Signs of hip dysplasia in infants. Gymnastic and massage techniques. Treatment of hip dysplasia in children

Hip dysplasia (abbreviated as DHS or congenital hip dislocation) is a pathology associated with musculoskeletal system, which is characterized by improper development of structures important for the formation of a full-fledged joint (ligamentous apparatus, bone surfaces, cartilage, muscles, nerve structures). Such disorders cause consequences associated with congenital hip dislocation.

DTS is abnormal development structures important for the formation of a full-fledged joint

The synonym for this pathology (congenital hip dislocation) more clearly describes the clinical picture of the disease. To differentiate the severity of the process, there is a special classification that will help you better understand this:

• 1st degree of severity, pre-dislocation – characterized by underdevelopment of osteochondral structures; muscular-ligamentous apparatus without pathological changes. Femoral head without deviation;
• 2nd degree of severity, subluxation - characteristic phenomena of preluxation give rise to dislocation of the head of the bone in an upward and outward direction;
• Grade 3 severity, dislocation is the most severe form of the disease, there is no contact of the articular surfaces of the head of the bone and the acetabulum of the hip joint.

Etiology of development of congenital hip dislocation in an infant

To date, there is no accurate information that would explain this pathology. But there are some theories, complementary to each other, that undoubtedly have the right to exist:

1. Hereditary theory. The disease arose due to genetic predisposition;
2. Hormonal theory. This theory is based on the fact that at the end of pregnancy there may be high level progesterone, which as a result affects the condition of the muscular-ligamentous apparatus, causing a decrease in its tone. This becomes the cause of disorders in the hip joint;
3. Exogenous theory. The influence of certain toxic substances, which also include some medications, disrupts the full development of bone structures, which as a result manifests itself in the form of pathology of the musculoskeletal system;
4. Multifactorial theory. A disease such as congenital hip dislocation develops against the background of the combined effects of the above reasons.

There are also certain conditions that are prerequisites for the occurrence of such consequences as hip dysplasia:

• It has been recorded that DTS develops more often with breech presentation of the fetus;
• Metabolic disorders with deficiency of vitamins and microelements (vitamin E, iron, phosphorus, iodine);
• Inadequate development of the acetabulum;
• Prolonged limited mobility of the fetus in the uterus.

Clinical symptoms and signs of hip dysplasia

When examining a newborn or infant, you should pay attention to:

• The size and position of the child’s feet;
• Symmetry of position skin folds child in the hip area;
• Muscular system tone;
• The range of motion in the joint is both active and passive.

Characteristic symptoms of dysplasia hip joints in infants:

• Clicking symptom (synonymous with sliding symptom). The child should be placed on his back and bent lower limbs simultaneously in the knee and hip joints so that angles of 90 degrees are formed (your thumbs should be located on the inner thighs, and the rest should be placed on outer surface hips). During abduction of the hips of the patient, pressure occurs in the area of ​​the greater trochanter, which leads to reduction of the femoral head. In contrast, with DTS, a characteristic clicking sound should appear;
• Limited hip abduction. Congenital hip dislocation is accompanied by limited abduction of the hip, up to 80 degrees or less. This symptom is more common with unilateral dysplasia;
• Shortened limbs. It is detected with high dislocations and is much less common than other manifestations;
• External rotation of the lower limb. Upon examination, it externally manifests itself as an outward rotation of the hip on the side of the corresponding pathology. You should be careful with this symptom, since it can be present not only in a child with hip dysplasia, but also in a relatively healthy newborn;
• Asymmetry of folds of both femoral and gluteal.

Auxiliary (minor, additional) signs of congenital dislocation in a newborn:

• Atrophic phenomena of soft tissues on the side of the corresponding pathology, decreased muscle tone;
• The pulsation of the femoral artery on the side of the DTS is reduced.

Quite rare clinical cases congenital dislocation of the hip, which are asymptomatic. Basic methods for diagnosing hip dysplasia.

In order to put correct diagnosis, the doctor must prescribe a series diagnostic studies. Such procedures include:

• X-ray examination. In order to correctly perform this study, it is necessary to use special protective pads. You also need to lay the child down and, if possible, position the limbs symmetrically. It is advisable that the child’s mother be present during the examination so that she can fix him in the desired position. With the help of X-ray examination, it is possible to identify a number of signs characteristic of this disease. These include: disruption of the structure of the acetabulum, changes in the location of the axis of the femoral head, discrepancy between the sizes of the head and the acetabulum.
• Arthroscopy. Research using special sensors of the joint cavity. During this study, you can consider in detail everything bone structures, cartilage and ligaments of the joint.
• Arthrography. This is an invasive procedure that is performed by general anesthesia. It is performed using an X-ray contrast agent, which stains all the structures of the joint. After contrast is administered, X-rays are taken to determine the condition of all joint structures. It is possible to determine the shape of the femoral head, its position, size and fusion of the acetabulum. Arthrography is very informative research, with which you can determine even the first degree of dysplasia.
• Ultrasound of the hip joint. Is not invasive examination, which is completely safe for the child. It can be used to track the dynamics of treatment and the development of the pathological process.
• And. Using these studies, it is possible to determine the degree of damage to the tissues surrounding the joint, as well as the severity of the pathological condition.

How to treat hip dysplasia?

Treatment of congenital hip dislocation should begin immediately after identification clinical signs of this disease. It is carried out non-medically. There are a number of therapeutic recommendations that must be followed. First of all, this is the correct position of the newborn. That is, he must constantly be with his hips apart and bent knee joints legs. For this purpose, special orthopedic devices are used - Pavlik stirrups, splints and bandages. The child must remain in these devices throughout the day and must move in them.

On average, these orthopedic devices are used for three months. But a specific period must be set by an orthopedic traumatologist. In addition, all newborns with this pathology are shown wide swaddling, as well as special massage.

Basic rules for performing massage for this disease

Dr. Komarovsky advises a fairly simple treatment. This massage treatment is indicated for children with hip dysplasia of any age. This massage for infants can be performed either with the help of a professional massage therapist or by parents.

• Before performing a massage, you should put the child on his back and start by stroking the arms, legs and tummy. After this, you should put the child on his stomach and spread his legs to the sides. You need to gently rub the baby’s thighs from the inside, gradually moving to the buttocks, and then to the lower back. In the buttock area, massage is performed with light tapping and pinching.
• After you finish massaging your baby's buttocks and lower back, you need to turn him over onto his back. Again, using gentle and light movements, you need to stroke and rub the front surface of the thighs, as well as bend and straighten the lower limbs. All actions should be slow and smooth so that they do not cause pain to the child.
• Next, you need to rotate the baby's hip inward, while raising his pelvis. Each limb should be rotated in turn.

To cure the disease, massage for hip dysplasia in infants should be carried out regularly and in full. If all the doctor’s instructions are followed, the likelihood of the child’s recovery will greatly increase.

Physiotherapy for hip dysplasia

Many physiotherapeutic procedures are used that eliminate the inflammatory reaction, improve joint trophism and reduce joint pain. The most commonly used procedures are:

• Electrophoresis. Using this procedure, you can inject anti-inflammatory and painkillers into the joint cavity.
• Mud therapy. During this procedure, the blood vessels dilate, resulting in improved blood flow in the joints.
• Ultrasound. This treatment also has an anti-inflammatory and resorption effect.

What is hip dysplasia in newborns? This disease is quite often diagnosed in children in the first days of life.

A pathological condition characterized by a violation normal development joint of the same name in babies in the first days of life, in practice it is manifested by a violation of the location of the head of the femoral bone relative to the acetabulum of the pelvic component of the joint.

Currently, the disease is detected immediately after birth little patient. The frequency of the disease is about 8-10 cases per 1 thousand newborns. At the same time, left-sided hip dysplasia is more often diagnosed in newborn girls, which is due to the structural features of the child’s body.

Read more about what hip dysplasia is

Hip dysplasia in newborns is quite common, but the causes can vary.

What causes pedicle dysplasia in infants? Today, scientists name several main factors that contribute to the development of dysplastic disorders in the structure of the ileofemoral joints in infants.

But before discussing the causes of dysplastic changes in the ileofemoral joints in newborns, it should be mentioned that the main etiological factor the occurrence of a pathological condition - changes hormonal levels in the body of the expectant mother.

The fact is that a few weeks before the expected birth, the woman’s body begins to intensively synthesize the hormone relaxin, intended to partially soften the bony joints of the woman’s pelvis and facilitate the process of the child passing through the birth canal.

Unfortunately, the action of relaxin is not selective. Therefore, in addition to the woman’s body, it also affects the fetus, causing the soft head of the baby’s femur to jump out of the acetabulum. According to statistical research, almost every fifth newborn baby today after birth is diagnosed with hip dysplasia, which is corrected by carrying out basic measures aimed at eliminating the defect. While 6-8 babies out of a thousand are at risk of being born with a severe form of the disease - congenital hip dislocation in newborns, requiring more serious approach to correction.

Other causes of hip dysplasia in infants include:

• first birth, when a woman’s body produces a lot of relaxin;
• female sex of the fetus, since girls are more prone to the development of dysplasia (softening of bones) in newborns;
• genetic predisposition to the occurrence of symptoms of the disease in infants;
• large size of the fetus, which complicates the process of normal development of the hip joints;
• breech presentation and breech birth, when increased pressure is placed on the baby’s pelvic girdle.

Hip dysplasia in an infant can also occur as a result of such a pathological condition as connective tissue dysplasia

Symptoms of the disease

All symptoms of hip dysplasia in a newborn can be divided into two main groups: those that are determined exclusively using additional techniques research, and signs that are accessible to visual definition.

So, the reason for the baby’s parents to immediately contact an orthopedist are the following signs of hip dysplasia in an infant:

• asymmetrical arrangement of the skin folds of the gluteal folds and the buttocks themselves;
• different amplitudes of motor acts when spreading the baby’s legs to the sides with bent knees;
• the appearance of a characteristic click when bending the leg at the hip and knee;
• different heights of the child’s knees, which is determined by the baby’s position on his back and bent knee joints.

You will learn more about the signs of dysplasia from the video:

Modern diagnostic methods

How to identify hip dysplasia in newborns? The presence of the above-described signs in a baby does not indicate the development of dysplastic disorders. And, conversely, to determine hip dysplasia in an infant, it is not necessary to be diagnosed with clinical symptoms of the disease. In some cases, asymmetry and clicks may not be detected, so the only effective method diagnosing a disease is ultrasound examination and radiography.

Ultrasound diagnostics It is carried out for babies up to the first year of life. This is an absolutely harmless technique that allows you to determine the condition of the hip joints and suspect the presence of hip dysplasia in newborns. X-rays are recommended for older children with stronger bones.

All information about modern methods You will learn how to diagnose joint diseases

Basic treatment approaches

How to treat hip dysplasia in infants? The choice of therapeutic tactics largely depends on the degree pathological disorders. Light form The disease can be easily corrected with wide swaddling. This method involves tightly fixing the baby's arms along the body and freeing the baby's legs from any diapers. Wide swaddling of a newborn with dysplasia allows you to get rid of the disease after the first two months from the birth of the baby.

Therapeutic gymnastics for hip dysplasia in newborns consists of a number of exercises aimed at correcting the defect in the location of the femoral head relative to the acetabulum. According to statistics, exercise therapy for hip dysplasia in newborns can achieve positive result in the treatment of the disease after the first sessions of its implementation. Also not bad therapeutic effect observed from massage for hip dysplasia in newborns, which should be carried out exclusively by a specially trained specialist.

You will learn examples of exercise therapy exercises for hip dysplasia from the video:

Other methods of treating congenital dislocation of the hip joint in a newborn include:

• , in particular, electrophoresis for hip dysplasia in infants with calcium;
• use of slings and special carriers for babies;
• fixation of the baby’s legs using corsets, plaster retainers, Pavlik stirrups and more.

It is important to remember that it is better not to look for information on how to cure hip dysplasia in infants on the Internet, but to immediately take your baby to doctors who, having established accurate diagnosis, will prescribe the most correct method of treating hip dysplasia in newborns.

What happens if dysplasia is left unattended?

What is the danger of hip dysplasia in newborns if it is not treated in time? By itself pathological condition does not in any way affect the baby’s well-being in the first months of life.

But after 2-3 years the child may develop the following violations from the musculoskeletal system:

• lameness;
• heavy inflammatory processes in the area of ​​the ileofemoral joint;
• painful dislocation of the femur.

In adulthood, left unattended leg dysplasia in newborns will make itself felt by the development of dysplastic coxarthrosis - a severe disease that leads to disability of a person with a sharp limitation in the ability to move freely.

Prevention

Prevention of hip dysplasia in newborns involves the use of special fixing agents to maintain the normal physiological position of the baby’s legs:

• carrying a child in slings, backpacks;
• use of car seats.

It is important to remember that it is always easier to prevent a disease than to cure it later. Therefore, one should not neglect simple methods of preventing diseases of the musculoskeletal system, which will protect the child from the occurrence of serious diseases in the future that significantly worsen the quality of his life.

Hip dysplasia is a congenital disorder of the joint formation process, which can cause dislocation or subluxation of the femoral head. Either underdevelopment of the joint or its increased mobility in combination with connective tissue deficiency is observed. At an early age, it manifests itself as asymmetry of skin folds, shortening and limitation of hip abduction. Subsequently, pain, lameness, and increased fatigue of the limb are possible. Pathology is diagnosed based on characteristic signs, ultrasound data and x-ray examination. Treatment is carried out using special means fixations and exercises for muscle development.

ICD-10

Q65.6 Q65.8

General information

Hip dysplasia (from the Greek dys - disorder, plaseo - form) is a congenital pathology that can cause subluxation or dislocation of the hip. The degree of joint underdevelopment can vary greatly - from gross violations to increased mobility in combination with weakness of the ligamentous apparatus. To prevent possible negative consequences Hip dysplasia must be identified and treated early - in the first months and years of the baby’s life.

Hip dysplasia is one of the most common congenital pathologies. According to experts in the field of traumatology and orthopedics, average frequency is 2-3% per thousand newborns. There is a dependence on race: in African Americans it is observed less frequently than in Europeans, and in American Indians it is observed more often than in other races. Girls get sick more often than boys (about 80% of all cases).

Causes

The occurrence of dysplasia is due to a number of factors. There is a clear hereditary predisposition - this pathology is 10 times more likely to be observed in patients whose parents suffered from a congenital disorder of the development of the hip joint. The likelihood of developing dysplasia increases 10 times with a breech presentation of the fetus. In addition, the likelihood of this pathology increases with toxicosis, medicinal correction pregnancy, large fetus, oligohydramnios and some gynecological diseases at the mother's.

Researchers also note a connection between the incidence rate and unfavorable environmental conditions. In environmentally disadvantaged regions, dysplasia is observed 5-6 times more often. The development of dysplasia is also influenced by national traditions swaddling babies. In countries where newborns are not swaddled and the baby's legs are in a position of abduction and flexion most of the time, dysplasia is less common than in countries with traditions of tight swaddling.

Pathogenesis

The hip joint is formed by the head of the femur and the acetabulum. In the upper part, a cartilaginous plate is attached to the acetabulum - the acetabular lip, which increases the area of ​​​​contact of the articular surfaces and the depth of the acetabulum. The hip joint of a newborn baby, even normally, differs from the joint of an adult: the acetabulum is flatter, located not obliquely, but almost vertically; ligaments are much more elastic. The femoral head is held in the socket by the round ligament, articular capsule, and acetabular labrum.

There are three forms of hip dysplasia: acetabular (impaired development of the acetabulum), dysplasia upper sections femur and rotational dysplasia, in which the geometry of the bones in the horizontal plane is disrupted.

If the development of any part of the hip joint is impaired, the acetabular labrum, joint capsule and the ligaments cannot hold the femoral head in place. As a result, it moves outward and upward. In this case, the acetabular labrum also shifts, finally losing its ability to fix the head of the femur. If articular surface The head partially extends beyond the socket, causing a condition called subluxation in traumatology.

If the process continues, the femoral head moves even higher and completely loses contact with the glenoid cavity. The acetabular labrum is below the head and is wrapped inside the joint. Dislocation occurs. If left untreated, the acetabulum gradually fills with connective and fatty tissue, making reduction difficult.

Symptoms of dysplasia

Hip dysplasia is suspected when there is shortening of the hip, skinfold asymmetry, limited hip abduction, and the Marx-Ortolani slip sign. Asymmetry of the inguinal, popliteal and gluteal skin folds is usually better identified in children older than 2-3 months. During the examination, pay attention to the difference in the level of location, shape and depth of the folds.

It should be taken into account that the presence or absence of this characteristic not enough to make a diagnosis. With bilateral dysplasia, the folds can be symmetrical. In addition, the symptom is absent in half of children with unilateral pathology. Asymmetry inguinal folds in children from birth to 2 months is not very informative, since it sometimes occurs even in healthy infants.

The symptom of shortening of the femur is more reliable in diagnostic terms. The child is placed on his back with his legs bent at the hip and knee joints. The location of one knee lower than the other indicates the most severe form of dysplasia - congenital hip dislocation.

But most important feature, indicating congenital dislocation hip, is a “clicking” or Marx-Ortolani symptom. The baby is lying on his back. The doctor bends his legs and clasps his thighs with his palms so that the II-V fingers are located on the outer surface, and the thumbs are on the inner surface. Then the doctor evenly and gradually moves the hips to the sides. With dysplasia, a characteristic push is felt on the affected side - the moment when the head of the femur is reduced into the acetabulum from a dislocated position. It should be borne in mind that the Marx-Ortolani symptom is not informative in children in the first weeks of life. It is observed in 40% of newborns, and subsequently often disappears without a trace.

Another symptom indicating joint pathology is limited movement. In healthy newborns, the legs are abducted to a position of 80-90° and laid freely on a horizontal table surface. If abduction is limited to 50-60°, there is reason to suspect a congenital pathology. In a healthy child of 7-8 months, each leg is abducted by 60-70°, in a baby with congenital dislocation - by 40-50°.

Complications

With minor changes and no treatment, any painful symptoms in at a young age may be missing. Subsequently, at the age of 25-55 years, the development of dysplastic coxarthrosis (arthrosis of the hip joint) is possible. As a rule, the first symptoms of the disease appear against the background of a decrease in motor activity or hormonal changes during pregnancy.

Characteristic features of dysplastic coxarthrosis are acute onset and rapid progression. The disease manifests itself unpleasant sensations, pain and limitation of movements in the joint. On late stages a vicious position of the hip is formed (the leg is turned outward, bent and adducted). Movements in the joint are sharply limited. IN initial period illnesses greatest effect is ensured by properly selected physical activity. With pronounced pain syndrome and vicious installation of the hip, endoprosthetics is performed.

With unreduced congenital dislocation of the hip, over time, a new defective joint is formed, combined with shortening of the limb and impaired muscle function. Currently, this pathology is rare.

Diagnostics

A preliminary diagnosis of hip dysplasia can be made in the maternity hospital. In this case, you need to contact a pediatric orthopedist within 3 weeks, who will conduct necessary examination and draw up a treatment plan. In addition, to exclude this pathology, all children are examined at the ages of 1, 3, 6 and 12 months.

Particular attention is paid to children who are at risk. This group includes all patients with a history of maternal toxicosis during pregnancy, a large fetus, breech presentation, as well as those whose parents also suffer from dysplasia. If signs of pathology are detected, the child is referred for additional studies.

A clinical examination of the baby is carried out after feeding, in a warm room, in a calm, quiet environment. To clarify the diagnosis, techniques such as radiography and ultrasonography are used. In children early age a significant part of the joint is formed by cartilage, which is not visible on x-rays, so this method is not used until 2-3 months of age, and then special diagrams are used when reading images. Ultrasound diagnostics is a good alternative to x-ray examination in children in the first months of life. This technique is practically safe and quite informative.

It should be borne in mind that the results alone additional research not enough to make a diagnosis of hip dysplasia. The diagnosis is made only when both clinical signs and characteristic changes on radiographs and/or ultrasonography.

Treatment of hip dysplasia

Treatment should begin as early as possible. Are used various means to hold the child’s legs in the position of flexion and abduction: devices, splints, stirrups, panties and special pillows. When treating children in the first months of life, only soft elastic structures are used that do not interfere with the movements of the limbs. Wide swaddling is used when it is impossible to carry out full treatment, as well as during the treatment of babies at risk and patients with signs of an immature joint identified during ultrasonography.

One of the most effective ways treatment of children younger age are Pavlik stirrups - a product made from soft fabric, which is a chest bandage to which a system of special straps is attached that holds the child’s legs abducted to the sides and bent at the knee and hip joints. This soft design fixes the baby's legs in the desired position and, at the same time, provides the child with sufficient freedom of movement.

Play a major role in restoring range of motion and stabilizing the hip joint. special exercises to strengthen muscles. Moreover, for each stage (spreading the legs, holding the joints in correct position and rehabilitation) a separate set of exercises is compiled. In addition, during treatment, the child is prescribed a massage of the gluteal muscles.

IN severe cases One-stage closed reduction of the dislocation is performed, followed by immobilization with a plaster cast. This manipulation is performed in children from 2 to 5-6 years old. Once the child reaches the age of 5-6 years, reduction becomes impossible. IN in some cases for high dislocations in patients aged 1.5-8 years, skeletal traction is used. If conservative therapy is ineffective, corrective operations are performed: open reduction of the dislocation, surgical interventions on the acetabulum and the upper part of the femur.

Prognosis and prevention

At early start treatment and timely elimination of pathological changes, the prognosis is favorable. In the absence of treatment or if therapy is insufficiently effective, the outcome depends on the degree of hip dysplasia, there is high probability early development of severe deforming arthrosis. Prevention includes examinations of all young children and timely treatment of identified pathologies.

Hip dysplasia (HJ) is a congenital pathology of newborns, during which the normal formation of joint tissue is disrupted. If this pathology is not detected and treated in time, then adults may develop dysplastic arthrosis - a serious disease of the hip joints, for which they are given disability:

• high risk of disproportionate development of limbs;
• the legs will be weak and will not be able to withstand the load,
• constant risk of dislocation or fracture,
• there is a gait disturbance, a decrease in the range of motion in the joint;
• walking and standing in place without support will cause pain.

Hip dysplasia is a congenital joint disorder

These include:

1. Heredity. Gynecological diseases Mom. Pathologies during pregnancy.
2. Birth ahead of schedule. In premature babies, some tissues and organs do not have time to fully form.
3. Incorrect position of the fetus during pregnancy. Any restrictions on the mobility of the fetus in the uterus are the reasons for the appearance of congenital anomalies child's joints.
4. Taking various medications by the mother during pregnancy, oligohydramnios, large weight of newborns.
5. Hormonal imbalance. If there is too much progesterone in the mother’s body before birth, this can subsequently cause muscle weakness.

A connection has been established between poor ecology and the number of diseases in newborns. In many ways, the cause of exacerbation of dysplasia is the harsh options for swaddling children. Hip dysplasia is much less pronounced in countries where it is not customary to swaddle newborns.

Diagnostics

The most the right time to determine the disease of a newborn - up to 3 weeks. Afterwards, it is impossible to notice signs of hip dysplasia, since there are no external symptoms. The first signs of a complicated dislocation appear in older children, when they begin to learn to walk.

It is necessary to carry out timely treatment of the hip joint

Only specialists can pre-diagnose pathology - even in the maternity hospital. Hip dysplasia in children has the following external symptoms:

1. The asymmetrical arrangement of the inguinal, gluteal and popliteal skin folds is clearly visible in children from two to three months.
2. Symptom of shortened thigh.
3. The “clicking” sign is when the femoral head may move out of the acetabulum with a loud sound and then move back again.
4. Limited ability to move the hips or pain when trying to spread the half-bent legs of infants to the sides (for infants, the normal position of the legs when spreading is up to 90 degrees).
5. Increased mobility of the hip joint - the legs can take an unnatural position, turning inward or outward.

In older children, hip dysplasia may have following symptoms: “duck” swaying gait, lameness, painful stepping on the heels.

If you have any suspicions, you should definitely consult a doctor. The sooner hip dysplasia is detected in newborns, the greater the chance of quickly curing it. To confirm the diagnosis, it is carried out X-ray examination and ultrasonography, which can detect the presence of pathology:

1. Deformation of the acetabulum (acetabular dysplasia), abnormal development of the head of the bone and cartilage.
2. Too stretched ligaments or capsule.
3. Dislocation of the hip bone.
4. Partial or complete displacement of the bone from the acetabulum.

All listed symptoms are good reasons for making a diagnosis of hip dysplasia (HJD).

Development of pathology

There are three degrees of development of hip dysplasia

If diagnosed late and without appropriate treatment, hip dysplasia can cause severe complications and even disability. Therefore, signs of hip joint pathology need to be identified and treated promptly. initial stage development. At early diagnosis and with the right course of treatment, the prognosis can be favorable.

There are three degrees of pathology - preluxation, subluxation and dislocation:

1. Pre-luxation of the joint: minor violations in the development of the joint in the acetabulum. As a rule, this process is diagnosed in newborn babies.
2. Subluxation of the joint: To this extent, there is displacement of the femoral head, but it is still at least partially located in the acetabulum. Disturbances in normal functioning and development are noticeable not only in the acetabulum, but also in the femur.
3. Joint dislocation: At this stage, the femoral head is completely displaced beyond the boundaries of the acetabulum. The voids formed during dislocation are quickly filled with connective tissue. Dislocation is the most difficult stage, difficult to correct. Surgery is often required to correct a dislocation.

Complex of therapeutic measures

If you have the slightest suspicion of the presence of pathology, you should contact a pediatric traumatologist or orthopedist. If the diagnosis is confirmed, treatment begins immediately. Its duration, measures taken and prognosis depend on the degree of development of the pathology in the baby.

The goal of the course to get rid of hip dysplasia in newborns is to securely fix the head of the bone in the acetabulum. The first step in this direction is to fix the limbs in a certain position (stirrups, splints, special pants, and wide swaddling are used for this). Since the ligaments and bones with dysplasia are too mobile, the next step is general strengthening cartilaginous tissues and muscular-ligamentous apparatus.

The following methods are usually used in the treatment of joints with acetabular dysplasia:

1. A set of exercises required to strengthen muscles and return normal range of motion. At different stages of children's development, different types of gymnastics are used. High results show exercises in water.
2. Massotherapy. The massage is done in two positions: children are placed on their backs, then on their stomachs. The procedure begins with stroking and kneading the limbs, body, and abdomen, followed by more intense massaging of the area of ​​the sore joint.
3. Thermal procedures using ozokerite or paraffin applications.
4. Physiotherapy: electrophoresis with calcium and chlorine, application ozokerite applications to strengthen the joint.

Timely treatment in 95% of cases leads to a complete recovery of the child

Attention! Gymnastics, massage and warming cannot be done at home. They should only be performed qualified specialists. Without certain skills and knowledge, you can only harm children.

Orthopedic treatment

Until the first signs of recovery are visible, it is important to help the child tolerate doctors’ orders more easily. For example, in order to help keep the legs in the abduction position for a long time, many auxiliary corrective devices have been invented. Special attention Frame's pillow, Pavlik's tight pants and stirrups deserve:

1. The Freika pillow is a special product that can be used to fix your hips in the desired position. Use the pillow for children from a month and earlier. The size must be selected by a specialist.
2. Becker's pants are an alternative to the Freik pillow and also allow you to support your baby's legs in the "frog" position. Compared to hard tires, they do not cause discomfort to children.
3. Pavlik stirrups. Stirrups consist of several parts - a chest fixation bandage and straps that hold the feet and hips in the desired position. You need to make sure that the stirrup belt fits snugly to the body, but is comfortable.

In the first months of life, the separation of infants' legs is ensured by wide swaddling and soft pads. Rigid and solid structures are not used at this age. It is recommended to use a sling, which creates the same effect as therapeutic stirrups.

Surgical methods

Surgical treatment in children is used extremely rarely, only in cases of dislocation (advanced hip dysplasia). Or when all other methods do not give any effect.

Massage is one of the most effective ways to strengthen the muscles of the buttocks and thighs

Hip surgeries can be performed in different ways:

• Carrying out an osteotomy in the pelvic area or on the femur: the bone is divided into two halves in order to ensure further proper fusion.
• Palliative interventions to equalize the length of asymmetrical limbs.
• Endoprosthetics is the replacement of a diseased joint with an implant.

After surgical intervention the legs will be fixed with a rigid splint. Of course, the child is unlikely to like this, and he will be capricious, but, believe me, splints are needed - they will allow for normal fusion of the joints and alignment of the position of the bones (the baby can bend his legs at the knees, but the angle between the hips remains fixed). In the future, to prevent residual manifestations of the disease, you can use therapeutic stirrups or pillows.

Features of caring for a sick child and prognosis

Besides professional treatment Children with dysplasia require proper care, slightly different from care for healthy babies. It is worth remembering some rules:

1. If the baby is lying on his back, then his feet should hang slightly - this will relieve excess tension from the joints.
2. When carrying, you need to take the children so that they are facing you and their legs are wrapped around you.
3. Do not try to put the baby on his feet - even minimal vertical loads are completely prohibited until the end of treatment.
4. When transporting children in a car, use car seats that will not compress their legs. When sitting on a high chair (for example, during feeding), use bolsters from a towel or pillow to keep the legs slightly apart.

If hip dysplasia has not been detected in children under one year of age, then the risk of further complications increases, treatment and recovery become more complicated. If the treatment complex takes effect in the first weeks of life, then the prognosis for getting rid of hip dysplasia for children is 100%. Until the first year of life, modern conservative methods Treatments (stirrups, massage, exercises, etc.) help cure about 95% of patients.

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, when 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:

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

Types of hip dysplasia

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The listed factors have different effects on the developing body of the baby, therefore, anomalies of immature joints will be individual. Congenital dysplasia of the hip joints in children, depending on the types of anatomical disorders, is divided into three types:

1. 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.
2. 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.
3. 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 Deviations from normal development may 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.

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

1. Click syndrome. Occurs when the legs are spread and brought together. Always present during dislocation.
2. Shortening one leg. This symptom is determined in case of severe dislocation of the limb. 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.
3. Hip abduction is limited. Indicates muscle dystrophy with disruption of bone formations.
4. Visible anomalous location hips.

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 younger than 2 months this symptom- 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.

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, intensifies inflammatory processes in the joint, ending in its 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. Besides visual methods use ultrasound. 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 later, 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:

1. 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.
2. Vilensky tire. It is put on the child once by an orthopedist and is not removed until full recovery. Consists of straps and a spacer, the length of which is adjustable.
3. Tübinger cut. It is a design of shoulder pads and 2 saddle-shaped spacers, which are connected by a metal rod.
4. 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.
5. 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°.

When the dislocation is formed, and conservative treatment did not produce results, applied closed reduction joint This operation is performed on children aged 1 to 5 years. After her on sore hip A plaster cast is applied 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 additional treatment. In combination with the main one, it will help the child cope with the disease faster. These methods include:

1. Ural Federal District. Prescribed individually, accelerates tissue regeneration and stimulates the immune system.
2. Electrophoresis with phosphorus and calcium to strengthen bones and joints (see also:).
3. Applications with ozokerite. They are applied to the diseased joint and promote tissue restoration.
4. 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.

The purpose of these methods is:

• muscle strengthening;
• improved blood circulation;
• maintaining joint mobility and development physical activity child;
• 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. Operative method used to restore joint mobility and blood circulation. However, there is a high risk of 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.