Dysplasia
The content of the article:
- Causes and risk factors
- Forms of dysplasia of the hip joints
- Stages
- Symptoms of hip dysplasia
- Diagnostics
- Treatment of dysplasia of the hip joint
- Possible complications and consequences
- Forecast
- Prevention
Dysplasia (from the Greek dys - violation + plaseo - form) - abnormal development of tissues, organs or body parts. One of the most common types of dysplasia is hip dysplasia.
The hip joints support the spine, upper and lower torso, they are flexible due to the connection of the femoral head to the acetabulum using ligaments and provide freedom of movement in several directions.
With dysplasia of the hip joints, disorders appear in the development of the osteoarticular base, the main parts of the articulation of the muscular and ligamentous apparatus, their incorrect position relative to each other is observed. The formation of such disorders occurs as a result of exposure to certain endogenous and exogenous factors during the period of intrauterine development of the fetus.
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Dysplasia of the hip joints occurs in 2-3% of infants. Children's dysplasia is more common in girls: 80% of diagnoses are recorded in female newborns. Familial cases of pathology are recorded in 25-30% of patients and are transmitted through the maternal line. About 80% of cases of dysplasia are due to damage to the left hip joint.
It is noticed that the incidence of this pathology in different regions is influenced by racial and ethnic characteristics, environmental conditions and traditions of child care. So, in Germany and Scandinavian countries, hip dysplasia is recorded more often than in South China or Africa.
Causes and risk factors
The main cause of abnormalities in the development of cartilage, bone and muscle tissue is genetic abnormalities.
In addition to genetic predisposition, the occurrence of dysplasia is influenced by other risk factors that arise during the embryonic and postnatal period of a child's life and affect the establishment and development of the fetal connective tissue:
- the effect on the fetus of toxic substances (drugs, pesticides, alcohol, narcotic substances) and aggressive physical factors (radiation, ionizing radiation);
- viral diseases suffered during pregnancy;
- endocrine disorders, anemia, diseases of the kidneys, heart, blood vessels, liver in the expectant mother;
- pronounced early toxicosis of pregnant women;
- unhealthy diet during pregnancy, vitamin deficiency, deficiency of vitamins B and E;
- unfavorable ecological situation in the region of residence;
- violation of the structure of the myometrium;
- elevated progesterone levels in the last trimester of pregnancy;
- a decrease in the volume of amniotic fluid below the normal level;
- breech presentation of the fetus (the fetus rests on the lower part of the uterus with the pelvis, not the head);
- a large fetus is an increased risk factor for the development of pathology of the hip joints, since if the location of the fetus inside the uterus is disturbed, the likelihood of bone displacement increases;
- the tone of the uterus during childbearing;
- tight swaddling.
Forms of dysplasia of the hip joints
- Acetabular (congenital) form of dysplasia is a congenital anatomical abnormality caused by the abnormal structure of the acetabulum. The pressure of the femoral head causes deformation, displacement and curvature of the limbus cartilage, located along the edges of the acetabulum, into the joint. The joint capsule is stretched, the acetabulum becomes elliptical, the cartilage ossifies, and the femoral head shifts.
- Epiphyseal (Mayer's dysplasia) - affects the proximal femoral region. There is stiffness of the joints, pathological disorders of the cervico-diaphyseal angle, its change in the direction of increasing or decreasing, and deformities of the limbs may occur.
- Rotational dysplasia is a deformity of the mutual localization of bones when viewed in the horizontal plane. Clubfoot is a manifestation of rotational dysplasia.
Dysplasia of the hip joints can also be congenital or acquired (the first symptoms of joint dysplasia appear and increase after the first year of life).
Stages
There are three stages of dysplasia, which differ in severity and clinical and radiological picture:
- Pre-dislocation ("mild dysplasia"). Some abnormalities in the formation of the hip joint are diagnosed: muscle fibers and ligaments are stretched, the head of the femur is in the beveled acetabulum, while the surface of the acetabulum remains practically unchanged.
- Subluxation. There is a flattening of the articular surface of the acetabulum and displacement of the femoral neck and head of the femur outside and upward relative to the articular cavity within the boundaries of the articulation.
- Dislocation. It is characterized by deep deformations in bone, cartilaginous, muscle tissue. The femoral head moves completely upward, leaving the borders of the acetabulum. Dysfunction of the muscles of the lower extremity develops, a pathological curvature of the spine forms in the lumbar spine.
Source: reh4mat.com
Symptoms of hip dysplasia
Dysplasia of the hip joint is manifested by the following disorders in the development of cartilage, bone and muscle tissue:
- disproportion of articulating surfaces: flattening of the acetabulum, which takes an elliptical shape with a spherical shape of the femoral head;
- elongation of the joint capsule;
- underdevelopment of the ligaments.
The first symptoms of hip dysplasia can be diagnosed even in the hospital, before the baby's parents have complaints:
- asymmetry of skin folds. The number of folds increases on one thigh; in the prone position, folds on one side are located higher and deeper;
- Slip Marx-Ortolani syndrome: the head of the femur slips with a characteristic click when pressure is applied to the hip axis and limbs are extended to the sides. During the period of increased muscle tone (starting from a week of age), the symptom disappears;
- shortening of one leg compared to the other, which is determined by the height of the kneecaps: on the healthy side, the joint is located higher than the affected;
- restriction during hip dilation, it is possible to separate the limbs by no more than 60 ° (normally, the limbs bent at the knees are spread apart at an angle of 80–90 °). The symptom is valid until the tone of muscle fibers increases, only in the first days of life.
The final formation of joints is completed after the child begins to walk independently. With the progression of changes in the connective tissue components of the joint, signs of late stages of hip dysplasia are distinguished:
- late getting to your feet and late starting to walk;
- gait disturbances (walking with the toe inward, lameness, "duck gait", that is, rocking from side to side);
- complaints of pain, pain in the hip joint and in the back;
- the development of excess lumbar lordosis;
- fatigue, instability in the hip joint after exercise or long walking.
Along with the main signs, concomitant symptoms of dysplasia can be identified:
- torticollis;
- violation of the search and sucking reflex;
- muscle atrophy in the affected area;
- softness of the cranial bones;
- decrease in the pulsation of the femoral artery from the side of the altered joint;
- valgus or varus placement of the foot.
Diagnostics
External examination and palpation are performed using orthopedic tests to detect slipping syndrome, symptoms of limited abduction of the lower limbs, asymmetric skin folds, and limb shortening.
The identified deviations are investigated in detail using the methods of instrumental diagnostics:
- Ultrasound of the hip joints. Due to the absence of radiation exposure, ultrasound can be performed repeatedly to assess the state of connective tissue structures in dynamics. The method allows you to identify deviations in the structure of the connective tissue, to calculate the angle of deepening of the hip joint;
- X-ray examination - establishes the anatomical relationship of the bones of the thigh and pelvis, the placement of the femoral head in relation to the edges of the acetabulum. Radiography is not inferior in reliability to ultrasound, but it has a number of disadvantages (radiation exposure, additional manipulations for visualization, the inability to assess the state of deviation in the structure of bones, cartilage, joints). Radiography also confirms secondary manifestations of coxarthrosis in adults;
- magnetic resonance imaging and / or computed tomography is prescribed when planning a surgical intervention and is used to obtain a clinical picture in various projections;
- arthrography and arthroscopy are invasive diagnostic methods, they are prescribed in severe cases of dysplasia to obtain detailed information about the joint.
Source: online.org
Treatment of dysplasia of the hip joint
Depending on the severity of the dysplastic process, conservative (in milder forms) and surgical methods (with subluxation or dislocation of the joint) are used.
The goal of conservative therapy for dysplasia is to normalize the anatomical shape of the hip joint and preserve motor function. The following methods are used:
- massage;
- maintaining the correct position of the hip joints. To do this, use wide swaddling, as well as special orthopedic devices for fixing the hip joints in the correct position - orthopedic pants, Frejk's pillow, elastic Vilensky and Volkov splints, Pavlik's stirrups, fixing braces;
- closed reduction of dislocation with temporary immobilization of the limb (imposition of a rigid bandage). The method is used in severe cases of the disease and only in children under 5 years old;
- Remedial gymnastics - carried out with each diaper change or swaddling, while the child's legs are pulled apart several times and brought back together. Swimming on the stomach is also effective;
- physiotherapeutic procedures (electrophoresis of calcium chloride or lidase, applications with paraffin, ozokerite, mud therapy);
- skeletal traction (traction) of the damaged joint;
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Surgical methods for the treatment of hip dysplasia include:
- open reduction of pathological hip dislocation;
- corrective osteotomy - correction of deformities of the femoral head and articular surfaces;
- endoprosthetics (replacement of an affected joint with an artificial one in adults).
Possible complications and consequences
Progressive dysplasia in children can lead to serious consequences:
- change in gait and posture;
- flat feet;
- dysplastic coxarthrosis in adulthood;
- lordosis;
- scoliosis;
- osteochondrosis;
- neoarthrosis;
- disposition of internal organs;
- necrosis of the tissues of the femoral head.
Forecast
On condition of early detection and initiation of adequate therapy under the supervision of an orthopedist, the prognosis is favorable, restoration of damaged structures and complete recovery is possible.
Prevention
In order to prevent the development of dysplasia of the hip joints in newborns, the following preventive measures are observed:
- prevention of negative effects on the fetus, including the refusal of the pregnant woman from bad habits, minimization of her intake of medicines;
- regular passage of a planned ultrasound scan in order to identify and correct breech presentation;
- control of the tone of the smooth muscles of the uterus;
- compulsory examination of newborns belonging to the risk group: children with a burdened heredity on this basis, belonging to the category of large, with deformed feet, female newborns;
- rational nutrition and an active lifestyle of the mother during pregnancy and breastfeeding;
- free swaddling;
- using diapers that do not put pressure on the pelvis.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
