Hip dysplasia ( congenital hip dislocation ) - Causes, Symptoms and Treatment .MF .
talk about such abnormality of the hip joint development as congenital hip dislocation or, to speak in the language of physicians, dysplasia of the hip joint .The reasons for the development of dysplasia can be a variety of factors, such as the "heredity", "breech", "toxemia of pregnancy", "large fruit" and even elementary underdevelopment of the fetus.And she dysplasia vary in shape: predvyvih (immature unstable joint, which in the future is developing or fine, or to the side of subluxation, and the head of the thigh it is easy sprained, so easily and reduce a into place), subluxation (this is a change in the joint structure,accompanied by the displacement of the femoral head to the acetabulum up and away) and dislocation (complete dislocation of the femoral head).All of these changes lead to the pathology of the support function of the lower limb.
reveal the presence of dysplasia can be a child's only after his birth.Therefore, mother should be adequate attention to the baby, starting from its ver
Congenital hip dislocation
symptoms of hip dysplasia in children
How can mom suspected congenital dislocation of the hip?Sure, you have to be attentive to the child who is at risk (above the causes of dysplasia have been described).Also, there are certain symptoms which can be suspected anomaly.These symptoms characterize the disease clinic.
1) If a child is not the year:.
- a symptom of "click" (symptom slipping Marx Ortolani in practice: in the moment of maximum abduction the femoral head as if with a "click" reduce a into the cavity ask mothers do not carry out experiments on children and to provide.definition of the symptom of skill);
- asymmetry of skin folds.Mom, watch this!When you put the baby in the abdomen and straighten the legs, it becomes noticeable that podyagodichnye folds are at different levels (at the healthy child they are the same);
- limiting rotation of the hips of your offspring in different directions;
- the naked eye can see the shortening of one leg relative to the other;
- during sleep is obvious that given to the tummy knees are at different levels.
Symptom Marx Ortolani
2) Children older than one year:
- child later becomes its feet and begins to walk (only 15-16 months, there is a desire);
- kid limping on his injured leg (duck walk);
- more pronounced lumbar bend;
- symptoms that you have identified in children under one year, become clearer.
- gluteal muscle attachment points are close together, and the weakened muscle tone.Since the symptom Trendelenburg: When standing on a sprained foot, then the other half of the pelvis omitted.
Diagnosis of hip dysplasia in child
If doctors suspect a diagnosis of dysplasia, they should be sure to carry out X-rays, on the basis of which the violation of the hip joint of the pelvis of a child is finally determined.It is also used ultrasound of the joints, arthrography, CT, angiography and arthroscopy.And most importantly, remember that your own need never put any diagnoses, because the child may not be dysplasia, but just strong bruise or sprain due to any injury.
good skill is required to identify the symptoms as limiting retraction thighs can also occur, for example, spastic paralysis, congenital hip viral strain, and even neonatal muscle spasm.Symptom asymmetry of skin folds is taken into account the presence of other symptoms, and is not an absolute indication, although it is observed in approximately 50% of patients.
When the doctor determined and diagnosed, it is necessary to strictly follow his further guidance and not to self-medicate.Remember, the earlier identified and began to treat the disease, the better the prognosis!
Treatment of hip dysplasia
Treatment consists in breeding and fixing baby feet until both joints and muscles "grow stronger".
Treatment predvyviha: take the legs (a straightened state) to the side and locked in that position (use the bus Vilna and rods-spacers that zafiksirovanny plaster or special cuffs
Treatment of subluxation:. thigh should be perpendicular to the axis of the body (used tire CITO, Volkova, perfume Frejka, stirrups Pavlik wide swaddling
Treatment of dysplasia:. stirrups Pavlik wide swaddling
Treatment of dislocation is much longer: apply its reduction by a long (about 4 weeks) stretching. Foot-axis simultaneous with their breeding, inward rotation and smooth summing the thigh bone to the head cavities and then superimposed the bus for up to 7-8 months if there is no result - have resorted to surgery
Information for moms: in.the first month of life it is necessary to use a wide swaddling baby in nezavisimomti on whether there is already a diagnosis of dysplasia or not (rectangular diaper folded and sandwiched between the baby's legs (feet take aside at 60-80 °).Legs bent at the hip and knee joints.The child quickly becomes accustomed to this kind of diaper changing and perfectly carries.Of course, if it is possible, it is best not to swaddle the baby at all.
is also necessary to carry out gymnastics: dilute baby hip during a diaper change, when dressing, prodelyvat exercise 6-8 times.Good to swim on his tummy.Thus it is possible to stretch and warm up the muscles of the lower extremities that your child will only benefit.
Furthermore, for the treatment of a child with joint dysplasia apply:
- physiotherapy (electrophoresis with calcium in particular for the hip area);
- massages (classic massage, use priemamy such as stroking, rubbing, kneading and vibration);
- physiotherapy (hydrocolonotherapy most effective - is exercise in water).
massage and physiotherapy exercises should be carried out only by trained health worker.
the treatment of hip dysplasia child begins to walk long.But do not put the child on his feet without the permission of an orthopedic doctor, because you can lose everything, what you have accomplished during the treatment of the disease.
If conservative treatment is not successful, surgery is performed: reposition head thigh.The operation can be carried out only for children older than five years.There are various surgical techniques.They can be divided into the following groups:
- open reduction of dislocation of the hip joint;
- operation on the part of the femur, which is closer to the pelvic bones;
- surgery on the pelvic bone (osteotomy Hiari);
- operation aimed at facilitating the lives of sick children, their sufferings and reduce pain (palliative surgery) in Shangqiu, Koenig.The number of operations is determined individually.After the operation is carried out long enough to fix, followed by rehabilitation with the use of reasonable physical activity, therapeutic exercises, physiotherapy and massage.
If we stick to the doctor's recommendations, the treatment ends in 1-2 years.
Rehabilitation of children with hip dysplasia
Postoperative rehabilitation of children with hip dysplasia is a controversial topic for many orthopedists.No one opinion about how much should last plaster immobilization of physiotherapy methods on when to start loading.One thing is for sure, is that a normal joint further development and avoid possible complications depends entirely on the quality of rehabilitation.
Tasks postoperative rehabilitation:
- improvement of the muscle;
- restoration of movement in the joint, which has undergone surgery;
- walking training.
Periods of rehabilitation:
2. immobilization period (koksitnaya bandage), lasts 2-3 weeks, plus reconstruction of the acetabulum up to 4-5 weeks.
3. Change the baby bandage of plaster at a special abductor bus Vilna (2-6 weeks after surgery).
4. The last period begins about a year after the operation and lasts about a year and a half.The main task of this period - the proper training of walking.A child should not walk with a limp, still maintain a level posture, steps should be smooth.Walking should immediately be short (5-10 minutes), gradually increasing the time to 30 minutes;be sure to alternate walking with rest.Along with walking exercises are used in a standing position (this may be squats and leg swings naturally with support).
Starting from the fourth period, it is desirable to carry out the exercises in the pool.
Physiotherapy with hip dysplasia
- strengthening the back, abdominal and gluteal muscles, hip internal rotators, etc., if necessary, stretching and relaxation of muscles when they are stretched;
- improving body tone;
- improvement of the respiratory and cardiovascular systems and their functions;
- breathing gymnastics, which will certainly enrich the child's body with oxygen and give new strength to fight the disease.
- On the second or third day of treatment employ UHF-therapy.Treatments take place every day at 6-10 minutes (5-7 exposures).
- From the second week with dysplasia joints should fall under the influence of an alternating magnetic field of low frequency (a sedative and tonic effect, increased metabolism, circulation, tissue nutrition Duration -. 10-20 minutes, daily, 15-20 sessions).
- UFO in the non-operated joint.
- vitamin (vitamins A, vitamins B, C, D, etc.)
- electric stimulation of weakened muscles.
- mineral wax or paraffin 3-4 times directly on the knee of the operated leg, and then the hip joint (30-40 minutes, the temperature of 40-45, every day, 20-25 procedures).
At discharge a sick child instructor physiotherapist teaches parents and some major individual for their baby massage techniques and complex exercise.
forecast hip dysplasia
If hip dysplasia to identify at an early age, then, if you assign the correct and timely treatment, the disease can be completely eliminated, as if it had never been.
Also today, many people live with hip dysplasia his whole life, and it does not experience any disturbing symptoms and signs, in addition to an external defect and gait changes, which is not a positive trend.
If a child's parents have not seen the child and the disease was found by chance during the examination, for example, of the X-ray, the patient must constantly newly and regular check-ups at the orthopedist and come on inspections not less than once a year.
Ed.doctor traumatologist Savchenko VR