Symptoms of hip dysplasia in an infant. Therapeutic gymnastics for hip dysplasia. Disorders of the spinal column and lower extremities

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

On the other hand, there is no need to panic, because... bone dislocations discovered after childbirth do not represent serious danger, if you start correcting them in time. Such conditions are quite successfully corrected and treated by modern medicine. Hip dysplasia in newborns becomes immediate cause congenital hip dislocation.

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

The main task of the hip joint in the human body is to ensure all functions of the lower limb (abduction-adduction, flexion-extension, rotation). This is a movable joint femur and pelvis, allowing simultaneously with muscular system walk, run, squat, etc. In terms of functional ability and range of motion of the limb, such a joint is second only to the shoulder. Dislocation (a process in which one of the articular surfaces leaves the joint) of the hip in such a joint leads to a complete disruption of the 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 are not yet able to walk, and accordingly, it is difficult for parents to identify such an orthopedic problem. The success of treatment of this pathology, diagnosed in the first year of life, guarantees good functional ability of the limb in adult life.

A variety of reasons that can lead to dysplasia in a baby, as well as high frequency The incidence of this pathology makes it a pressing disease for both pediatricians and young parents.

Modern medicine has still not been able to establish single reason, which provokes the development of joint dysplasia in young children. Doctors' observations indicate that hereditary causes play an important role in the formation of this pathology. It is worth considering that the effect of various unfavorable factors environment leads to 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 hip to the pelvis.

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

1. Breech presentation. This is the position of the fetus in the uterus when its legs are facing the woman’s pelvis. In this position, the child's lower limbs are functionally limited to the cramped space of the uterus. This most likely results in underdevelopment hip joints. Childbirth in the case of such a presentation of the fetus is not easy for both the unborn child and the mother. Therefore, in the process of moving the fetus through birth canal Dislocation of the femoral head from an immature joint quite often occurs.
2. A child who has a prenatal body weight greater than average values, those. more than 4kg. Dysplasia in this case is also associated with a relative lack of space in the uterine cavity. This prevents the joint surfaces from fully and correctly developing due to the fact that the legs cannot move to their full amplitude.
3. Toxicosis during pregnancy. An increased risk of developing hip dysplasia has been established in babies whose mothers suffered toxicosis during gestation, especially in the last trimester of pregnancy. Probably, the development of such a pathology is associated with a disruption of normal metabolic processes in the fetus. Such changes reach their maximum severity during the period when intoxication did not allow the pregnant woman to eat normally and also adhere to proper routine day.

Dysplasia of the legs in newborns, which often manifests itself as deformation of the feet, can also accompany the process of underdevelopment of the hip joint. In this case, the cause of disruption of normal development lower limbs become different exogenous factors(toxins, chemicals, medications, radiation, etc.) or endogenous causes(row infectious diseases etc.).

How to identify the disease in a newborn?

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

• When trying to separate the baby’s legs, there is a feeling of limited movement of the limb, which is accompanied painful sensations. Since the femoral head does not fully contact the articular surface of the acetabulum, the amplitude of abduction of the leg is reduced.
• Symptom of hip slippage which is also determined when trying to separate the baby’s legs. In this case, the femoral head automatically moves into the joint (a characteristic click is felt), and then leaves it again due to the underdevelopment of the structures of this anatomical region.
• Femur displacement causing the limb to become shorter. This also manifests itself as visual asymmetry inguinal folds skin of a newborn.

Every neonatologist and obstetrician-gynecologist knows how to identify symptoms congenital form hip dislocation that accompanies dysplasia. It is these specialists who, after identifying signs of pathology, invite a pediatric orthopedist for consultation after childbirth. 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.

The pediatric orthopedist fully evaluates all segments of the lower limb, the length of both legs, and the angles at which the child’s leg can flex, abduct, or adduct. It is also assessed whether the “clicking” symptom and insufficient angle of abduction of the limb actually occur. For installation final diagnosis A specialist prescribes an ultrasound of the hip joints for a child in his first year of life, and 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 a newborn.

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

Diagnosis of dysplasia

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

The characteristics of the bones in children of this age allow the doctor to evaluate a fairly wide range of parameters of the hip joint using ultrasound. Ultimately, this helps determine whether neonatal dysplasia is present. During the examination, the following parameters are assessed:

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

By assessing all these parameters, it is possible not only to establish the type and subtype of dysplasia, to confirm a violation of the integrity of the joint, but also to answer the question of whether dysplasia of the hip or pelvic bone is progressing over time. The resulting planar images from ultrasound give the same picture as radiography. This allows the results of both research methods to be compared.

However, the application x-rays It is not advisable to diagnose dysplasia in children of the first year of life. This is due to both the risks of increased radiation exposure to the body (x-ray diagnostics emits ionizing radiation) and the low information content of the method (the proximal femur and pelvic bones are still worn cartilaginous structure, therefore poorly distinguishable on an x-ray). If, for a number of reasons, X-rays are still preferred to determine dysplasia, then such diagnosis is carried out by drawing conditional lines and determining the angles formed by the anatomical structures in the joint.

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

Treatment and rehabilitation for pathology

Hip dysplasia of any degree requires competent and sometimes long-term treatment. The goal 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 later life child.

Treatment of such a pathology should include a special position of the legs (a posture in which the legs are bent and moved to the side), 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 stirrups, Volkov splint, Freik pillows, etc.).

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

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.

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're talking about unstable hormonal background pregnant – the body notes high level progesterone. This hormone has a relaxing effect on ligaments, joints and cartilage - this is necessary for labor activity and safe delivery. But the “trick” is that progesterone has high placental permeability and enters the fetal bloodstream - this provokes softening of the ligamentous apparatus of the unborn 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 takes place in the 10th week of 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 chemicals, this includes certain medications;
• unfavorable environmental situation;

Note:play the largest role in the formation of tissues in the fetus viral diseases– if a woman has had this disease in the 1st trimester of pregnancy, then the risk of having 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 the birth of a 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 anatomical structure 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 - there are no obvious signs; a pediatrician or orthopedist can pay attention to the manifestations during preventive examination. But parents themselves must carefully monitor appearance and the 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.

If these signs occur, 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 in some cases It is advisable to carry out an 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:

1. "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.
2. Asymmetry skin folds . This symptom is checked in a child lying on his stomach and lying on his back. What you should pay attention to is not the number of folds (it varies even among healthy children), and on their depth and height of location.

1. 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.
2. 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. U 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.
3. 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). U 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 will be noted on the affected side, and if you press on the heel bone, mobility will be noticeable from the foot to the femur (the child should lie on his back with his legs straightened).

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! Therapeutic gymnastics are performed the first few times by a medical professional, and parents learn to do the procedure correctly.

An orthopedist (or pediatrician) conducts dynamic monitoring of the child’s condition, and if no positive changes are observed, then 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 the child grows and physically develops:

• 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:

1. 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.
2. To change the vest, there is no need to remove the orthopedic device - you just need to untie the ties on the shoulders.
3. Suits, dresses, vests and any clothing can be worn on top of the splints/stirrups.
4. 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 it is necessary to completely wash the child, you can unfasten one strap, but hold the leg in a given position during the procedure. hygiene procedure, and then wash the other side of the body in the same way.
5. 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 such procedures yourself - this can significantly worsen the baby’s health. Only a specialist who constantly monitors a small patient can give any 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. Exists general description exercises:

1. The child lies on his back, the parents lift the baby’s legs up one by one, while bending the knee and hip joints.
2. 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.
3. 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.

You will receive more complete information 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:

1. 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 the inside of the legs, especially the hips - for free access to these places you just need to move the child’s legs to the sides.
2. 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.
3. 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 may sharply contract (spasm), which will provoke 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.
4. 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 therapeutic exercises and massage, it is important to understand that physiotherapeutic procedures will also be effective - paraffin applications, electrophoresis using medicines, which contain calcium and phosphorus.

If the diagnosis of hip dysplasia was carried out late, or the above therapeutic methods do not give positive result, then doctors prescribe long-term, step-by-step casting. In particular 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.

In the case of severe forms of 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 exercise, it is recommended to visit 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:

Ekaterina Morozova is a mother of many children, editor of the “Children” section in Colady magazine

A A

With dysplasia ( congenital dislocation hips) in newborns, parents encounter it quite often. The disease is characterized by underdevelopment or improper formation of joints.

If a child has been diagnosed with this, treatment must be started immediately to prevent problems in the functioning of the musculoskeletal system.

Features of the structure of the hip joints

The joints of a child, even with normal development, differ from the anatomical parameters of adults, although, in both cases, the joints serve as a connecting link between the bones of the hip and pelvis.

The upper part of the femur has a spherical head at the end, which fits into a special notch in the pelvic bone ( acetabulum). Both structural parts of the joint are covered cartilage tissue, preventing wear of the bones, promoting their smooth gliding and cushioning the loads acting on the joint.

The task of the joints - provide body rotations different sides, flexion and extension of the limbs, movement of the hip in space.

The acetabulum of the hip joint in children is not in an inclined position, as in the body of an adult, but almost vertical and has a flatter configuration. The head of the bone is held in the socket by ligaments, the acetabular labrum and the joint capsule, which encircles almost the entire femoral neck.

In children, ligaments have significantly greater elasticity than in adults, and most hip area consists of cartilage tissue.

Joint dysplasia in children is classified by specialists according to the level of deviation of joint development from standard parameters

Causes of hip dysplasia in children

There are several factors that, to one degree or another, influence the formation of dysplasia in a newborn:

1. Hereditary factors when pathology occurs due to abnormalities in the body under the influence of genes. That is, the disease begins at the level of the embryo and interferes with the normal development of the fetus.
2. Restriction of free movement of the fetus in the womb caused by incorrect position baby in the uterine cavity (, etc.).
3. Up to 50% of dysplasia occurs due to big size fetus , as a result of which it shifts from its normal anatomical position ().
4. Gender of the child. Most often the disease occurs in girls.

Often the cause of dysplasia is factors, the carriers of which are the expectant mother herself:

• Infectious or viral infections, which a pregnant woman suffered from.
• Unbalanced diet, lack of vitamins B and D, as well as calcium, iodine, phosphorus and iron.
• Metabolic disorders in the body.
• Toxicosis in early or late stages of pregnancy.
• Wrong lifestyle expectant mother(smoking, alcohol).
• Problems with the cardiovascular system.

Important! Inexperienced parents often accuse doctors who deliver babies of allowing dysplasia to occur due to unprofessional actions. In fact, the pathology of the hip area develops during fetal growth in the womb, and not during the birth process.

How is hip dysplasia diagnosed in children - symptoms and signs of the disease

If the pathology in the hip joint is quite pronounced, the baby is diagnosed in the maternity hospital.

Unfortunately, It is not always possible to detect the disease in the first days after birth . The defect in the joint does not cause any inconvenience to the baby, so he behaves calmly, and the parents cannot suspect the disease based on the child’s behavior.

Signs of the disease are identified by the doctor during medical examination. In addition, according to some obvious indicators, the mother can determine the pathology on her own.

The presence of the disease is indicated by such signs as:

Important! Sometimes there may be cases of asymptomatic disease. To avoid starting the process, visit an orthopedist. If in doubt, the doctor will prescribe an ultrasound or x-ray.

If the pathology is not detected in time early stages, the femoral head will shift until a dislocation forms and a change in the supporting motor functions joint

Features of treatment of hip dysplasia in children

Treatment of dysplasia should begin immediately after diagnosis. The main task of eliminating pathology is to ensure that the head of the femoral bone is correctly positioned and fixed in the acetabulum.

For this, treatment methods such as:

In addition, the attending physician may prescribe paraffin wraps and electrophoresis with calcium and phosphorus to strengthen the joints.

If you have even the slightest suspicion of pathology, you need to urgently contact a specialist and start treatment!

The website warns: the information is provided for informational purposes only and does not constitute medical advice. Do not self-medicate under any circumstances! If you have any health problems, consult your doctor!

Hip dysplasia in a newborn – serious problem, requiring qualified and integrated approach. Early detection of the disease increases the effectiveness of therapy many times. What does the effectiveness of treatment depend on? Swaddling: benefit or harm? The role of parents at the stage of diagnosis and therapy. You will find answers to these questions in the article.

A bit of geometry

First, let's deal with the main question - a diagnosis of hip dysplasia in children has been made, what is it?

The shape of the hip joint is spherical. Movements are carried out in 3 planes (sagittal, frontal, vertical). The joint consists of:

• Articular head. This is the head of the femur.
• Acetabulum. Has a crescent shape.
• Vertabular lip. A cartilaginous plate that serves as a protective barrier against displacement of the head upward outside the joint.
• Joint capsule. Connective tissue forms a hermetic cavity by weaving its fibers into the structures of the joint.
• Ligaments and muscles. Keep all elements of the joint in the correct position.

Fine articular head occupies a mid-position in the capsule. The angle formed by 2 lines (1 line along the femur, 2 parallel to the socket) is 90º. This ensures even pressure distribution.

With the correct development of the components of this complex system, there are no functional problems. But if something goes beyond the norm, hip dysplasia develops in the newborn.

In other words, dysplasia is the inferiority of structures.

With untimely and inadequate therapy, serious complications arise in the form of subluxation and joint dislocation. Treatment is complex and not always 100% successful.

First symptoms: what to look for?

Everyone looks at their sleeping baby with tenderness. But often a child’s sleeping position can tell a lot. When the baby sleeps, his muscles are relaxed, he lies on his back with his legs spread wide apart. In some cases, with pronounced muscle tone () or problems with the joint, the child’s arms and legs are compressed.

Parents often wonder and worry that their baby has uneven legs. However, we hasten to reassure them and note that this shape of the legs at this age is the necessary conditions for proper development of the joint.

How to determine hip dysplasia in newborns? For this purpose orthopedist conducts mandatory routine examinations of children. The first time is in the maternity hospital, then every month, at 3 months, at six months and a year.

Signs and diagnosis of hip dysplasia in children

The folds on the legs are located asymmetrically

To do this, the child is placed on the table, first on his back. The inguinal folds are examined, their severity (depth) is noted by the symmetry of the level of placement on both legs.

Next they turn over onto their stomach. The gluteal and popliteal folds are assessed. On the leg where the problem is fixed, there are more folds and they are deeper. When diagnosing hip dysplasia in a newborn, the photo shows a clear picture of the location of the folds. This method is informative from 2 months of age.

This test is not worth taking as a panacea.. Because there are cases of completely healthy children with asymmetry of the folds. If bilateral hip dysplasia is diagnosed in an infant, the folds, on the contrary, are symmetrical.

One leg is shorter than the other

The child is placed on his back. The doctor bends the legs at the hip and knee joint. If the level of one kneecap is lower, this is a bad prognostic sign. Occurs when a dislocation occurs.

Clicking symptom

Diagnostic symptom of dislocation. The baby lies on his back, the legs are flexed at the hip and knee joints and taken to the sides.

This is done without pressure! At a certain moment, the doctor feels a characteristic click. The reason is that the head goes beyond the socket. This test is additional, since in 4 out of 10 newborns examined it will be positive, although the children are completely healthy. Information content decreases with age.

Legs abducted to the sides

The baby lies on his back, legs are bent in the same way as described in the previous test, and moved to the sides. Normally, the outer side of the leg should touch the table. This may not be the case with muscle hypertonicity.

You can detect dysplasia in a child up to one year old on your own at home. But To 100% confirm the diagnosis, you must conscientiously visit a pediatric orthopedist within the time allotted for scheduled inspection.

If symptoms of hip dysplasia in children are detected, in this case, additional examination is carried out to clarify the diagnosis.

For these purposes, ultrasound and radiography are used. Ultrasound is prescribed more often in children under one year of age, because At this age, cartilage is not yet visible.

Reasons: good information content in early age, the child’s health is not in danger, unlike radiation exposure during radiography.

In more complex clinical situations, X-ray diagnostics are performed. To decipher it, certain lines are drawn and angles are measured.

What are the causes of hip dysplasia in newborns?

Let us note the main cases.

• Antenatal (intrauterine) period. Toxicoses. Taking medications.
• Childbirth. Breech presentation. This position of the fetus is challenging task, requires skilled labor management. Often, in order to avoid complications during breech presentation of the fetus, C-section. A large fetus (more than 4 kg) is also at risk.
• Genetic predisposition. In 30% of cases, this disease is hereditary.
• Tight swaddling. The baby is swaddled, arms and legs are tightly wrapped in diapers. The legs are aligned - this is highly undesirable!

With this swaddling method, the necessary conditions for the normal development of joint structures are reduced to zero, which is fraught with consequences. Hands can be swaddled, but legs - under no circumstances.

What will the statistics say?

• Hip dysplasia in a newborn occurs more often in girls. In this case, there are several hypotheses. The main one among them: “it’s about the hormone relaxin, which is produced in the mother’s body during childbirth. Its task is to soften the ligaments and bones necessary for the baby to pass through the birth canal. It is believed that girls’ bodies are also sensitive to the influence of the hormone.”
• The right joint is most often affected.
• Residents of the tropics have a low incidence rate, while Scandinavians, on the contrary, have the highest.
• If parents are diagnosed with the disease, the risk of developing the disease in children increases 10 times.

Main forms of the disease

• Impaired development of the acetabulum. It takes on a flattened, beveled appearance. Accordingly, the head of the femur, due to the altered anatomy, cannot be maintained in the median position (which is the norm). In addition, in infants, the ligaments are very elastic. This leads to the formation of subluxation and even more dangerous complication such as a dislocation.
• Problems associated with developmental disorders proximal part femur. To diagnose this form, the neck-diaphyseal angle is determined, the value of which varies depending on age.
• Dysplasia due to changes in bone geometry in the horizontal plane.

Treatment

Examination and therapy (when the first symptoms are detected) are carried out by a pediatric orthopedic surgeon.

Massage for hip dysplasia in newborns is performed to improve blood circulation and eliminate muscle hypertonicity.

The course consists of 10-15 procedures. Repeat after 1-1.5 months.

Execution technique

• The baby is lying on his back. Stroke the outer surface of the thigh and lower leg, then proceed to rubbing these areas. Make it the main one and index finger spiral kneading movements. Without much pressure, but you should press deeper to improve trophism in the muscles and ligaments.
• The baby is turned over on his stomach. Stroking lumbar region, outer thigh. Rub these areas with spiral movements.
• Next, the buttocks are massaged. Local massage is performed on the dysplastic area. The joint is fixed with one hand, and the leg is abducted with the other, rotating the thigh inward.

After carrying out the stroking, rubbing, kneading movements described above, 3 main exercises are performed for hip dysplasia in newborns.

Execution technique

1. The child lies on his back. Alternately bend and unbend each leg.
2. Move the leg bent at the knee to the side (without pressure). Up to 10-15 repetitions at a time and up to 300 repetitions/day.
3. "Bike". Use your feet to imitate a child riding a bicycle.

Note that Exercise therapy for hip dysplasia in children is important and an effective element of treatment. Electrophoresis helps saturate bones with calcium ions. The procedure lasts up to 5 minutes. Carry out under the supervision of a doctor.

To treat hip dysplasia in newborns, by holding the legs apart, Pavlik stirrups, Becker panties, and Freik's pillow are most often used.

Pavlik stirrups are most often used for up to 3 months, then in combination with Volkov splints.

In case of a serious form of the disease, the method of hip reduction with the application of a plaster cast is used (performed for children aged 2 to 5 years).

After 5 years, use open surgical method reduction.

Consequences of hip dysplasia in children

1. Limitation of mobility in the joint.
2. Severe inflammatory process.
3. Severe pain syndrome.
4. Lameness.

In the absence of adequate diagnosis and rational treatment, dysplasia can cause disability.

5 steps to prevent the development of the disease

1. Complete refusal of swaddling. The baby is dressed in ordinary clothes.
2. Using diapers. When Evgeniy Olegovich was asked what is a preventive measure for hip dysplasia in a newborn, Komarovsky replied that wearing a diaper every day is not only a help to parents, but also a good prevention of the disease.
3. Use of kangaroo backpacks and slings.
4. Proper carrying of the baby. When the little one begins to hold his head confidently, parents can carry him in vertical position"Push". One hand holds the little one at chest level, the other holds the feet with knees bent and legs apart.
5. Swimming on your tummy. Hydro procedures are very useful. The baby, overcoming the resistance of water, develops different groups muscles.

Dysplasia is a disorder in the development of the joint, which results in a predisposition to dislocation—the head of the bone coming out of the joint capsule. 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 joint malformations

The musculoskeletal system of the fetus begins to form at 4-5 weeks of pregnancy. This process ends after birth, when the baby begins to actively walk. Contrary to popular belief, hip dysplasia in newborns does not appear as a result of improper actions of doctors 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 families where cases of dysplasia in newborns have already been observed. The gender of the child also matters: for girls birth defects joint development is diagnosed 4 times more often than in boys. Dysplasia most 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 not positioned correctly in the mother's belly, this prevents him from actively moving. As a result, the tissues of the joints can be formed in such a way that the child is born with the first stage of dysplasia (the so-called preluxation - a condition of the joint when the head of the femur is not yet displaced);
• The baby's birth weight is too high or too low;
• Infectious diseases suffered by a woman during pregnancy;
• Violations metabolic processes in the mother's body and, as a consequence, a violation water-salt metabolism in the fetus;
• Severe cases of early or late toxicosis;
• Chronic heart disease that affects the baby's mother.

Those children who are tightly swaddled by inexperienced parents are also at risk. These babies were not diagnosed in time light form congenital dysplasia can develop into subluxation or dislocation of the hip joint.

Signs of dysplasia in newborns

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

Attentive parents may notice the following signs of dysplasia in their child:

• Limitations of leg abduction. With a baby lying on his back, his 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 inability to assume such a position: the affected joint does not fully extend;
• "Click Syndrome" When the baby's legs bend, a characteristic clicking sound is heard at the knees and hips;
• Asymmetry of the buttocks and gluteal folds. A baby lying on his tummy has buttocks different shapes. The folds on the affected leg are higher than on the healthy one. An additional fold appears on the thigh.

If the mother notices at least one of these signs, she should show the child to the doctor. It should be remembered that if a newborn has dysplasia, the count is literally days - the baby needs immediate help, since without it the severity of the disease will increase, and the result can affect the entire future life of the child, even to the point of limited mobility and disability.

Treatment of dysplasia in newborns

To restore full motor functions in children suffering from subluxations or dislocations of the hip joints, manual therapy, massage, physiotherapeutic procedures, physical therapy. Light shape joint dysplasia in a newborn, experienced chiropractor can be corrected in several sessions. In such cases, when caring for a baby, wide swaddling is recommended: a folded piece of cloth or a flat pad is placed between the baby’s legs, which gently holds the hip joints in a moderately apart position. In more severe cases, complex treatment of dysplasia in newborns is used, which takes much longer. In this case, the baby has to wear special “spacers” (Feik’s feather bed or Pavlik’s stirrups), which fix the legs in the “frog pose” and ensure further normal development joints. Parents who find this treatment too harsh should not worry: this position does not cause any discomfort 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 with this position of their legs, cases of dysplasia in newborns are relatively rare. votes)