Canine hip dysplasia: causes and treatment of the disease
Congenital diseases of the musculoskeletal system are becoming more common, including hip dysplasia. Due to improper lifestyle of the mother during pregnancy, harmful habits, as well as on a background of reception of some medicines is the birth of children with underdeveloped limbs, cartilage and bone-muscular system. One of the most adverse outcomes is congenital dislocation of the hip.
Hip dysplasia in ICD 10
In the international classification of diseases this disease is a separate class and group: M24.8 — refined the defeat of the joints, which were not displayed and not classified in the other groups.
What most often develop this condition?
Newborns in utero observed underdevelopment of the articular surfaces, forming the hip joint that can lead to congenital hip dysplasia.
Acetabulum primarily cartilaginous tissue. In utero and neonatal its cavity increases due to the cartilage lip (limbus). The basin consists of three bones, the final hardening of the arteries which ends by the age of 18. The head of the thigh bone, its neck and greater trochanter are mostly composed of cartilage (on radiographs of education data is not visualized). The head of the femur in neonates are always more of the articular surface of the pelvis. All the above factors lead to insufficient strength of the joint.
The mismatch of the articular surfaces (disagreement) creates the conditions for the development of previlige thigh — a condition in which there is a spontaneous dislocation of the femoral head, the reverse reduction (this does not require much effort). Some children spontaneously reposition the head of the bone, after which the joint develops normally. In others, due to the long existing previlige, is offset from the head bone relative to the glenoid cavity, and then develops a subluxation of the hip (the femoral head is displaced, but beyond the boundaries of the limbus it comes out).
If such a state exists for quite a long time, then over time, due to the traction gaining muscle tone is pulling the limbs to the top and to the side (which depends on the displacement of the head), which develops dislocation of the femur. Gradually kosteneva, head fixed in the area peredeniya pubic bone, getting a new fulcrum (in severe cases, the head displacement may occur at the rear surface of the Ilium). Thus there is a decrease in the relative length of the limb.
What are the risks of type 2 and slow ossification in children
Usually, children have observed the development of the hip joint by type 2A. There are several types of joints, which correspond to the stages of development of dislocation:
- 1 type healthy joint;
- Type 2 violation, and delayed ossification;
- Type 3 subluxation of the hip;
- 4 type — full dislocation.
Type 2A (develops in babies up to 3 months) characterized by the presence of rounded and short bony roof of the acetabulum, the size of the angles alpha and beta in the range of 55 degrees (these angles describe the position of the head in certain orientations or axes), and centered the head of the bone without displacement. When running the process occurs stepwise transition to dislocation.
Dysplasia of the hip in children: causes
The basis for the development of this disease the crucial role belongs to the wrong position of the fetus during pregnancy. As the statistics shows, most often hip dysplasia develops in the breech with crossover front arms and legs. This occurs usually in girls, especially in left-hand position of the fetus in the womb.
By adopting such a body position is offset from the heads of the femur relative to the joint cavity, which is developing hip dysplasia. Long-term stay in this position, the cartilage bones are unable to fully develop (as this requires full compliance).
Detection and treatment of disease in children
Diagnosis begins immediately after the birth of the child. Already in the hospital, for the identification of dysplasia, it is necessary to determine the presence of “clicking symptom” — the symptom occurs only with vivanta joint (which can take place due to improper management of labour and assistance of the midwife baby). A symptom is defined due to the fact that the joint capsule of the baby pererastayut, whereby the femoral head “walks”. A click is detected after slipping from the edge of the acetabulum. This symptom, which indicates dysplasia, it is checked very carefully so as not to damage the delicate tissue of the baby and the blood vessels.
To identify the symptom of the baby laid on the table, he legs bent at the hip and knee joints. The thumb is on the inner thigh of a baby, and the other four on the outer surface of the joint (the middle finger must be on the greater trochanter of the femur). Hip kid hung to the side at a slight angle (typically up to 40 degrees), followed by traction of the hip of a child along its axis. At the same time being the pressure on the greater trochanter. If the proper procedure, you can feel a loud click (it is not perceived by the ear, and is felt through the tactile sense).
As they grow older this symptom loses its value, and its being replaced by others. In the first place, it becomes possible to define enhanced muscle tone of the limb.
This symptom should be identified together with neurologists to differentiate dislocation with neurological disorders. A symptom is defined as follows. The baby is carefully placed on the table. Placing her hands on the inner thighs of the child, conduct abduction of his hips to the side. In the normal hips of the child should lie on the surface of the table (for the newborn); if a child is more Mature, the angle between the table surface and the leg should be at least 60 degrees. This restriction develops because of high muscle tone, as well as in a later age, due to the fact that the head of the femur rests on the iliac bone.
Symptoms and consequences
In unilateral dislocation is important symptom of symmetry breaking longitudinal axis. When bent at the knee joints legs, while diverting them to the sides, there is a visual decrease in the longitudinal axis of the leg (due to the fact that the head is not in the articular cavity, and is biased towards her). In parallel, on the side of the dislocation, marked retraction of the soft tissues in the area of the triangle of Scarpa. Along with them there is asymmetry of the skin folds.
There are several signs of hip dysplasia. At the age of years one of the main symptoms of dislocation — diving claudication (in unilateral dislocation) or duck gait (with bilateral lesions).
In addition to the definition of the gait, is detected and symptom of Trendelenburg: when standing on the bad foot with a raised and bent knee is healthy, there is a shift of the body toward healthy leg parallel retraction of the tissues in the region of the patient’s joint. Observed lowering of the gluteal fold.
Additional symptoms — the offset of the greater trochanter above the line Rosera-Nelaton and increased bending of the lumbar spine.
X-ray diagnosis of children under one year is not possible, since cartilaginous structures are not delayed x-rays, and they pass by the bones. For a more accurate diagnosis using the ultrasonography (us).
X-ray it is possible to use year (this age is the ossified femoral head), and we can determine the offset of the hip.
To determine the degree of displacement of the head using a special scheme. Most prevalent among them received the scheme of Hinderaker. It is estimated the spatial arrangement of the structures of the hip joint. In addition, can be used schemes, but the essence of their use is the same: they allow to determine the position offset of the femoral head and to identify the degree of displacement and the possibility of active movements in the joint.
The most complete and accurate information regarding the joint gives arthrography and imaging of the joint.
The treatment of the disease
Specific treatment of dysplasia currently exists. If a defect was discovered in the neonatal period, often offset the femoral head reduce back on and the joint starts to develop normally. If the state was running, running to the correction of the offset of the limb. For this purpose, so-called, wide swaddling when dysplasia or placing the spacers.
The swaddling, if applicable dysplasia in young children (most often used under the age of 4 months). Due to the tight swaddling of the legs gives them a forced position of abduction in which the return of the articular head in place.
In children under six months of age, the tight swaddling, pillow frejka, or use of stirrups Pavlik will not have the desired effect. For correction of the joint begin to use gypsuming limb Ter-Egiazarova. Parallel to put spacers in the knee joints. As straightening of the joints and decrease in muscle tone increases the retraction limb that allows you to put wider spacers and thus, to achieve normal abduction and recovery in the joints. In parallel, to achieve relaxation in the muscles of the hips, use a warm bath. The struts and rest of the treatment in this way takes about 3-4 months.
The ineffectiveness of these methods resort to a skeletal traction of the limb. The traction is carried out according to the method overhead, thanks to which it is possible to bring the head of the femur to the articular cavity. After that, its right by closed reposition, and always under General anesthesia. After reduction, the hip is fixed in koksetau a sling for up to six months. After this period, starting with the development of movements in the affected limb, and the load allowed at the end of the year, holding them to a special bus-girth Vilna.
In parallel with medical treatment, it is recommended to conduct appropriate rehabilitation therapy and physical therapy. Useful would be manual therapy sessions, massage, physiotherapy medicinal products on the affected joint to restore the metabolism in it.
With the development of this pathology in adults, it is possible to use manual therapy, hydrotherapy. If the illness is severe, the only way out of this situation is surgical treatment with complete replacement of the articular surfaces.
A set of exercises in the underdevelopment of the hip joints
Prevention of the disease in the first place should provide for the normal course of pregnancy and the prevention of its pathology. In addition, you should pay due attention to the definition of uterine tone (can affect the intrauterine position of the fetus), proper diet (often can lead to the development of congenital degeneration of the cartilage tissue).
For the prevention of recurrence of dysplasia or prevelika the baby recommended special exercises. These exercises promote learning baby crawl and its preparation for the first steps. Exercises tone the muscles of the limb, restore the normal position of the bone structures.
It is recommended to exercise on a soft Mat and gym ball support mom or dad.
There are such exercises as:
Exercises must be done in conjunction with medical observation.
Due to the fact that it is not always possible to diagnose this disease, be sure to familiarize parents with self-treatment dysplasia (tight swaddling, but before the vote, be sure to show the child the doctor).
Dysplasia in adults
With age, changes that occurred in childhood can affect adult health. There are cases of development of osteoarthritis in humans, a child suffering from hip dysplasia. To provoke this can injure the joint, pregnancy, hormonal changes in the body. The disease is quite difficult, and the prognosis of this unfavorable, often end in disability.
Oddly enough, but the people in my childhood who suffered from dysplasia of the hip joint, there have been significant advances in gymnastics. This is due to abnormal hypermobility of the joint — echo dysplasia. If the hypermobility of the joint does not reach significant figures, there is usually no pathology of the joints is found.
At risk for the development of this disease are women. This is quite a high probability of child with dislocation of the hip, provided that such a dislocation was they themselves.
It is also quite common in adults can reveal this pathology, as neurotron — the formation of a new joint. People with this disorder can go and not be aware that they have a pathological displacement of the joint. Newartriot takes place, as mentioned above, the displacement of the femoral head to the posterior surface of the iliac wing. The disease is detected, normally by radiography of the joint.
On severe stages of hip dysplasia, especially in the development of osteoarthritis may require surgical correction of the hip joint or endoprosthesis operation. And any operation on the hip joints dysplasia threat.
Disability, in these diseases, is established on the basis of decisions of medico-social examination. ITU aims to monitor the growth of morbidity and the pain of debilitating diseases, keep records of all factors of disability, to determine the risk of its development in certain groups of people, to be able to determine the degree of occupational risk for those diseases. In addition, this body is responsible for the development of prevention programs for various diseases.
As you can see from written, hip dysplasia is one of the most common causes of disability in children, the complication of the process, and adults. It is crucial to know the essential signs of hip dysplasia and the diagnosis algorithm. Only such an approach can affect the incidence of dysplasia and reduce the frequency of its occurrence. Only competent work of doctors at all levels can affect the morbidity and to serve as a prevention of diseases of the musculoskeletal system in the future.