. Symptoms: an acetabulum of a non-standard size, as a rule, is reduced in diameter, has a flat base and an underdeveloped cartilaginous dome.
• Dislocation of the femur. Normally, the femoral neck connects to the body at an angle of 40 degrees in adults and 60 degrees in newborns. Violation of the angle leads to dislocation.
• rotational dysplasia. Described as a violation of the anatomical structure and placement of bones. It manifests itself in children in the form of clubfoot, shortening of the limb.

Degrees of dysplasia in children

Doctors distinguish several stages of development of violations of the geometry of the hip joint, depending on the severity. These include:

• Initial stage. When structural changes have already begun, but have not yet developed to the point where the doctor can make a diagnosis after visual inspection.
• Predislocation. It is characterized by stretching of the capsule, a slight displacement of the femoral head.
• Hip subluxation. The head of the joint is noticeably displaced in relation to the trochanteric cavity. It slightly shifts the rim, as a result of which the ligaments of the thigh become stretched.
• Dislocation. The head is outside the acetabulum, up and out. The edge of the cartilaginous rim is pressed and bent inward. Retaining elastic ligaments have lost their flexibility.

What is dangerous hip dysplasia in children

A dislocation that is not diagnosed in time can cause serious disorders in the structure of the hip organ and many unpleasant symptoms. With unilateral dislocation in children, there is a violation of gait, limited mobility, pelvic tilt, pain in the knees and hips, and slight muscle atrophy. If bilateral dysplasia has been diagnosed in a child, you can notice a duck gait, deterioration in function internal organs small pelvis, the appearance of pain in the lumbar region.

For adults, the consequences of dysplasia are fraught with arthrosis of the hip joint and dysplastic coxarthrosis. The last pathology of the musculoskeletal system is characterized by a decrease in physical activity, deterioration of the muscles, pain in the back, legs, and hips. Sometimes, at the place where the femur is in contact with the pelvic bone, there is an increase in a false joint - neoarthrosis. Clinical symptoms manifested in the form of acute pain, lameness, shortening of one leg. Often, neoarthrosis is observed in other connective tissues and threatened with disability.

Signs in babies

Visual diagnosis is desirable to carry out up to seven days after birth. At this stage muscle ligaments the baby is relaxed, more mobile and elastic. Doctors can suspect hip dislocation in children at risk: girls, babies with breech presentation, newborns in mothers with severe toxicosis, or when the child was born with a large weight. Wherein external signs hip dysplasia in infants may be absent. Diagnosis is usually based on three main criteria.

Asymmetry of skin folds

The skin folds under the knee, in the groin, on the back and front of the thigh should be a mirror image of each other: they should be of the same size and depth. If, in the prone position, the cavities are located higher than each other, it is likely that the symptom indicates instability of the joints. Do not forget that slight asymmetry can be even in healthy children. The criterion for diagnosing gluteal folds is not objective in case of bilateral disorders.

Click symptom

Such a sign is considered the most reliable only when the diagnosis of the disease is carried out no later than 3 weeks after birth. If the head of the femur moves when the hip is abducted or the turn of the leg is accompanied by a click, this indicates that the head has slipped from the joint capsule. To detect dysplasia in older children, it is advisable to use more informative examination methods.

Angle of hip abduction

Another symptom congenital dislocation- the inability to spread the child's legs in the supine position at an angle of 90 degrees. For an unhealthy hip of 2 or 3 degrees of severity, the angle of inclination is not more than 60 degrees. Such a symptom can be found at the age of 3 to 6 weeks. When muscle tone is increased, it will be problematic to achieve the desired result.

How to identify hip dysplasia in newborns

If a clinical methods diagnostics did not give a definite answer, the orthopedist will prescribe additional examinations: X-ray or ultrasound procedure. Both methods help to detect underdevelopment of the acetabulum, deviations in the structure of the neck, head or bone. In the case when this did not give results, they resort to magnetic resonance imaging or CT.

X-ray diagnostics

Transillumination of the bone skeleton with X-rays, although it creates a serious radiation load on the child's body, but at the same time helps to get a picture of the structure of the acetabulum and head. In newborns and children younger age most of the hip joints consist of cartilage, so the study is carried out in a special way. The picture is drawn horizontally and vertical lines to form a cetabular angle. Its value is the basis for the diagnosis.

Ultrasound diagnostics

The method is considered to be the safest. Doctors conduct an initial examination up to 7 days after birth for children who are predisposed to the development of pathology. In the future, with the help of an ultrasound machine of the hip joints, the following is monitored: the state of the bone part, the cartilaginous protrusion, the position of the femoral head at rest and during movement is studied, and the angle of the acetabulum is calculated. To interpret the data obtained, fixed norm tables are used.

Treatment of dysplasia in children

Therapy for congenital dislocation of the joint will be more successful the earlier it was started. Treatment is always carried out in a complex using therapeutic gymnastics, physiotherapeutic procedures, special struts, orthopedic splints and massages. Full recovery the anatomical structure of the hip joints will take a long time. On average, doctors give forecasts from two months to a year, but sometimes the treatment regimen is extended.

Wide baby swaddling

One of the effective methods of treatment in the first days of a baby's life is the fixed swaddling technique. To do this, a soft diaper, folded several times, is placed on the crotch and secured with another cloth. Due to this, the baby's legs remain constantly in the divorced position of breeding / bending at the desired angle. If dysplasia in children was detected on late stage, the legs are additionally fixed with a plaster cast.

Stirrups Pavlik

The principle of this method is based on fixing the bend of the legs at the knees using stirrups. Pavlik's adaptation is produced ready for use - it is a chest bandage sewn from soft tissues, with shoulder and popliteal strips for fixing the limbs. You need to wear a bandage for about a month. If the results of the control examination are unsatisfactory, the dislocation is reduced under anesthesia, and the stirrups continue to be worn for another 5-6 months. The Pavlik design cannot be used when:

• pronounced displacement of the femoral head;
• infringement of the capsule;
• significant violations in the structure of the acetabulum.

Massage

Massotherapy helps to speed up blood circulation, strengthen the hip muscle groups, improve trophism ligamentous apparatus. The technique involves the use of soft stroking, tapping or rubbing movements. Massage is done daily. First knead the chest, upper and lower parts of the body, stomach. Then smoothly transition to massage inner surface hips, bend and take the legs to the sides, make movements with the limbs in a circle.

Physiotherapy

Physiotherapy is used to improve metabolic processes in tissues, normalize blood circulation in the damaged area. Different techniques contribute to the elimination of pain and muscle spasms. For children, as a rule, choose:

• warm baths;
• ultraviolet irradiation;
• paraffin or ozocerite compresses;
• electrophoresis with calcium, phosphorus or iodine.

Reduction of congenital hip dislocation

When conservative treatment dysplasia does not help, the doctor may suggest a joint correction procedure - closed reduction of dislocation. As a rule, this method will give the desired effect in the treatment of children under two years of age. After bloodless reduction, it will be technically difficult to perform, therefore, for children from 3 years old, head reduction is done in a way skeletal traction. After the procedure, for rigid fixation, plaster bandages will be put on the legs, in which it is necessary to pass up to 6 months.

Surgery

The operation is indicated for children who have not been helped by all of the above methods. Its essence lies in the arrangement of all components of the hip part in the right direction. Surgical methods There are a lot of treatments: open reduction of a dislocation, corrective surgery, derotational osteotomy, joint replacement surgery, and so on. The choice of the best method depends on the degree of deformation of the pelvic cavity and the elasticity of the ligaments.

Treatment of dysplasia in adults

To relieve chronic pain and reduce inflammation, drugs from the NSAID group are used, for example, Ketoprofen, Naproxen, Ibuprofen or Diclofenac. To prevent complications or treat osteoarthritis, neoarthrosis, to prevent the development of coxarthrosis, chondoprotectors are prescribed: Rumalon, Arteparon and other intramuscular injections. Eliminate defects and serve as a prevention of dysplasia exercise exercise therapy.

Exercises

The task of gymnastics is to strengthen muscles, to establish motor activity. Exercise therapy is used at all stages of treatment, except surgical intervention(immediately before and after). It is recommended to do exercises daily 2-3 times, during breaks for rest, you can knead the limbs with a massage. Approximate set of exercises:

• Get into a supine position. Bend your knees. On the count of three, start imitating cycling by moving your legs back and forth. You need to repeat gymnastics 10-15 times.
• From the same position of the body, try to bring the feet as close to each other as possible.
• Do alternate flexion-extension of the legs, equally distributing the load on both limbs.

Video

Dysplasia is a violation of the development of the joint, as a result of which there is a predisposition to dislocation - the exit of the head of the bone from the articular bag. In newly born babies, this defect most often affects the hip joints. Dysplasia in newborns is quite common: in some regions of Russia, up to 20% of children suffer from it.

Causes of malformations of the joints

The musculoskeletal system of the fetus begins to form at 4-5 weeks of gestation. This process ends after birth, when the baby begins to walk actively. Contrary to popular belief, hip dysplasia in newborns does not appear due to improper actions of physicians during childbirth, but occurs gradually during pregnancy. Experts consider heredity to be the most common risk factor: more than a third of children suffering from this disease are born in those families where cases of dysplasia in newborns have already been observed. The sex of the child also matters: in girls, congenital defects in the development of the joints are diagnosed 4 times more often than in boys. Dysplasia often affects the left joint (in 60% of cases), developmental defects of the right joint and both joints simultaneously account for 20% of cases.

The causes of hip dysplasia in newborns can also be:

• Breech presentation of the fetus. If the baby is located in the mother's abdomen incorrectly, this prevents him from actively moving. As a result, the tissues of the joints can be formed in such a way that the child will be born with the first stage of dysplasia (the so-called pre-luxation is a state of the joint when there is no displacement of the femoral head yet);
• Too much or too little baby weight at birth;
• Infectious diseases suffered by a woman during pregnancy;
• Violations of metabolic processes in the mother's body and, as a result, a violation of the water-salt metabolism in the fetus;
• Severe cases of early or late toxicosis;
• Chronic heart disease that the mother of the baby suffers from.

At risk are also those children who are tightly swaddled by inexperienced parents. In these babies, an undiagnosed mild form of congenital dysplasia can develop into subluxation or dislocation of the hip joint.

Signs of dysplasia in newborns

Until the middle of the last century, defects in the development of the hip joints in infants in our country were considered only obviously severe forms dysplasia: dislocations and subluxations. Today, predislocations are also diagnosed, which makes it possible to avoid severe complications and in time to help babies born with malformed joints. Therefore, every child in the first days of life is examined by an orthopedic doctor. If the baby is at risk or has Clinical signs diseases, the doctor prescribes ultrasound: this method is the most reliable in the diagnosis of hip dysplasia in newborns under the age of one and a half to two months.

Attentive parents may notice in a child the following signs dysplasia:

• Leg abduction restrictions. In a baby lying on his back, legs bent at the knees can be spread so that the angle between the hips is 160-170 degrees (“frog pose”). A sign of dysplasia in a newborn is the impossibility of taking such a position: the affected joint does not fully unbend;
• "Click Syndrome". When bending the legs of the crumbs, a characteristic clicking sound is heard in the knees and hips;
• Asymmetry of the buttocks and gluteal folds. In a baby lying on his tummy, the buttocks have different shape. The folds on the affected leg are higher than on the healthy one. There is an additional fold on the thigh.

If the mother noticed at least one of these signs, she should show the child to the doctor. It should be remembered that in the case of dysplasia in a newborn, the count goes literally for days - the baby needs immediate help, because without it the severity of the disease will increase, and the result can affect the entire future life of the child, up to limited mobility and disability.

Treatment of dysplasia in newborns

To restore full motor functions in babies suffering from subluxations or dislocations of the hip joints, apply manual therapy, massage, physiotherapeutic procedures, physiotherapy exercises. An experienced chiropractor can correct a mild form of joint dysplasia in a newborn in a few sessions. In such cases, when caring for a baby, a wide swaddling is recommended: a folded piece of cloth or a flat pad is inserted between the baby's legs, which gently holds the hip joints in a moderately divorced position. In more severe cases, complex treatment of dysplasia in newborns is used, which takes much longer. At the same time, the baby has to wear special “struts” (Feik’s perinka or Pavlik’s stirrups), fixing the legs in the “frog pose”, and ensuring the further normal development of the joints. Parents who find such treatment too cruel should not worry: such a position does not cause any inconvenience to the baby. On the contrary, it is natural for him. By the way, in those regions of the world where it is customary to carry children on their backs in this position of the legs, cases of dysplasia in newborns are relatively rare. votes)

Such a diagnosis as hip dysplasia in infants is often made to newborn children. Although the diagnosis of pathology is often difficult, to detect initial symptoms can already be in the 1st year of a child's life. If the therapy is not started in time, the disease may be accompanied by negative consequences that worsen the quality of life.

Such a pathology of the musculoskeletal system develops as a result of the impact on the body of one of the many factors that cause a violation of the intrauterine laying of organs. These factors cause underdevelopment of the hip joints and all their elements that form the joints.

Severe pathology occurs with a violation of the articulation between the acetabulum and the head of the femoral bone. Violation of the musculoskeletal system causes unpleasant clinical manifestations for the child, including pain and complications in case of untimely treatment. Congenital underdevelopment is often diagnosed: 3 out of 100 newborns have such a pathology. Girls are more susceptible to the disease than boys.

In addition, underdevelopment more often affects the left side, while the right side undergoes changes less often. Bilateral pathology is also rare.

Causes and factors contributing to the development of pathology

What is hip dysplasia and what are the causes of the pathology? An incorrectly formed hip joint is a consequence of a violation of the development of the fetus during the prenatal period, the laying of the musculoskeletal system starting from the 4th-5th week of its stay in this environment.

Sources that can adversely affect the fetus can be considered:

• gene mutations, which contribute to the development of orthopedic abnormalities with a violation of the primary anlage and the formation of a defect in the hip region of the embryo;
• negative physical and chemical agents that affect the fetus: ionization, chemicals, poisons, medicines that a woman abuses during the period of bearing a child;
• breech presentation of the fetus or large size fetus, which can cause joint displacement due to a violation of the anatomical localization of the fetus in the uterine environment;
• disturbed water-salt metabolism in the fetus with the development of intrauterine infection or renal pathology.

Among the factors that relate to a pregnant woman, we can distinguish:

• development of a severe somatic disease in a pregnant woman: heart dysfunction, vascular pathology, severe renal or hepatic pathology, heart disease;
• development of beriberi, anemia;
• disturbed metabolic processes in a woman's body;
• the development of a severe infectious and viral disease;
• maintaining an unhealthy lifestyle (abuse of smoking or drugs, alcohol), non-compliance with proper nutrition;
• early or late toxicosis.

There is a risk group for the development of such pathological condition, given which, the doctor can timely detect hip dysplasia in children under one year old. This group includes premature babies, large children, as well as children who were in the womb in a breech presentation. They take into account how burdened the anamnesis is and how the pregnancy proceeded.

Please note: if the child has too weak muscle tone, this may indicate. This disease manifests itself in the inability of the muscles to function normally.

Symptoms and severity

The first examination is carried out even within the walls of the maternity hospital, immediately after birth.. If dysplasia was diagnosed during this period, it will be easier to cope with the underdevelopment of the femoral region. Sometimes the symptoms of hip dysplasia in children can be noticed already at home, after discharge from the hospital (read about). Parents should be alert for the following symptoms:

• asymmetric folds (gluteal, inguinal, femoral): if you put the baby on a flat surface, for example, on a changing table, and legs at the knees, all inguinal, femoral and gluteal folds will not be at the same level;
• different amplitude: if you put the baby on his back, bend his legs at the knees, and then spread them to the sides, the knees will not touch the surface or will have different angle tilt.

All symptoms of a condition such as hip dysplasia in infants can be distributed according to severity:

• 1 degree (pre-luxation): the femoral part is underdeveloped, but there is no displacement of the femoral head;
• Grade 2 (subluxation): head hip bone partially displaced;
• Grade 3 (dislocation): the head is completely displaced.

Follow to find out if a hematoma on the head of a newborn is dangerous and how to determine its presence.

Types of dysplasia

Pathology can be unilateral and bilateral. The latter type is rarely diagnosed. also in medical practice There is a division of pathology into the following types:

• acetabular displacement: non-standard size of the acetabulum, mostly reduced, the cartilaginous dome is underdeveloped;
• dislocation of the hip: with the normal development of the femoral neck and its body, the angle connecting them is 40 ° (if the angle is violated, dislocation occurs);
• rotational displacement: violated anatomical structure and placement of bones (symptoms: clubfoot, limb shortening).

Diagnostics

To make a correct diagnosis, the doctor finds out whether the newborn is at risk: whether the pregnant woman suffered an infectious disease or intoxication, in what environmental situation she lived, whether there is a burdened family heredity, etc.

To confirm the diagnosis, instrumental diagnostic measures are prescribed.

Ultrasound examination of the hip is a mandatory method to help identify dysplasia. AT without fail Ultrasound is performed for children under the age of 3 months who have signs of pathology. Manipulation is completely safe and quite informative. Examining the deformed area, the doctor checks the condition of the bone as a whole, the cartilaginous protrusion, the angle of the acetabulum.

X-ray will be informative in detecting pathology in babies over the age of 7 months. Up to 7 months, most of the acetabulum and the head of the bone are covered with cartilage, and it will not be visualized on an x-ray.

Therapy Methods

Treatment of hip dysplasia in newborns is divided into several groups:

• orthopedic;
• physiotherapy;
• surgical.

The choice of the method of therapy depends on what are the features of the development of the pathology and the degree of its severity. In any case, it is necessary to carry out physiotherapy exercises and massage for hip dysplasia in newborns. Follow the link to find out how the treatment is carried out and how this disease is diagnosed.

Orthopedic Therapy

The main goal of orthopedic therapy for a disease in infants is to center the femur in the joint and “build up” its roof. The hips are given a "forced" position with the help of devices:

• Freyka pads;
• diverting trousers;
• discharge bus Vilensky;
• outlet bus Koshlya;
• discharge bus Mirzoev;
• outlet bus Volkov;
• stirrups Pavlik;
• Gnevsky apparatus.

The choice of device and its fitting are assigned to the orthopedist. It is strictly forbidden to select and choose a device on your own, because you can not only slow down recovery, but also cause additional harm to the health of the baby. The doctor will consult on how to care for the child in the device, how to remove it.

Wearing orthopedic appliances should occur around the clock. Its withdrawal is possible only for the time of acceptance. water procedures, massage and physiotherapy exercises. With mild dysplasia or in the final period of therapy, the device is worn only at night.

Physiotherapy treatment

Dysplasia in a newborn responds well to physiotherapy. One of the main ones is. Wet plates are applied to the diseased area - electrodes with a solution of Eufillin (most often). Electrophoresis for hip dysplasia in children has a minimum of contraindications.

Another way of physiotherapy is thermotherapy, or rather paraffin therapy. Exposure to the affected areas of white paraffin contributes to their heating. For newborns, use white look paraffin, since it does not contain any harmful substances and impurities.

Magnetotherapy is also often prescribed. The affected area is affected by a magnetic field, which helps to speed up metabolic processes and blood microcirculation. Such processes contribute to the acceleration of tissue development (muscle, cartilage, connective).

It is possible to reduce increased excitability, nervousness and hyperactivity in infants with the help of hydrotherapy. The main advantage of the method is the possibility of using it at home. For example, decoctions from medicinal herbs or sea salt.

Physiotherapy can be supplemented with gymnastics, which, with hip dysplasia in newborns, gives good results. Exercise therapy for hip dysplasia in children is prescribed by a doctor, taking into account the peculiarities of the development of the pathology.

Surgery

Surgical intervention is necessary only for hip dysplasia in children after 1 year. Direct indications for surgery - true congenital dislocation and impossibility of reduction conservative methods. The operation is performed if, after a closed reduction, a repeated dislocation occurs.

A common surgical technique is open reduction of the femoral bone (osteotomy). Despite its effectiveness, the risk of re-dislocation still remains. Another disadvantage is the long recovery period.

Complications in case of untimely action

Delayed initiation of therapy may cause dangerous consequences. When the baby begins to walk, he may limp. Lameness manifests itself both barely noticeable and pronounced (depending on the severity of dysplasia). It will be difficult for him to move his leg to the side, he will be disturbed constant pain in the knees and in the pelvic region. Perhaps even distortion of the bones and muscle atrophy.

With age, such unpleasant symptoms only increase in intensity. Among the consequences of hip dysplasia in children is a "duck" gait, with a rollover from one leg to the other. Limitation motor activity dangerous underdevelopment not only of the thigh, but also of bone elements in other areas, as well as a violation of the work of all internal organs.

Prevention

You can avoid such complications and the development of pathology if you follow simple recommendations:

• daily physical activity(for example, rotational movements of the legs, their breeding to the sides, etc.);
• bringing the legs into moderate breeding (free swaddling);
• preventive massage;
• proper holding of the child in her arms: facing the mother so that the legs cover her torso.

Prevention also applies to pregnant women. Expectant mother should lead a healthy lifestyle, observe proper nutrition, exclude the influence of harmful factors.

Forecast

If timely start taking remedial measures hope for a favorable prognosis and full recovery. In the absence of proper therapy, the outcome depends on the severity of the pathology.

conclusions

A child who has been diagnosed with such a diagnosis is registered with an orthopedic doctor until the age of 16. Even in infancy, pathology cannot be eliminated for short term, and if you start treating it at the wrong time, the correction will take even more time and effort.

Finally, watch the following video. In it, Dr. Komarovsky will talk about what hip dysplasia is and how to identify it in a baby.

Congenital joint diseases are not such a rarity in newborns. It is important for the parents of these children to understand that the health of the joints and bones of the child in adulthood depends on how quickly such pathologies are eliminated by doctors.

On the other hand, you should not panic, because. dislocations of bones found after childbirth do not pose a serious danger if they are corrected in time. Such conditions are quite successfully corrected and treated. modern medicine. Hip dysplasia in newborns is the direct cause of congenital dislocation of the hip.

Until recently, domestic orthopedists singled out this condition as a separate disease. But the results of studies of patients with this pathology indicated that the cause of its development is underdevelopment articular surfaces, as well as other anatomical structures of the hip joint. Dislocation in this case is the result of a severe degree of impaired intrauterine development of this anatomical region, which is commonly referred to as hip dysplasia (hip joint).

The main task of the hip joint in the human body is to provide all the functions of the lower limb (abduction-adduction, flexion-extension, rotation). This is a movable articulation of the femur and pelvis, which allows walking, running, squatting, etc. simultaneously with the muscular system. In terms of functional ability and amplitude of movement of the limb, such a joint is second only to the shoulder joint. Dislocation (the process in which one of the articular surfaces leaves the joint) of the hip in such a joint leads to complete violation supporting function of the leg.

In a newborn child, mild degrees of underdevelopment of the hip joint and even its dislocation can only be diagnosed by a doctor. This is due to the fact that children in this early period life is not yet able to walk, and accordingly, it is difficult for parents to identify such an orthopedic problem. The success of the treatment of this pathology, diagnosed in the first year of life, guarantees a good functional ability of the limb in adulthood.

A variety of reasons that can lead to dysplasia in a baby, as well as a high incidence of such a pathology, make it an urgent disease for both pediatricians and young parents.

Modern medicine has not yet been able to establish a single cause that provokes the development of joint dysplasia in young children. Physicians' observations indicate that hereditary causes play important role in the development of this pathology. It should be noted that the effect of various adverse factors environment leads to the development genetic mutations and affects the rate of intrauterine development of the fetus. Naturally, this negatively affects the formation of bone structures such as joints, and especially those that connect the thigh to the pelvis.

In addition to heredity and poor environmental conditions, other conditions have been established that provoke the occurrence of this pathology. Most often, joint dysplasia in a newborn is associated with the following intrauterine factors:

1. Pelvic presentation. This is the position of the fetus in the uterus, when its legs are turned towards the woman's pelvis. In this position, the lower limbs of the child are functionally limited by the tight space of the uterus. Most likely, this leads to underdevelopment of the hip joints. Childbirth in the case of such a presentation of the fetus is not just for both the unborn child and the mother. Therefore, in the process of moving the fetus through birth canal quite often there is a dislocation of the femoral head from an immature joint.
2. A child with an intrauterine body weight greater than the average, those. over 4kg. Dysplasia in this case is also associated with a relative lack of space in the uterine cavity. This does not allow the articular surfaces to fully and correctly develop due to the fact that the legs cannot move to their full amplitude.
3. Toxicosis during pregnancy. An increased risk of developing hip dysplasia in babies whose mothers suffered toxicosis during gestation, especially in the last trimester of pregnancy, has been established. Probably, the development of such a pathology is associated with a violation of normal metabolic processes at the fetus. Such changes reach the maximum degree of severity during the period when the phenomena of intoxication did not allow the pregnant woman to eat normally, and also to adhere to proper routine day.

Leg dysplasia in newborns, which is often manifested by deformity of the feet, can also accompany the process of underdevelopment of the hip joint. In this case, the cause of the violation normal development lower extremities become various exogenous factors (toxins, chemicals, medicines, radiation etc.) or endogenous causes (a number infectious diseases etc.).

How to detect a disease in a newborn?

Mild hip dysplasia usually does not show up in a baby after birth. However, at an older age, the occurrence of pain and the appearance of intolerance to large physical exertion indicate that the joint was underdeveloped even in utero. In the case when such changes in the articular surfaces lead to the failure of the joint, its subluxation or dislocation develops, the following signs of which can be determined in a newborn:

• When trying to spread the baby's legs, there is a feeling of limitation of the movement of the limb, which is accompanied by pain. Since the femoral head does not fully contact the articular surface of the acetabulum, the amplitude of leg abduction decreases.
• Hip slip symptom which is also determined when trying to breed the baby's legs. In this case, the femoral head is independently reduced into the joint (a characteristic click is felt), and then leaves it again due to the underdevelopment of the structures of this anatomical region.
• displacement of the femur, leading to the fact that the limb becomes shorter. This is also manifested by the visual asymmetry of the inguinal folds of the skin in a newborn.

Every neonatologist and obstetrician-gynecologist knows how to identify the symptoms of a congenital form of hip dislocation that accompanies dysplasia. It is these specialists who after childbirth, having identified signs of pathology, are invited for a consultation. pediatric orthopedist. Having examined the newborn, he can not only confirm the disease, but also prescribe a set of examinations to accurately determine the degree of hip dysplasia.

A pediatric orthopedist evaluates in full all segments of the lower limb, the length of both legs, as well as the angles at which the child's leg can be bent, abducted or adducted. It is also assessed whether there is indeed a "click" symptom and an insufficient angle of abduction of the limb. To establish the final diagnosis, the specialist prescribes an ultrasound of the hip joints to the child of the first year of life, less often - an x-ray of this area of ​​the body. Based on the results of the examination, the doctor will be able to choose the most effective method treatment of this pathology in the newborn.

Hip dysplasia in a newborn is detected by the results objective examination, as well as ultrasound (or radiography).

Diagnosis of dysplasia

The “golden” diagnostic standard, which allows to determine the presence of insufficient development of the hip joints in a child, is ultrasound. This study is carried out for all children, without exception, with symptoms of a dislocation in the hip joint, as well as newborns who have an increased risk of developing dysplasia. Unlike other examination methods, ultrasound is absolutely safe and harmless to babies. Ultrasonic waves do not cause any negative reactions in body tissues.

Features of the bones in children of this age allow the doctor to assess enough wide range parameters of the hip joint. Ultimately, this helps determine if newborns have dysplasia. During the examination, the following parameters are evaluated:

1. The position of the femoral head (it should be centered relative to the acetabulum, its displacement is not observed normally).
2. Tilt of the acetabulum of the pelvic bone. This indirectly indicates the development of such a formation (the bone roof of the joint).
3. Cartilaginous roof angle of the joint and cartilaginous prominence

By evaluating all these parameters, one can not only establish the type and subtype of dysplasia, confirm the violation of the integrity of the joint, but also answer the question of whether hip or pelvic bone dysplasia progresses over time. The displayed planar images during ultrasound give the same picture as radiography. This allows you to compare the results of both research methods.

However, the use of x-rays for the diagnosis of dysplasia in children of the first year of life is undesirable. This is due both to the risks of increased radiation exposure to the body (the radiodiagnostician emits ionizing radiation), and the low information content of the method ( proximal the hips and pelvic bones still have a cartilaginous structure, therefore they are poorly distinguishable on the radiograph). If, for a number of reasons, X-rays are still preferred to determine dysplasia, then such a diagnosis is carried out by drawing conditional lines and determining the angles formed by anatomical structures in the joint.

A congruent joint is one in which the articular surfaces fit together perfectly. That should be the norm.

Treatment and rehabilitation for pathology

Hip dysplasia of any degree requires competent and sometimes long-term treatment. The task of all measures taken by the orthopedist is to ensure the correct development of the articular surfaces, which are responsible for the functionality of the joint in the later life of the child.

The treatment of such a pathology should include a special position of the legs (a posture in which the legs are bent and laid aside), but without rigid fixation of the limbs. Domestic and foreign doctors have proposed a wide range of orthopedic products that can be used to treat dysplasia in children of the first year of life (Pavlik's stirrups, Volkov's splint, Freik pillows, etc.).

In modern medical practice, doctors use industrial medical devices to give the necessary position to the lower limbs of the child. The basis for them is the principle proposed by the Czech orthopedist Arnold Pavlik. If, for various reasons, such orthopedic products cannot be used in a newborn, it is recommended to carry out wide swaddling with the position of abduction of the lower extremities up to 60-80 degrees. Also, this method is recommended for prophylactic use in children at risk of developing dysplasia.