Procedures for hip dysplasia. Features of treatment of hip dysplasia in children

Most orthopedists and pediatricians under dysplasia hip joint imply congenital inferiority of the joint, which is caused by its underdevelopment and can lead to subluxation or dislocation of the hip. This pathology can significantly complicate the child’s life in the future and lead to gait disturbances and pain in the hip joints. It is clear that it is important for young parents that the first symptoms of dysplasia are recognized in time: only then can all the necessary therapeutic and preventive actions to prevent the development of this disease.

Manifestations of dysplasia

Hip dysplasia is the most common type of musculoskeletal deformity in children. Hip dysplasia, taking into account the degree of severity, can be divided into three types: preluxation, subluxation and dislocation.

When the hip is dislocated, the head femur completely loses contact with the acetabulum, with subluxation - only partially. With pre-dislocation, the centering of the femoral head in the socket is disrupted.

Based on this, it is possible to determine the main manifestations of hip dysplasia.

First of all, it should be noted the limitation of hip extension and the presence of asymmetry of the inguinal and gluteal folds. There are more of them on the affected side and they are deeper. With dislocation, these symptoms are accompanied by shortening of the leg on the affected side. It should be noted that limited hip abduction and asymmetry of skin folds can be associated not only with hip dysplasia, but also be a consequence of impaired muscle tone.

In severe cases, when the femoral head is in a state of complete dislocation, the slipping symptom, or “clicking symptom,” is determined. It appears when the child’s legs are bent at the knee and hip joints, as well as during their subsequent separation, when the femoral head is reduced into the socket of the hip joint.

In case of late diagnosis of subluxation in a child older than six months, limited hip extension and the presence of slight shortening of the limb are determined. With complete dislocation, shortening increases and gait is impaired. "Duck gait" or intermittent claudication is observed with bilateral dislocations.

Diagnostics

How to recognize dysplasia on early stages? In the maternity hospital, already early postpartum period, diagnosis can be made by performing an ultrasound of the hip joints. This method is absolutely harmless and can give reliable result about the presence of a gross pathology in the child, such as dislocation or pre-dislocation of the hip joints. All of the above symptoms of this disease may be an indication. With the aim of early detection For joint malformations, orthopedists recommend an ultrasound scan for all newborns. But it should be noted that at present this study is still done only if pathology is suspected or when risk factors are identified.

Even if an ultrasound diagnostic specialist does not suspect any abnormalities, do not forget: at the age of 1 month the child should be examined by an orthopedist, and at the same age it is recommended to do the first ultrasound of the hip joint. This required condition for early detection of hip dysplasia. Starting from 3 months, children can undergo an X-ray examination of the hip joints, which will most reliably show the presence or absence of one of the three forms of dysplasia in the child (dislocation, subluxation, preluxation). The main difficulties in diagnostic terms are, of course, caused by the first degree of dysplasia, which can It is completely asymptomatic, and a diagnosis can only be made by taking a picture. On radiographs of the hip joints, early radiological signs of dysplasia are detected using a special scheme, which allows one to determine the underdevelopment of the hip joint and the location of the femoral head relative to the glenoid cavity. The main indicator of the stability of the hip joint is the angle of inclination of the roof of the glenoid cavity. The steeper it is, the better the support, and the more stable the joint. Considering this main indicator, you can decide on methods for the prevention and treatment of hip dysplasia.

Structure of the hip joint

The hip joint - a movable connection of bones that allows them to move relative to each other and performs a supporting function - is one of the large ball-shaped joints of our body. It is the main supporting joint and bears a significant load when walking, running, and carrying heavy loads. Its shape can be imagined as a ball located in a deep round socket. The articular cavity of the hip joint is formed pelvic bone and is called the acetabulum (acetabular) cavity. It contains the head femur, which is connected to the body of the femur by femoral neck. Somewhat below the femoral neck there is a bony prominence called large skewer. The muscles of the gluteal region are attached to this place of the femur. Joint capsule The hip joint is strengthened by powerful ligaments, attached at one end to the pelvic bone and the other to the femur. The normal anatomy of the hip joints is determined by three main parameters: the first is the angle of inclination of the roof of the hip joint - the upper part of the acetabulum, the second is the centering of the femoral head in the socket of the joint and the third is the amount of rotation of the femoral neck relative to its body.

Treatment and prevention

It is known that in newborns and children in the first months of life, under certain conditions, spontaneous reduction of the femoral head into the socket of the joint can occur. Therefore, the main collateral successful treatment is to keep the child in a position with his legs abducted. In countries with a warm climate, for example in Africa, where mothers most of the time carry their children on their backs or on their stomachs with their legs apart and children are not swaddled, the incidence of this pathology is low, since this position contributes to the proper development of the hip joints. For countries with cold climates, tight swaddling is more common (when the baby's legs are pressed against each other), in which there are no conditions for self-adjustment, and the frequency of hip dislocations remains at the same high level.

As a preventive and therapeutic measure, it is also necessary to exclude the reduction of the hips during swaddling. Loose swaddling not only helps to reduce dislocations at an early stage, but also stimulates the development and inclination of the roof of the hip joint during subluxation, thereby eliminating it. It is important to ensure the functionality and mobility of the joints. The likelihood of reduction and elimination of subluxation in this case depends on the age of the child: the younger he is, the more often self-reduction occurs and there is a reserve of time for the development of the roof of the joint. Observing the reduction of dislocations in certain positions of the child, and also taking into account the fact that the cause of the dislocation is not fully understood, it is advisable for all newborns to undergo wide swaddling. Its essence is that the baby’s legs are spread apart. To do this, a wide diaper is placed between the child’s legs (this type of swaddling can be combined with disposable diapers, but the diaper must be tight to prevent arbitrary contraction of the legs).

Immediately after the baby is born, movement in the hip joints is usually free, and only then does restriction of abduction develop. This is due to the predominance of the physiological tone of the flexors over the tone of the extensors. From the first days of a child’s life, it is necessary to include abductor-circular movements in the hip joints (3-5 movements each) in the complex of daily gymnastics in order to prevent restriction of abductor movements of the hip joints. Such gymnastics is needed for children with limited hip abduction.

Free swaddling and therapeutic exercises for most children with easy degrees dysplasia (subluxation or preluxation with slight displacement of the femoral head) ends with the normal formation of the hip joints. If treatment and preventive measures begin before the age of 3 months, then complete recovery is possible. Due to the fact that clinical signs may not be detected immediately, at 3 months all children need to be re-examined by an orthopedist. The triple examination system (in the maternity hospital, at one month and at three months of age) makes it possible to identify pathology of the hip joint in the first months of life in the vast majority of babies. In most cases, radiological data in combination with the results of a doctor's examination are sufficient to establish the correct diagnosis.

What is the cause of dysplasia?

Every year, up to 3% of babies are born with a diagnosis of hip dysplasia. What are the reasons leading to this violation? There are many theories about the origin birth defect joint development.

One explanation is a defect in the formation of organs and tissues, when incorrect formation joint occurs in the first two to three months of pregnancy. This is mainly due to unfavorable environmental factors(chemicalization and general pollution environment), affecting the formation of tissues and their further development.

Dysplasia due to hereditary predisposition is more common, so it is necessary to take into account the presence in the family of relatives with pathology of the hip joints, dysplasia or congenital dislocations of the hips, as well as systemic diseases, striking connective tissue. The hormonal factor also affects the development of joints during gestation. Towards the end of pregnancy, the mother's body produces a large amount of oxytocin, a hormone that stimulates labor. It also increases the tone of the fetal thigh muscles, which can lead to hip subluxation. This is why dysplasia occurs five times more often in girls than in boys: a female fetus is more susceptible to the influence of the mother’s hormonal levels than a male fetus. Incorrect intrauterine position of the child, prolonged labor, especially in the breech position (when the fetal buttocks are facing the exit from the uterus), and even subsequent tight swaddling of the child contribute to the slipping of the femoral heads from the sockets.

Conservative measures

Anatomical and physiological features childhood are such that the bones are more flexible and susceptible to pathological deformities. The strength of bone and its elasticity depend on the ratio of the biological (protein ostein) and mineral parts. Normally, this ratio is U3-In young children, there is relatively more osteon in the bones - up to 50%, which determines the child’s growth. The head and neck of the femur are mainly represented cartilage tissue. Therefore, if the anatomical relationship in the joint is incorrect, during the child’s growth, deformation of the femoral head and acetabulum is formed and subsequently increases. To break this vicious circle, it is necessary to center the femoral head in the hip joint, thereby creating an anatomically correct relationship between the joint structures.

For the treatment of hip dysplasia and centering of the femoral head in the glenoid cavity, different kinds outlet tires. All of them are designed to hold the child's legs in the spread position. This position stimulates and determines the normal development of the roof of the joint. In children in the first 2-3 months of life, if hip dysplasia is suspected or symptoms of dislocation are present, X-ray confirmation of the diagnosis is not required, because in any case the same treatment and preventive measures are applied. These are leg extensions using special spacers (soft splints such as Freik's pillow or Pavlik's stirrups), gymnastics using abductor-circular movements in the hip joints, massage of the gluteal muscles.

Treatment can be combined with physiotherapy, which allows you to relax the muscles that prevent the hips from spreading: for children of any age, paraffin applications are used on the joint area and electrophoresis with calcium and phosphorus (the number of procedures is determined by the attending physician). At this age it is completely unacceptable use of hard structures, that is, splints that prevent the movements of the limb made by the baby. The best principle for treating children with dysplasia, subluxation and dislocation of the hip is a combination of the optimal position of the child with freedom of movement. This is not always possible, but we must strive for this through the joint efforts of the doctor and parents.

It should be noted that the child must remain in the abduction pillow around the clock until the thigh muscles are completely relaxed. The decision to remove the diverter splints is made by the attending physician. In this case, when removing the Freik pillow, the legs remain in the abduction position without extra effort. This is a criterion for a good result in the treatment of dysplasia.

At mild degree dysplasia, the child is instructed to wear this device only while sleeping. Once the basic parameters of the hip joint are normalized on the x-ray, the above abduction splints can be removed.

The question of termination or continuation of treatment is decided by a control radiograph. In cases where the reduction of the dislocation does not occur within 2-4 weeks, but thanks to treatment it is achieved complete relaxation thigh muscles, resort to more rigid fixation in combination with constant traction. To do this, casting is performed in the Lorenz position (legs are bent at the hip joints at a right angle, hips are completely apart). It makes no sense to continue wearing Pavlik stirrups and Freik’s pillow, since they turned out to be ineffective in this case. A plaster cast-spacer consists of plaster sleeves placed on semi-bent knee joints and secured with a traction bar in the abduction position. The same tactics are used for delayed reduction of congenital hip dislocation. Such complex structures are used in cases of late detection of congenital dislocation of the hips, when soft structures are no longer effective. Therefore, I would like to once again emphasize early diagnosis.

Normalization of the hip joint with early treatment dysplasia occurs within 3-6 months in 88-95% of children.

All of the above treatment methods are aimed at gentle step-by-step reduction of a dislocation in the hip joint, which leads to a significant reduction in the number of complications compared to a one-stage closed reduction of a dislocation under anesthesia, which should not be used in any case. Most often, such an intervention leads to disruption of the blood supply to the joint and its subsequent destruction.

Patients with congenital hip dislocation after the age of one year can be divided into: the following groups: children who did not receive any treatment, those who were treated unsuccessfully various methods and children with residual effects (subluxations, consequences of closed reduction). Each child requires an individual approach in choosing a treatment method.

After the dislocation is reduced and the orthopedic splints are removed, a course of conservative treatment is carried out: massage, gymnastics and physiotherapy.

Radical measures

Irreversible dislocations usually undergo open reduction. This is a joint operation aimed at centering the femoral head in the glenoid cavity and, if possible, forming a normal glenoid cavity that provides the supporting function of the joint. It is formed surgically.

In cases where the dislocation can be corrected, surgery on the joint is not required. However, there may be a need for extra-articular surgery (leading to stabilization of the joint and its supporting function). The decision on surgical treatment for extra-articular operations can be postponed until 3 years, when the child can more easily tolerate anesthesia. For late-diagnosed (after a year) hip dislocation, the longer surgical treatment is delayed, the worse the prognosis. The fact is that by the age of one year the formation of the hip joint should be completed, since at this age children begin to walk. After surgical treatment The child is recommended to follow a comprehensive orthopedic regimen, which is selected individually for each patient, depending on the severity of the pathological process, as well as restorative treatment: therapeutic exercises, physical therapy, massage, mud therapy.

If your child is diagnosed with hip dysplasia, do not despair. In the early stages, this disease is completely curable. The main thing is not to lose contact “doctor-parent”: a lot depends on the timely and correct implementation by parents of the recommendations of the attending physician. Remember that the health and well-being of your child largely depends on you.

Hip dysplasia is a common pathology, diagnosed in 3 out of 1000 children in infancy. Most often, the disease is detected immediately after birth and is characterized by underdevelopment of the joint or weakness of the muscle ligaments. Measures to correct pathology should be applied immediately to avoid serious problems with the child's future health.

When the disease is diagnosed early in newborns and infants up to 6 months, dysplasia responds well to treatment and completely disappears by the time the baby takes his first steps. However, in advanced stages or interrupted treatment, problems with the child’s gait may occur. Limping will be accompanied by painful inflammation of the joints.

Causes of dysplasia in children

There are many reasons for the immaturity of the hip joints. Statistics show that girls are more susceptible to the disease (80% of cases), and about 60% of cases suffer from dysplasia of the left hip joint. Most often it develops during pregnancy. During this period, the appearance of anomalies is influenced by the following factors:

Genetic predisposition. If parents had immature joints in childhood, there is a high probability of developing the disease in children.
Hormonal imbalances. The increased content of progesterone in the body of the expectant mother in the last stages can weaken the baby’s muscle ligaments.
Improper and inadequate nutrition of a pregnant woman, as a result of which developing fetus There is a lack of microelements and vitamins involved in the structure of the child’s body.
Increased muscle tone of the uterus, which affects the formation of the baby’s skeleton and organs throughout pregnancy.
A large fetus with an abnormal location in the womb may be subject to anatomical displacement of the bones.
The birth of a premature baby can cause deviations from the norm in the further development of its organs, muscles and musculoskeletal system.
Bad habits and taking medications also negatively affect the development of the fetus.
Some diseases of mother and child can cause underdevelopment of joints.

Types of hip dysplasia

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The above factors have different effects on developing organism baby, therefore the anomalies of immature joints will be individual. Congenital dysplasia Hip joints in children, depending on the types of anatomical disorders, are divided into three types:

Acetabular. Congenital pathology associated with immaturity of the joint. Basically, this deviation is classified as type 2a according to Graf (ultrasound classification that determines the maturity of the joints). The disease is characterized by deviations in the structure of the acetabulum. At the same time, the femoral head puts pressure on the limbus cartilage located along its edges, causing its deformation. As a result, the capsule is overstretched and the femoral head is displaced.
Epiphyseal dysplasia. This disease is characterized by stiffness of the joints, which leads to deformation of the limbs with painful sensations. The difference in diffuse angles can change either upward or downward. This is clearly visible on the X-ray image.
Rotary. This type of disease is characterized by improper placement of bones, which leads to clubfoot in the child.

The disease can occur in mild and severe forms. Depending on this, dysplasia is determined by severity:

I degree – pre-dislocation. This deviation from the norm develops when the head of the femur enters the beveled socket of the joint, while the muscles and ligaments do not change.
II – subluxation. Part of the upwardly displaced femoral head enters the articulation cavity. In addition, the ligaments lose their tone and stretch.
III – dislocation. The head of the femur moves upward and completely emerges from the socket. The strained ligaments are stretched, causing the limbus cartilage to move inside the joint.

Symptoms of the disease

Depending on the type of DTBS in different period Throughout life, the disease will manifest itself differently in children. Severe symptoms of deviations from normal development can be noticed by attentive parents or a pediatrician during the next examination. If a diagnosis is suspected or made, the doctor prescribes a consultation with an orthopedist, who will subsequently see the child.

In newborns

Congenital hip dysplasia can be detected in newborns while still in the maternity hospital. This disease is difficult to visually recognize in grades 1 and 2, because a baby under 2 months does not feel any abnormalities, but if the problem is not eliminated in time, a feeling of discomfort and pain will begin to be felt as bones grow and cartilaginous tissue thickens.

With early dysplasia in newborns, parents may be alarmed by the following symptoms:

asymmetry of skin folds in the area of the popliteal cavities and buttocks;
the child reacts by crying when his legs try to separate;
it is difficult to separate your legs bent at the knees.

Asymmetrical skin folds on the buttocks and hips of a child with dysplasia

However, grade 3 dysplasia in newborns is more pronounced, so it is difficult to miss. In this case, the following symptoms are observed:

Click syndrome. Occurs when the legs are spread and brought together. Always present during dislocation.
Shortening one leg. This symptom is determined in the case severe dislocation limbs. To do this, the child is placed on his back, and his legs are bent at the knees, placing his feet on the table. If asymmetry is noticeable at the knee level, then dysplasia is clearly present.
Hip abduction is limited. Indicates muscle dystrophy with disruption of bone formations.
Visible abnormal placement of the hip.

In infants up to one year old

Hip dysplasia in infants under one year of age will be determined by the local pediatrician during examination. In children, there is problematic hip abduction, and in grades 2 and 3, shortening of the leg.

These symptoms are accompanied by additional signs:

asymmetry of skin folds on the legs (but in infants under 2 months of age, this symptom is a variant of the norm);
click syndrome;
muscle atrophy;
weak pulsation of the femoral artery;
disturbance of the sucking reflex.

In babies after one year

Undiagnosed and untreated hip dysplasia will cause many problems for the baby and his parents. As soon as the child begins to walk, he will feel pain and discomfort. Obvious signs of the disease will be:

limping;
pain when walking followed by inflammation of the joints;
duck gait, which occurs with bilateral dislocation.

Consequences of the disease for the child

Untreated hip dysplasia is dangerous. It leads to severe undesirable consequences, which are not always treatable. Subsequently, painful inflammatory processes lead to the death of the muscles of the diseased limb, dysfunction of the musculoskeletal system and disability.

The consequences of late detection of hip dysplasia are fraught with disability

Children who have begun to walk experience pelvic distortion, pain and muscle atrophy. Such a child begins to walk late, while limping and being capricious. With age, dysplastic coxoarthrosis develops, which by the age of 30 during hormonal changes increases inflammatory processes in the joint, resulting in immobility. The diseased joint is replaced with an artificial one.

How is dysplasia diagnosed?

When identifying underdeveloped joints in infants, the orthopedist prescribes full diagnostics diseases. In addition to visual methods, ultrasound is used. Infants from 3 months of age may additionally be prescribed x-ray diagnostics. X-rays are always used if there is a suspicion of dislocation and bilateral immaturity of the joints. All these methods help the doctor determine the severity of the disease.

After studying the results of the ultrasound and photos of the patient’s X-ray, the orthopedist will make a diagnosis and prescribe treatment (we recommend reading:). The child will be registered and the effectiveness of the prescribed treatment will be monitored over time. In general, infants up to six months of age recover quickly; it is more difficult to treat children after one year.

Features of treatment

Based on these examinations, the doctor prescribes orthopedic devices, physiotherapy and massage. They help strengthen and develop muscles, improve blood flow and rapid tissue regeneration.

However, when these methods are ineffective or the disease is diagnosed at a later stage, surgical intervention is used.

Conservative methods

For the treatment of stage 1 THD in newborns, the doctor prescribes wide swaddling (we recommend reading:). The baby is placed on his back, his legs are spread apart and cushions of 2-3 diapers are placed between them. All this is fixed with another diaper on the baby’s belt. This method is used both for the treatment and prevention of hip dysplasia. For grades 2 and 3, orthopedic devices are prescribed:

Pavlik stirrups. The baby's legs are fixed in a bent and spread position using straps and a bandage that is attached to the chest.
Vilensky tire. It is put on the child once by an orthopedist and is not removed until complete recovery. Consists of straps and a spacer, the length of which is adjustable.
Tübinger cut. It is a design of shoulder pads and 2 saddle-shaped spacers, which are connected by a metal rod.
Tire Volkova. Prescribed for children from 1 month to 3 years. The child's torso is secured in the crib structure, and the legs are secured in its side parts.
Freika's tire. Prescribed for grade 1 and 2 dysplasia without dislocation. The splint fixes the child's legs at an angle of more than 90°.

Pavlik stirrups

When the dislocation is formed, and conservative treatment did not produce results, closed reduction of the joint is used. This operation is performed on children aged 1 to 5 years. After this, a plaster cast is applied to the affected hip for up to 6 months. Typically, such treatment is difficult for children to tolerate.

Physiotherapy

Depending on the severity of the disease, the doctor may prescribe physical therapy as an additional treatment. In combination with the main one, it will help the child cope with the disease faster. These methods include:

Ural Federal District. Prescribed individually, accelerates tissue regeneration and stimulates the immune system.
Electrophoresis with phosphorus and calcium to strengthen bones and joints (see also:).
Applications with ozokerite. They are applied to the diseased joint and promote tissue restoration.
Warm bath with sea salt. Activates protective functions, improves blood circulation and promotes rapid tissue regeneration.

Therapeutic massage and gymnastics

Exercise therapy and massage are prescribed individually. These methods are used in complex therapy or for the purpose of preventing dysplasia. The massage is carried out in courses of 10 days exclusively by a specialist as prescribed by a doctor, after which it is repeated every other month. After the sessions physical therapy Usually parents are instructed to continue studying at home.

Dysplasia detected in time can be eradicated with massages and exercise therapy alone.

The purpose of these methods is:

muscle strengthening;
improved blood circulation;
maintaining joint mobility and developing the child’s physical activity;
preventing the occurrence of complications.

Surgical intervention

With severe underdevelopment of the head of the joint, late diagnosis, ineffective treatment and severe dislocation with displacement, there is an urgent need for surgical intervention. The surgical method is used to restore joint mobility and blood circulation. However, there is big risk complications after surgery:

inflammatory processes;
severe blood loss;
suppuration of the joint;
tissue necrosis.

Preventive measures

Many parents are faced with a situation where it is quite difficult to recognize hip dysplasia and the diagnosis is made when the disease is already in an advanced state.

There are cases when the disease develops gradually. Prevention is recommended to prevent the occurrence of THD. TO preventive methods relate.

3 out of 1000 newborns are diagnosed with joint dysplasia, a disease associated with congenital dysfunction of joints. Most often, the most large joints in the human body - hip, the consequences of violations of their functions can be very serious and even lead to disability. Therefore, it is important to diagnose the disease on time and begin treatment before irreversible processes develop.

Table of contents:

Causes of hip dysplasia in children

In medicine, there are three main reasons for the development of the considered pathology of the hip joint:

genetic predisposition;
violations of tissue formation during intrauterine development of the fetus;
hormonal influence.

According to statistics, hip dysplasia (HJ dysplasia) is diagnosed in 25% of cases in children whose parents have a history of the same disease. Quite often, the disease in question is diagnosed simultaneously with myelodysplasia - disorders in the process of formation of red blood cells bone marrow. Doctors associate this disorder directly with hip dysplasia.

We are talking about the unstable hormonal background of a pregnant woman - there is a high level of progesterone in the body. This hormone has a relaxing effect on ligaments, joints and cartilage - this is necessary for labor and successful delivery. But the “trick” is that progesterone has high placental permeability and enters the fetal bloodstream - this provokes softening ligamentous apparatus future child.

Note:such negative impact the hormone progesterone is particularly intense in the case of abnormal fetal position or birth in the breech presentation.

Improper tissue formation in the fetus

The rudiment of the hip joint is observed already at 6 weeks of age in the fetus; its first movements unborn child commits in the 10th week of his intrauterine development. And if at these stages the pregnant woman (and therefore the fetus) is affected by negative/harmful factors, then the likelihood of developing hip dysplasia increases significantly. Such harmful factors may include:

various chemical substances, this also includes certain medications;
unfavorable environmental situation;

Note:Viral diseases play the biggest role in the formation of tissue in the fetus - if a woman has had one in the 1st trimester of pregnancy, then the risk of giving birth to a child with hip dysplasia increases sharply.

In addition, the disease in question is diagnosed in the following cases:

the fruit is too large;
the mother is diagnosed with oligohydramnios;
breech presentation of the fetus;
diseases of the mother of a gynecological nature - for example, adhesions and others.

Classification of hip dysplasia

There are three degrees of development of the disease in question, each of them is characterized by certain symptoms.

1st degree – immaturity of joint tissue components

Most often observed in the case of birth premature baby, doctors define it as a transient condition between a healthy and a diseased joint.

Often, grade 1 hip dysplasia is diagnosed in full-term children, but born with low birth weight. This happens if the mother had feto-placental insufficiency during pregnancy.

2nd degree – pre-dislocation of the hip joint

Doctors note a change in the shape of the acetabulum, but the femur itself does not leave the socket and remains within its boundaries. No and pathological changes in the anatomical structure of the acetabulum.

3rd degree – subluxation of the hip joint

At this stage of hip dysplasia, a change in the shape of the femoral head is already noted; it moves freely within the joint, but does not extend beyond its limits.

Very important: The most serious option is considered to be a dislocation of the hip joint, which is characterized by:

gross violation of the anatomical structure of the joint;
changes are observed in the ligaments, muscles, and joint capsule;
the head of the femur extends beyond the glenoid cavity and is located either on the side or behind it.

Most often, the disease in question is diagnosed in girls, moreover, in the first year of life.

Symptoms of hip dysplasia

Signs of hip dysplasia can be divided into two large groups:

characteristic clinical picture in children of the first year of life;
symptoms characteristic of children over 12 months of age.

It is very difficult to diagnose grades 1 and 2 of hip dysplasia - obvious signs are absent, a pediatrician or orthopedist can pay attention to the manifestations during preventive examination. But parents themselves should carefully monitor the appearance and behavior of the newborn. The following factors should be of concern:

asymmetrical arrangement of folds on the buttocks and popliteal cavities;
it is problematic to separate the legs, bent at the knees;
the child shows obvious dissatisfaction and cries loudly when spreading his legs with bent knees.

At similar signs parents should visit a doctor and undergo full examination at the orthopedist. The specialist will definitely prescribe ultrasonography hip joint, which will help identify late ossification of the femoral head. In some cases, it is advisable to carry out x-ray examination– the image will clearly show the bevel of the outer edge of the acetabulum and the flattening of its roof.

Dysplasia of the hip joint is much more intense in grade 3 and with dislocation. In these cases, the following characteristic signs will be present:

"Click" symptom. This sound is heard when the doctor or parent begins to spread the legs, bent at the knees, to the sides - the head of the femur at this moment begins to enter the glenoid cavity and does this with a characteristic click. When moving back, the same sound is heard - the head of the femur again extends beyond the glenoid cavity.
Asymmetry of skin folds. This symptom is checked in a child lying on his stomach and lying on his back. It is worth paying attention not to the number of folds (it varies even in healthy children), but to their depth and height of location.

Spreading the legs to the sides is carried out with restrictions. It is this symptom that makes it possible to diagnose hip dysplasia in newborns in the first 5-7 days of life with 100% confidence. Stick to next indicator: If the limitation reaches 50%, then the disease in question is definitely present.
Shortening of the leg of a relative nature. This symptom is checked as follows: lay the baby on his back, bend his legs at the knees and place them with his feet towards the table/sofa. In a healthy child, the knees will be at the same level, but if one knee is clearly higher than the other, then this means the presence of shortening of the leg.
Erlacher's sign. Doctors determine it by bringing the newborn's straightened leg to another leg, then try to bring the limb under study behind the other (fold the legs crosswise). In a healthy newborn, the intersection of the legs occurs in the middle or lower part of the thigh; with hip dysplasia, this phenomenon is observed in the upper third of the thigh.

In the case of congenital dislocation of the hip, the painful leg will be observed to be turned outward (in an unnatural way). This is determined when the newborn lies on his back with the leg straightened at both the hip and knee joints.

Signs of hip dysplasia in children older than 12 months

It is very easy to identify the disease in question in children over 1 year of age - a characteristic sign is a gait disorder: the child limps on one leg if hip dysplasia develops on one side, or has a “duck” gait if pathology develops on both sides.

In addition, small forms of the gluteal muscles on the affected side will be noted, and if you press on calcaneus, then mobility will be noticeable from the foot to the femur (the child should lie on his back with straightened legs).

As soon as hip dysplasia is diagnosed, treatment must be started immediately to ensure recovery.

In the first month after birth, doctors prescribe wide swaddling for the baby. It is done as follows: a regular flannel diaper is folded into a rectangle 15 cm wide (approximately, +- 2 cm is allowed), it is laid between the child’s legs, which are bent at the knees and spread apart by 60-80 degrees. The edges of the diaper reach to the knees, and it is secured to the baby's shoulders with ties.

Note:The newborn quickly gets used to this type of swaddling, does not become capricious and calmly endures the moments of “packing” the legs into the desired position. After some time, the child himself begins to put his legs in the desired position before swaddling, but you will need to be patient - at first it will be difficult to calm the child down.

Wide swaddling is almost always combined with therapeutic exercises - it is elementary: with each diaper change or next swaddling, you need to slowly spread your legs to the side and return them to their place. Swimming on your stomach will also be effective.

Any procedures for diagnosing hip dysplasia can only be prescribed by a specialist! The first few times he performs therapeutic exercises medical worker, and parents learn to do the procedure correctly.

An orthopedist (or pediatrician) conducts dynamic observation monitor the child’s condition, and if no positive changes are observed, then the wearing of specific orthopedic devices may be prescribed. These include:

Treatment with specific orthopedic devices is aimed at fixing the child’s hip joints in correct position legs

The doctor prescribes devices as you grow and physical development child:

from 1 month to 6 months– it is advisable to use Pavlik stirrups; in some cases, a splint with popliteal splints will be effective;
from 6 to 8 months the doctor prescribes a splint with femoral splints;
aged 8 months to 12 months If the child is subsequently allowed to walk, the child must wear a walking splint.

Specific orthopedic devices must be worn daily, so parents are always concerned about the issue of caring for a child in this position. To make your work easier, you need to remember the following rules:

When changing the diaper, you should not lift the baby by the legs - you need to put your hand under the buttocks and gently lift them.
To change the vest, there is no need to remove the orthopedic device - you just need to untie the ties on the shoulders.
Suits, dresses, vests and any clothing can be worn on top of the splints/stirrups.
If the doctor has prescribed wearing splints, then get ready to bathe your child more rarely: 3 times a day, parents should examine the baby’s skin under belts and garters to avoid skin irritation and diaper rash. Instead of bathing, you can use regular wipes with a rag soaked in warm water. If you need to completely wash the child, you can unfasten one strap, but hold the leg in a given position during the hygiene procedure, and then wash the other side of the body in the same way.
Constantly monitor the condition of the splint itself - it should not be wet, and talc, baby powder or cream should not get under its belt/strap, as this can cause irritation of the skin.

Note:While feeding the child, the mother must ensure that the child’s legs are not brought together by the hips if this process is carried out without specific orthopedic devices.

The duration of wearing such support devices is quite long, so parents must be patient, be prepared for the whims and excessive anxiety of the baby, and in no case be cowardly! The option “let the child take a break from these terrible tires” and “nothing terrible will happen in 30-60 minutes” can result in disability in the future.

Paying attention to the dynamics of the disease in question, seeing the results of wearing specific orthopedic devices, the doctor can prescribe therapeutic exercises and massage.

Under no circumstances should you carry out this yourself similar procedures– this can significantly worsen the baby’s health. Only a specialist who leads constant surveillance for a small patient, can give some recommendations.

Therapeutic exercises for hip dysplasia

If such a procedure is prescribed, then the parents of a child diagnosed with hip dysplasia should attend several classes with a physiotherapist - the specialist will show how to do the exercises correctly and give a specific schedule of classes. There is a general description of the exercises:

The child lies on his back, the parents lift the baby’s legs up one by one, while bending the knee and hip joints.
The baby remains lying on his back, and the parent bends his legs at the knee joints and hip joints, without lifting them above the surface. Next, you need to spread the child’s legs moderately, giving minimal load, and also make rotational movements with the hips.
In a similar starting position, the child’s legs, bent at the knees and hip joints, are spread as far apart as possible, trying to get the knees closer to the table surface.

Note:each of the described exercises should be performed at least 8-10 times, and at least 3 such “approaches” should be done per day.

More full information You will learn about the diagnosis of dysplasia and exercises for hip dysplasia in a child by watching this video review:

The following can be said about massage:

despite the fact that for newborns and children under the age of 12 months it is carried out in a gentle manner, the benefits from it are enormous - the disease in question can be cured;
if you do the recommended exercises with the frequency prescribed by the specialist, the first results can be noticed after a month of such treatment;
massage by itself is unlikely to have any effect positive impact on the child’s health – it is important to carry out complex therapy.

The doctor will tell you the rules for performing a massage for hip dysplasia, and the physiotherapist will show and teach parents how to perform all the procedures correctly. Recommended set of massage exercises:

The baby lies on his back, the parent strokes his feet, hips, kneecaps, arms and stomach. Then the child needs to be turned over on his stomach and the whole body should be warmed up in the same way with soft stroking. Don't forget to "work" on internal part legs, especially the hips - for free access to these places you just need to move the child’s legs to the sides.
The child lies on his stomach, and the parent strokes/rubs the lower back, smoothly moving to the buttocks, at the end we perform gentle pinching of the gluteal muscles.
We turn the child onto his back and begin to work on the thigh muscles - stroking the legs, shaking, gently pinching. Under no circumstances should you apply any force during this part of the massage - the thigh muscles can sharply contract (spasm), which will cause severe pain. After rubbing and relaxing the muscles, you can begin to flex/extend the legs at the knee and hip joints, but only within the limits indicated by the orthopedist.
Internal rotation of the hip - the parent should fix the hip joint with his hand, the second should grab the knee and, with slight pressure, rotate the hip in inner side. Then work on the other hip joint.

After the massage, you need to give the child a rest - stroke him, rub his body effortlessly.

Note:The massage is done once a day, each exercise must be performed at least 10 times. It is impossible to take breaks in the massage course - this risks stopping the positive dynamics. The duration of the massage course is determined by the doctor.

During the therapeutic exercises and massage, it is important to understand that physiotherapeutic procedures - paraffin baths, electrophoresis using medications that contain calcium and phosphorus - will also be effective.

If the diagnosis of hip dysplasia was carried out late, or the above therapeutic methods do not give a positive result, then doctors prescribe long-term step-by-step plaster casting. In especially severe cases, it is advisable to carry out surgical treatment. But such decisions are made exclusively on an individual basis, after a thorough examination of the patient and long-term monitoring of the progression of the disease.

When severe forms hip dysplasia, disturbances in the functioning of this apparatus are lifelong, even if diagnosis and treatment were carried out in a timely manner.

Recovery period

Even if the treatment was successful, a child diagnosed with hip dysplasia remains under the care of an orthopedic doctor for a long time - in some cases until growth stops completely. Experts recommend performing a control X-ray examination of the hip joints once every 2 years. The child is subject to restrictions on physical activity, and it is recommended to attend special orthopedic groups in preschool and school institutions.

Hip dysplasia is quite complex disease, many parents literally panic when they hear such a verdict from doctors. But there is no reason for hysteria - modern medicine copes well with the pathology, timely treatment and patience of the parents make the prognosis quite favorable.

Comprehensive information about the signs of hip dysplasia, methods of diagnosis and treatment of hip dysplasia in children - in the video review of the pediatrician, Dr. Komarovsky:

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category.

When talking about dysplasia of the hip joint in children, they mean an incorrectly formed joint or, to describe the phenomenon even more accurately, an “underformed” joint. As mentioned above, dysplasia itself is not considered a disease. However, if appropriate measures are not taken in time, then it can subsequently become a serious problem, developing into a fully formed dislocation with all the ensuing consequences - pain, inflammatory processes, lameness for life. It should be noted that scientists have not yet come to a consensus on what causes the occurrence and development of hip dysplasia. Several proposals have been put forward:

heredity and genetic predisposition;
premature pregnancy;
gluteal predisposition of the fetus;
difficult or very prolonged labor;
entanglement of the umbilical cord in the womb;
C-section;
birth and postpartum injuries;
unfavorable environment.

Symptoms

It has already been said that dysplasia detected on early stage, can be treated with simple conservative methods and does not leave any consequences in the child’s future life. This means that it is necessary to closely monitor the health of children and pay close attention to any developmental deviations. What should parents be wary of if they suspect dysplasia in a child:

the desire to stand on your toes and walk on them;
while walking, turn the toes of one or both feet outward, or vice versa, inward;
severe clubfoot;
curvature of the spine in lumbar region, forming a “duck walk”;
different leg lengths;
slouch;
visually noticeable curvature of the spine.

If you notice these signs in your child, there is no need to delay visiting the doctor. Do not delay contacting a specialist. Don't miss the moment when you can help your child correct the incorrect predisposition of the hip joint and completely restore health.

Diagnosis of hip dysplasia in a child

Parents themselves may suspect hip dysplasia in their child based on the symptoms listed above. But put accurate diagnosis Only a specialist can. The fact is that very similar signs can occur in other conditions of the body, for example, with increased muscle tone. In order not to cause harm and to establish a reliable diagnosis, it is necessary to show the child to a specialist.

After the visual inspection, collecting complaints and medical history, the doctor will prescribe a number of special examinations:

ultrasound diagnostics;
radiography.

These studies will give full picture the condition of the joint, its location in the articular cavity, the presence or absence of pathology. If the doctor nevertheless determines that your child has dysplasia, then there is absolutely no need to panic. To be appointed individual treatment, and if all recommendations and prescriptions are followed accurately, the effect will not be long in coming.

Complications

If you do not pay attention to the symptoms of incipient hip dysplasia in a child in time, you may miss the moment when everything is restored without consequences and be faced with a fact dangerous complications. What complications are expected in advanced cases:

complete dislocation;
different lengths lower limbs;
lifelong lameness;
arthrosis;
lordosis of the sacral spine.

Treatment

What can you do

Mild forms of dysplasia, which include subluxation or preluxation with slight displacement femoral head, usually results in the normal formation of the hip joints, provided that all recommended treatment and preventive measures are followed. The doctor will recommend them to you, and you will be able to do all the necessary exercises with your child at home, and, if necessary, a simple massage.

What does a doctor do

Having diagnosed a child with hip dysplasia, the doctor will prescribe the following measures:

therapeutic exercises;
physiotherapy;
massage.

The listed recommendations are prescribed comprehensively or selectively, depending on the severity of the disease. In case of ineffectiveness conservative methods To correct anomalies in the development of the hip joint (this happens extremely rarely), surgical intervention is prescribed. After the operation, a long-term restoration of the functionality of the joint and all motor functions limbs.

Prevention

Spontaneous reduction of the femoral head into the socket of the joint can occur in the first months of a child’s life - nature has thought of everything very wisely. Therefore, for preventive purposes, it is recommended not to restrict the movement of your baby’s legs, use wide swaddling or use disposable diapers.

The point of such prevention is that when the legs are positioned when they are wide apart, reduction occurs very easily. Next, the position of the femoral head is fixed in the socket and the risk of dysplasia is minimized, and its primary signs completely disappear.

That is why in African countries, where it is customary to carry a baby behind your back with legs spread wide apart, the incidence of hip dysplasia is minimal.

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Arm yourself with knowledge and read a useful informative article about the disease hip dysplasia in children. After all, being parents means studying everything that will help maintain the degree of health in the family at around “36.6”.

Find out what can cause the disease and how to recognize it in a timely manner. Find information about the signs that can help you identify illness. And what tests will help identify the disease and make a correct diagnosis.

In the article you will read everything about methods of treating a disease such as hip dysplasia in children. Find out what effective first aid should be. How to treat: choose medications or traditional methods?

You will also learn what can be dangerous untimely treatment the disease hip dysplasia in children, and why it is so important to avoid the consequences. All about how to prevent hip dysplasia in children and prevent complications.

And caring parents will find on the service pages complete information about the symptoms of hip dysplasia in children. How do the signs of the disease in children aged 1, 2 and 3 differ from the manifestations of the disease in children aged 4, 5, 6 and 7? What is the best way to treat hip dysplasia in children?

Take care of the health of your loved ones and stay in good shape!