Asymmetry of the hip joints in newborns. Video: Preventive exercises and massage methods for the initial stages of dysplasia. Causes and factors contributing to the development of pathology

pelvic dysplasia hip joints a newborn has a serious problem that requires qualified and integrated approach. Early detection disease increases the effectiveness of therapy many times over. What determines the effectiveness of treatment? 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 issue - a diagnosis of dysplasia hip joints in children, what is it?

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

Articular head. This is the head femur.
Acetabular cavity. It has a semilunar shape.
Rotary lip. A cartilaginous plate that serves as a protective barrier against displacement of the head upwards beyond the joint.
articular capsule. Connective tissue forms an airtight cavity by weaving its fibers into the structures of the joint.
Ligaments and muscles. Keep all elements of the joint in the correct position.

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

In the picture on the left - the norm, on the right - dysplasia (dislocation) of the hip joint in a child

With the proper development of the components of this complex system, functional problems does not occur. But if something goes beyond the norm, hip dysplasia develops in a newborn.

In other words, dysplasia is the inferiority of structures.

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

The first symptoms: what to look for?

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

Often parents 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 joint.

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

Signs and diagnosis of hip dysplasia in children

The folds on the legs are not symmetrical

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

Then turn over on the stomach. Assess the gluteal and popliteal folds. 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.

Take this test for a panacea is not worth it.. Because there are cases of completely healthy children with asymmetric 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 laid out on the back. The doctor bends the legs in the hip and knee joint. If at the same time the level of one patella is lower - this is a poor prognostic sign. Occurs during dislocation.

Click symptom

Diagnostic symptom of dislocation. The kid lies on the back, the leg is bent at the hip and knee joint and taken to the sides.

This is done without pressure! At some point, the doctor feels a characteristic click. The reason is the exit of the head beyond the cavity. This test is optional, as 4 out of 10 examined newborns will have it positive, although the children are completely healthy. With age, information content decreases..

Pulling the legs to the side

The baby lies on its back, the legs are bent in the same way as described in the previous test, they are taken to the sides. Normally external side surface feet should touch the table. This may not be the case with muscle hypertonicity.

You can detect dysplasia up to a year in a child yourself at home. But for 100% confirmation of the diagnosis, it is necessary to conscientiously visit a pediatric orthopedist within the time allotted for scheduled inspection.

X-ray examination child's hip joint is more revealing after a year

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

For these purposes, ultrasound, x-rays are used. Ultrasound is prescribed more often in children under one year old., because at this age, cartilage is not yet visible.

Reasons: good information content in early age, nothing threatens the health of the child, unlike radiation exposure during x-rays.

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

What are the causes of hip dysplasia in newborns?

We note the main cases.

Antenatal (intrauterine) period. Toxicosis. Taking medication.
Childbirth. Pelvic presentation. This position of the fetus is a difficult task, requiring skilled labor management. Often, in order to avoid complications when breech presentation fetus, perform a caesarean 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, the arms and legs are tightly wrapped in diapers. The legs are aligned - this is highly undesirable!

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

What will the statistics say?

Hip dysplasia in a newborn more common 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, bones, necessary for the baby to pass through birth canal. It is assumed that the body of girls is also sensitive to the influence of the hormone.
The right joint is most commonly affected.
In the inhabitants of the tropics, the incidence rate is low, in the Scandinavians, on the contrary, the highest.
If parents are diagnosed with an illness, the risk of developing the disease in children increases 10 times.

The main forms of the disease

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

Treatment

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

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

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

Execution technique

The baby lies on his back. Stroking outer surface thighs and lower legs, then proceed to rubbing these areas. Make it basic 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 the stomach. Stroking lumbar, outer thigh. Rub these areas with spiral movements.
Next, massage the buttocks. A local massage is performed on the dysplastic area. With one hand they fix the joint, with the other they take the leg away, rotating the thigh inward.

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

Execution technique

The child lies on his back. Alternately bend and unbend each leg.
Take 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.
"Bike". Imitate the legs of a child riding a bicycle.

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

For the treatment of hip dysplasia in newborns by keeping the legs in a divorced position, Pavlik's stirrups, Becker's panties, and Freik's pillow are most often used.

Pavlik's stirrups are used most often up to 3 months, then in combination with Volkov's tires.

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

Devices for the conservative treatment of hip dysplasia

After 5 years open surgical method reduction.

Consequences of hip dysplasia in children

Limited mobility in the joint.
Strong inflammatory process.
Pronounced pain syndrome.
Lameness.

With absence adequate diagnosis and rational treatment, dysplasia can cause disability.

5 steps to prevent the development of the disease

Complete rejection of swaddling. The baby is dressed in ordinary clothes.
Use of diapers. When Evgeny 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 good prevention illness.
Use of kangaroo backpacks, slings.
Proper wearing of the baby. When the little one begins to confidently hold his head, parents can wear it in an upright position “away from you”. One hand holds the little one at chest level, the other - the feet of bent at the knees and legs apart.
Swimming on the tummy. Hydrotherapy is very useful. The kid, overcoming the resistance of water, develops different muscle groups.

Immaturity of the hip joints occurs in 20% of newborns. In medicine, this phenomenon is also called dysplasia. Under this pathology, orthopedists and related specialists mean congenital abnormalities in the development of joint structures and their inferiority (underdevelopment). Graf type 2a (ultrasound classification) is an immature dysplastic joint. The initial stage is pre-dislocation, and if you do not respond in time and start treatment, then pre-dislocation will have dangerous consequences: subluxation or dislocation of the hip head in children.

Hip dysplasia in newborns is the most common diagnosis in the office of an orthopedist

Even in absolutely healthy children who have just been born, the structure of the hip joint is not a fully formed structure (immaturity), and possible problems are associated with this.

For reference. Immaturity of the hip joint in an infant (type 2a) is a physiological component, a concept that includes delayed development of the joint due to different reasons. Dysplasia is an initially incorrect formation of hip joint. Both of these concepts were previously combined into one, and the treatment was the same. However, it should be remembered that the line between these two diseases is very thin, and if you do not start observing a newborn with a diagnosis of "underdevelopment of the hip joints (type 2a)" in time, then you can get all the "charms" of dysplasia with all the ensuing consequences.

The ligament system in children has the following differences from the adult hip joint:

In newborns, the verticality of the articular cavity is large in size.
In newborns, the ligaments are more elastic.
In newborns, the acetabulum has a more flattened structure.

The femur does not move upward due to the limbus (cartilaginous plate of the articular cavity). If there is congenital disorders in the development of the joint (underdevelopment), the cavity becomes flatter. Excess elasticity prevents the ligaments from holding the head of the hip joint in one position. With violations in its development, the shape, size and integral geometry of the bones can change.

If you do not start treatment in time and do not correct congenital dysplasia (immaturity) in children, the limbus turns out with an upward shift. Strongly deformed, he is no longer able to hold the head inside the acetabulum. The slightest careless movement of the baby can lead to subluxation and even dislocation.

Forms of the disease

Immaturity of HBS in newborns has several varieties:

Acetabular (congenital pathology of the acetabulum).

The immature dysplastic joint of newborns (type 2a according to Graf) is a fairly common phenomenon. If the elasticity of the ligaments and changes in the centralization of the head in the acetabulum have slight deviations, the usual therapeutic massage plus exercises quickly correct such a deviation. Almost all children in the first month of life may experience some degree (often put type 2a) underdevelopment (immaturity) of the hip joint. Therefore, the examination of babies begins from the second month, when the tendency of cartilage strengthening of the hip joint is already visible. If a serious concerns appear earlier, carry out unscheduled ultrasound procedure(according to Graf - underdeveloped dysplastic joint of newborns - type 2a).

Proximal femoral dysplasia.

Congenital disorders of bone development in the proximal section (underdevelopment) are changes in the neck-diaphyseal angle. The indicator is calculated along the line connecting the centers of the neck and head of the femur, and along the line of the diaphysis. A frontal x-ray can detect pathology in children.

Rotational dysplasia (immaturity).

In girls, underdevelopment of the hip joints is 5 times more common than in boys.

Such a developmental disorder in which the angle between the axis of the hip joint and the axis of the knee changes (in the horizontal plane). Geometric anatomical measurements healthy person have the following indicators: in infants - about 35 °, in children by three years - 25 °, in an adult - 15 °. With age, the angle decreases due to vertical position body. With excessive antetorsion (changing the degree of the angle), the centering of the hip joint in the acetabulum is disturbed.

Risk zones

Congenital underdevelopment (immaturity) of the joints in children can be a consequence of how the mother's pregnancy proceeded, so the following factors influence the occurrence of pathologies:

Treatment with strong drugs during pregnancy.
Acute toxicosis.
Improper nutrition, avitaminosis.
Availability chronic diseases in a pregnant woman.
family predisposition.
First birth.
Very large fruit.
Breech presentation of the fetus.
Early childbirth (immaturity of the mother's body).
Preterm birth (prematurity of the fetus).

Infants who are at risk are immediately registered with an orthopedist and treatment begins. Pregnant women in case large fruit or its malpresentation, a caesarean section is usually prescribed. Natural childbirth is dangerous possible consequences: when the fetus passes through the birth canal, its already weak hip joints may be disturbed.

Significantly affects the likelihood of dysplasia and the sex of the child. Statistics note that in girls, immaturity (underdevelopment) of the hip joint occurs five times more often than in boys. In female infants, the ligaments have a higher elasticity, which leads to big risk"instability" of the head of the hip joint in the acetabulum.

Stages, diagnosis and getting rid of the disease

The stages of dysplasia include predislocation and subluxation of the joint - underdevelopment (immaturity) of the hip joint without displacement or with a slight displacement of the femoral head relative to the acetabulum. The most difficult type of dysplasia is a dislocation of the bone. A dislocation causes pain in children when walking and a change in gait (clubfoot, lameness and other defects).

Anterior dislocation, subluxation and dislocation is detected through visual inspection and application modern technologies. Clinical manifestations of immaturity of the hip joint can be noticed by an orthopedist or the parents themselves.

For the treatment of the disease, massage and the use of various orthopedic devices are prescribed.

Symptoms and treatment of immaturity of different stages:

1. Pre-luxation.

The symptoms of the initial stage of pathology in newborns are mild (look at the photo or video - children with predislocation are almost indistinguishable from babies without pathology of the hip joints). Asymmetry of skin folds on the legs and buttocks is not observed. The legs of a newborn do not differ in size from each other. The following may indicate the initial stage of immaturity: if you put the newborn on its back and spread the bent legs a little to the side, you will feel a slight push and perhaps a slight crunch - this is the femoral head enters the acetabulum. If this symptom is found, you should immediately consult a doctor for a more accurate diagnosis. Pathology is quite fixable even with simple conservative methods:

Massage.
Therapeutic exercises (with a trainer or a special video at home).
Electrophoresis.
Wide swaddling of newborns.

2. Subluxation.

The main signs of subluxation are as follows:

Asymmetry of skin folds in the legs and buttocks of a newborn.
Leg extension limitation.
Different leg lengths or different height knees while bending the legs.
A characteristic click during the breeding of the legs to the sides (sliding symptom according to Marx-Ortolani).
Restlessness of the newborn when moving, loss of sleep and appetite.

Suspicions of subluxation obtained during the examination should be confirmed by ultrasound. Exhaustive indicators are provided by ultrasonography. X-rays are used only when the baby reaches the age of three months. With subluxation, as a rule, treatment is prescribed by conservative methods: massage, exercise, electrophoresis. Surgical intervention is mainly recommended only in difficult cases of dislocation.

With underdevelopment of TBS in a baby, good result provides massage.

To reduce the subluxation, infants and older children are prescribed orthopedic devices:

Freyka pillows.
Becker's special pants.
Pavlik's stirrups.
Tires of Vilensky or Volkov.
Coxite bandage.

The action of these devices is aimed at fixing a stable position in order to get rid of subluxation, allowing the joint to strengthen and grow with ligaments.

Symptoms of dislocation are similar to those of subluxation, only more pronounced - asymmetric skin folds, limited range of motion in the joint, different length legs, etc. For the treatment of dislocation, one-stage reduction of the hip joint can be used. In most cases, corrective surgery is prescribed, although this is last resort. After successful reduction of the dislocation, the doctor prescribes a course of restorative procedures, including electrophoresis, therapeutic massage and a complex exercise, which moms can do on their own (use the advice of experts from training videos that will allow you to choose the right exercises).

Features of wellness procedures

The most common medical procedures which are used in parallel with drug treatment dysplasia in newborns are:

Massage.
Recreational gymnastics.
Electrophoresis.

If a lot of articles and reviews have been written about the first two procedures, then the last procedure is covered rather poorly - let's dwell on it in a little more detail.
Electrophoresis is a physiotherapy procedure, as a result of which small current pulses are applied to the patient's skin. Since the current passes through the gauze soaked in the medicine, the drug enters the epidermis through the skin, and then, together with the blood, enters the desired part of the body. The procedure is completely safe and therefore suitable even for babies. For the treatment of dysplasia, the electrode plate is applied to the gluteal muscle. Eufillin dissolved in pure distilled water or dimexide is used as a medicine. Electrophoresis normalizes blood circulation in the tissues surrounding the diseased joint, saturates them nutrients. In the treatment of neonatal dysplasia, a course of 10 electrophoresis procedures will be sufficient.

It is important that immaturity (dysplasia) of the hip joint in newborns be detected at the earliest stages. The sooner the orthopedist prescribes treatment, the more effective it will be.

Hip dysplasia (HJD) is a congenital pathology of newborns, during which the normal formation of articular tissues is disturbed. If not detected and treated this pathology on time, then adults can develop dysplastic arthrosis - serious disease hip joints, for which disability is given:

high risk of disproportionate limb development;
the legs will be weak and will not be able to withstand the load,
constant risk of dislocation or fracture,
there is a violation of gait, a decrease in the amplitude of movements in the joint;
walking and standing still without support will cause pain.

Hip dysplasia is a congenital defect of the joint

These include:

Heredity. Gynecological diseases Mom. pathology during pregnancy.
Birth before term. In premature babies, some tissues and organs do not have time to fully form.
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 of the joints of the child.
Acceptance by the mother of various medications during gestation, oligohydramnios, large weight of newborns.
Hormonal imbalance. If too much progesterone is noted in the mother's body before birth, then later this can cause weakness of the muscular apparatus.

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 rigid options for swaddling children. Hip dysplasia is much less pronounced in countries where it is not customary to swaddle newborns.

Diagnostics

Most right time to determine the disease of the newborn - up to 3 weeks. After 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 the pathology - even in the maternity hospital. Hip dysplasia in children has the following external symptoms:

The asymmetric location of the inguinal, gluteal and popliteal skin folds is clearly visible in children from two to three months.
Symptom of shortened hip.
The "click" symptom - the femoral head may move out of the acetabulum with loud sound and then back again.
Limited movement of the hips or pain when trying to spread the half-bent legs of babies to the sides (for babies, the normal position of the legs during breeding is up to 90 degrees).
Increased hip mobility - legs can take an unnatural position, turning inward or outward.

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

If you have any doubts, be sure to consult a doctor. The sooner hip dysplasia is detected in newborns, the more likely it is to be cured quickly. To confirm the diagnosis, an X-ray examination and ultrasonography are performed, which can detect the presence of pathology:

Deformity of the acetabulum (acetabular dysplasia), misdevelopment heads of bone and cartilage.
Too stretched ligaments or capsule.
Dislocation of the hip bone.
Partial or complete displacement of the bone from the acetabulum.

All of these symptoms are good grounds for the diagnosis of hip dysplasia (HJD).

Development of pathology

There are three degrees of development of hip dysplasia

With late diagnosis and without appropriate treatment, hip dysplasia can cause severe complications and even disability. Therefore, signs of pathology of the hip joint must be identified and treated at the initial stage of development. At early diagnosis and the correct course of treatment, the prognosis can be favorable.

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

Predislocation of the joint: minor disturbances in the development of the joint in the acetabulum. As a rule, such a process is diagnosed in newborn babies.
Subluxation of the joint: in this degree, there is a displacement of the femoral head, but it is still at least partially located in the acetabulum. Violations in normal functioning and development are noticeable not only in the region of the acetabulum, but also in the femur.
Dislocation of the joint: at this stage, the femoral head is completely displaced beyond the boundaries of the acetabulum. The voids formed during dislocation are quickly filled connective tissue. Dislocation is the most difficult stage, difficult to correct. Often, surgery is required to repair the dislocation.

Complex of therapeutic measures

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

The task of the course of getting 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 fixing the limbs in a certain position (for this, stirrups, splints, special pants, wide swaddling are used). Since the ligaments and bones are too mobile with dysplasia, then next step becomes general strengthening cartilaginous tissues and musculoskeletal system.

In the treatment of joints with acetabular dysplasia, the following methods are usually used:

A set of exercises required to strengthen muscles and restore normal range of motion. On the different stages child development apply different types gymnastics. High results show classes in the water.
Massotherapy. 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, abdomen, followed by more intensive massaging of the diseased joint area.
Thermal procedures with the use of ozocerite or paraffin applications.
Physiotherapy: electrophoresis with calcium and chlorine, application ozocerite applications to strengthen the joint.

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

Attention! Gymnastics, massage and warming up 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 more easily endure the prescriptions of doctors. For example, in order to help keep the legs in the abducted position for a long time, many auxiliary corrective devices have been invented. Frame's pillow, Pavlik's hard pants and stirrups deserve special attention:

Frejka pillow is a special product with which you can fix the hips in the desired position. Use a pillow for children from a month and earlier. The size should be selected by a specialist.
Becker panties are an alternative to the Frejk 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.
Pavlik's stirrups. The stirrups consist of several parts - a chest fixing brace and straps that hold the feet and hips in the desired position. It is necessary to ensure that the stirrup belt fits snugly to the body, but is comfortable.

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

Surgical methods

Surgical treatment in children is used extremely rarely, only in cases of dislocation (advanced hip dysplasia). Or when all other methods fail.

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

Hip surgery can be done in a variety of ways:

Osteotomy in the pelvic region 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 asymmetric limbs.
Endoprosthetics - replacement of a diseased joint with an implant.

After surgical intervention the legs will be fixed with a rigid tire. Of course, the child is unlikely to like this, and he will be capricious, but believe me, splints are needed - they will allow you to achieve normal fusion of the joint and alignment of the bones (the baby can bend the legs at the knees, but at the same time the angle between the hips remains fixed). In the future, in order to prevent residual manifestations diseases, you can use medical stirrups or pillows.

Features of caring for a sick child and prognosis

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

If the baby is lying on his back, then his feet should hang down a little - this will relieve excessive stress from the joints.
When carrying, you need to take the children so that they are facing you, and the legs wrap around you.
Do not try to put the baby on his feet - even minimal vertical loads are completely prohibited until the end of treatment.
When transporting children in a car, use car seats in which their legs will not compress. When sitting on a chair (for example, while feeding), use rolls of a towel or pillow so that the legs are slightly apart.

If hip dysplasia has not been detected in children under one year old, then the risk further complication increases, treatment and recovery become more complicated. If the treatment complex came into effect in the first weeks of life, then the prognosis for getting rid of hip dysplasia for children is 100%. Before the first year of life, modern conservative ways treatments (stirrups, massage, exercises, etc.) help to cure about 95% of patients.

Childhood hip dysplasia (PHD) is a congenital pathology in which bones and muscles develop abnormally. Often the disease occurs in children under one year old.

Hip dysplasia in children affects and disrupts the formation of all elements of the joint: ligaments, cartilage, muscles, bones and nerve endings. In medicine, this disease is also called congenital dislocation hips. There are three main levels of severity hip dysplasia in newborns:

The first (pre-dislocation) is characterized by insufficient development of bones and cartilage, but without pathologies of the musculoskeletal system. The femoral head does not deviate.
The second (subluxation): the displacement of the femoral head outwards and upwards joins the symptoms of the first stage.
The third (dislocation) is accompanied by a lack of contact between the femur and the acetabulum.

Causes

Doctors have identified several versions that explain the causes of hip dysplasia:

genetic predisposition;
Elevated levels of progesterone in the last weeks of pregnancy, which provokes muscle and ligament weakness and causes instability of the hip joint;
Exposure to toxins, including medications, in which there are violations in the formation of the musculoskeletal system;
Multifactorial theory implies the simultaneous influence of several groups of factors.

In addition, there are certain conditions that can increase the risk of hip dysplasia in infants. These include breech presentation of the fetus, underdevelopment of the acetabulum, and minerals (phosphorus, calcium, iron and vitamin E), as well as limited motor activity fetus in the womb.

The increased number of children with dysplasia is directly related to the method of swaddling. For example, in Africa and Asia, where newborns are carried on their backs, there are practically no cases of dysplasia. This fact forced the Japanese to conduct a special experiment: children with dysplasia were no longer tightly swaddled, and as a result, the number of sick babies decreased by almost ten times.

Signs of pathology

A qualified doctor will be able to determine dysplasia even during a routine examination, examining the position and size of the legs, skin folds on the thighs, determining muscle tone and the number of movements.

However, there are also characteristic symptoms hip dysplasia, which include:

The femoral and gluteal folds are located asymmetrically.
Slip or click symptom. When the child lies on his back, the doctor bends his legs at the knees and hips and presses on greater skewer. In this case, the femoral head falls into place, which is accompanied by a characteristic click.
External rotation of the legs (thigh rotated outward). This sign meets not only in children with DTS, but also in absolutely healthy babies.
The child cannot fully abduct the hip to the side.
If the dislocation is located high, the child may experience a relative shortening of the diseased leg.

Minor signs of dysplasia include soft tissue atrophy on the affected side and reduced pulsation of the femoral artery. Very rarely, DTS is not accompanied by any symptoms.

Methods for determining the disease and differential diagnosis

To diagnose dysplasia, a child will need to undergo a set of examinations to assess the degree of damage and prescribe the correct treatment. Diagnostic manipulations include:

X-ray. The child is laid symmetrically and a picture is taken quickly using protective pads. During the procedure, parents or medical personnel must be present so that the child lies still. On the x-ray in the presence of dysplasia, acetabular obliquity, displacement of the femur or protrusion of the femoral head, as well as deviation from the norm in the size of the head and socket will be clearly visible.

Arthrography allows you to assess the condition of the ligaments and capsules. This method diagnosis allows you to determine even dysplasia of the first degree. The procedure is carried out under general anesthesia: skin, capsule and joint cavity are pierced with a thin needle. Then insert through the hole contrast agent and take a few pictures.

Arthroscopy is a procedure in which an instrument with a camera at the end is inserted into the joint cavity, and the doctor examines the condition of the bones, cartilage and ligaments on the screen.

Ultrasound is the safest and least traumatic method that allows not only timely detection of DTS, but also control of the treatment process. Ultrasound is performed on children with clinical manifestations illness, with severe course childbirth and pregnancy in the mother, as well as low muscle tone of the legs.

CT is used only if the child is indicated for surgery.

However, diagnosis is complicated by the fact that there are a number of diseases that manifest similar symptoms. Therefore, it is important to carefully differential diagnosis to distinguish DTS from pathological or paralytic hip dislocation, arthrogryposis, or metaphyseal fracture.

The statistics say that early start treatment (up to three months) allows not only to completely cure dysplasia, but also significantly reduce the course of therapy ( average duration is two months). Late initiation of treatment can result in a person struggling with DTS for the rest of their lives. However, the difficulty is that in almost half of the cases it is not possible to diagnose dysplasia before six months.

Treatment of hip dysplasia is necessary when the first signs of the disease are detected and x-ray results confirm the presence of the disease. In addition, if the pregnancy was difficult, and the newborn has asymmetry of the femoral or gluteal folds, therapeutic measures should be started immediately.

First of all, for the treatment of dysplasia in a child, they are used conservative methods. These include:

The child is freely swaddled so as not to constrain his movements. AT this case the dislocation may retract on its own.
The child is given special spacers or tires (for example, Pavlik's stirrups), which give the child the opportunity to move the leg to the side and freely bend and unbend it.
Use special plaster bandages with distraction system.
Actively use physiotherapy methods that relieve pain, inflammation and resist the formation of complications. For the introduction of drugs into the hip joint, electrophoresis is used. Mud therapy, magnetic laser therapy, massage, acupuncture and ultrasound are also used.

If a conservative treatment did not give positive results, recommended surgical treatment joint dysplasia. The dislocation can be reduced openly or endoscopically treated.

Parents who have a child with DTS need to strictly monitor the observance of the child's daily routine. The baby should regularly do special exercises and wear special shoes fixing the ankle. It is not recommended to teach a child to walk early or use a walker for this purpose.

For rehabilitation after dysplasia, newborns are prescribed measures aimed at strengthening the muscles of the hip joint and the complex special exercises to activate the process of recovery and adaptation of the joint to a new position.

To prevent the development of DTS, you can not swaddle the child tightly. You should regularly be examined by an orthopedist and a neurologist, do exercises and periodically conduct an ultrasound scan of the hip joints.

Childhood dysplasia is not as dangerous as the immaturity of the hip joints, these two conditions must be able to distinguish. If the symptoms are similar, only a doctor can distinguish one disease from another, so the newborn must be shown to an orthopedist in order to exclude pathology. Timely treatment allows you to completely get rid of the disease.

Causes of the disease

The very concept of "dysplasia" means a violation of the development of any part of the body. If this ailment struck precisely the hip joints, then this often manifests itself in:

improper development of the articular cavity;
immaturity of the femoral head;
impaired mobility of the hip joint.

These conditions can result in predislocation (predisposition to dislocation), subluxation and dislocation in newborns.

The reasons why the hip joints do not develop normally have not yet been elucidated. But some have been found character traits diseases. Firstly, such an ailment is more common in girls than in boys. Secondly, the tendency to this pathology is genetically determined and is transmitted from generation to generation. And thirdly, improper swaddling of a newborn can provoke dysplasia.

It has been noticed that where it is customary to swaddle babies freely, this disease is much less common. For example, as soon as tight swaddling of babies was abandoned in Japan, the frequency of dislocations of the hip joints in babies decreased by 10 times.

So, in what cases are babies more vulnerable to dysplasia:

if the family has already had cases congenital subluxation femoral joints;
if children are born in breech presentation;
in the presence of deformed feet;
when too big weight at the time of birth;
with pathologies of pregnancy.

Clinical symptoms

Signs of subluxation or dislocation of the hip in infants are visible when visual inspection. It:

asymmetrically placed skin folds in the groin, on the buttocks and knees;
shortened thigh;
limited hip mobility.

The best signs of the disease are visible in children aged 3 months. In any case, if you notice the symptoms of the disease, you should not panic, consult a doctor and start timely therapy. Examining the baby, the doctor draws Special attention on skin folds in the groin, gluteal area and under the knees - in the affected areas they are larger and deeper than usual. However, with bilateral dysplasia, the asymmetry may not be as obvious.

However, hip folds can be asymmetrical in healthy children, so you need to pay attention to a few more indicators.
Lay the baby on his back and gently bend his legs at the knees and at the hips. If you notice that the knees are on different levels, this is already a serious enough reason to show the newborn to the doctor.

The orthopedist at the examination should check for symptoms of slipping and limited mobility of the hip joints. The presence of the latter feature is most important in making a correct diagnosis.

Diagnosis of the disease

For early definition dysplasia, it is necessary to show the baby to an orthopedic surgeon almost immediately after birth - at 1 month. and at the age of a little older - at 3 months. Diagnosis is made by ultrasound and X-ray. X-ray is used for older children - from 6 months. The treatment itself, its methods and speed depend on how early the disease is detected.

So, if you are outward signs suspected the presence of dysplasia in the newborn and went to the doctor, then an ultrasound scan will be required to clarify the diagnosis. The study will reveal complete picture ailment.

Ultrasound is a painless and completely harmless procedure for babies, available in almost any clinic. The examination helps to determine the severity of the disease.

By degree, the disease is divided into:

light, when the muscles and ligaments do not fit well to the joint, because of this hip bone incorrectly located in the articular fossa;
pre-dislocation - a borderline condition in which the head of the femur is partially located in the articular cavity, and partially goes out;
dislocation - in this state, the head of the bone is outside the articular cavity, in this position, not only a gradual deformation of the joint occurs, but also the mobility of the leg in the thigh is impaired.

The form of the disease can be unilateral and bilateral. The second option is hip dysplasia in a newborn.

After the ultrasound, it is necessary to carry out x-ray examination, this is done at an older age, when the baby is at least six months old.

Treatment of the disease

Dysplasia is treated enough for a long time, so you should not expect the first results immediately after the start of treatment. The disease is not treated with medication.

Firstly, the child's legs must be constantly fixed in a divorced position with bent knees, and secondly, the child must move in this position.

In order to keep the baby's legs in the right position, there are various devices - splints, bandages, Freik's pillow, Pavlik's stirrups, etc. At first, during the treatment of the disease, the baby must be in them all the time.

The child must stay in orthopedic devices for at least 3 months, but only the orthopedist sets the exact period. Further prognosis largely depends on how early treatment began. Diagnosis and treatment of the disease at the most early dates gives a 90-95% chance of recovery. If subluxations and dislocations of the hip joints are not treated in time, the baby may remain lame.

For very young children, soft pads and wide swaddling are used, while hard orthopedic constructions used to treat older children. Only in extreme cases it is possible to treat with surgical methods, usually a cure can be achieved with the devices listed above.

In addition to various devices for the treatment of the disease, and physiotherapy. The doctor may also refer you to physical therapy, for example, or paraffin therapy.

How to massage and exercise

The treatment advised by Dr. Komarovsky is very simple. This is a massage that greatly increases the effectiveness of therapy, it is also useful for healthy children, and even in the case pathological development hip joints is shown at 100%. The procedure can be carried out by both a professional massage therapist and the parents themselves.

The process itself is quite simple, it is only important to consult with an orthopedist before it - he will tell you how to properly massage.

Step 1

Lay the newborn on his back and start the massage with light strokes on the arms, legs and abdomen, and then turn the baby face down. Make sure that in this position the legs are laid aside.

Gently stroke and rub the baby's hips from the inside, then work out the lower back of the newborn with similar movements. After that, you can move on to the buttocks, the massage is done with light tapping movements and gentle pinching.

Step 2

After you have massaged the back and buttocks, turn the child over again and continue the massage, develop the front surface of the thighs, gently bending and unbending the baby's legs. Do not do it sudden movements and watch the reaction of the newborn - he should not be hurt. Otherwise, the baby will begin to act up during subsequent massage procedures.

Step 3

Then begin to rotate the baby's hip inward. Do this alternately with each leg - with one hand hold the baby's pelvis, and with the other hand slowly bring the knee closer to the body and gently rotate the thigh inward. This massage will help proper formation hip joint sockets. Let your child rest by gently stroking their entire body.

At the end, take care of your feet - put a small ball under them and roll it.

The final stage is chest massage.

Wellness gymnastics

The exercises are extremely simple and do not require any equipment. Gymnastics should be carried out often - at least 5 times a day before feeding. Within 3-4 months, you should do the exercises 15-20 times.

First exercise: rotate the leg of the newborn bent at the hip and knee in a circle along the axis of the thigh.
The second exercise: bend and unbend the legs at the hips and knees towards the stomach, while the hips should be in a horizontal position.

Together with physiotherapy massage, gymnastics and orthopedic devices will give excellent results.

Disease prevention

For all newborns early detection pathology of the development of the hip joints in the maternity hospital or in the clinic at 1 month. perform a pelvic ultrasound.

One of the preventive actions, according to Dr. Komarovsky, is to wear the baby in a sling facing the mother.

As a preventive measure, wide swaddling is popular, contrary to the old-fashioned method of tightly fixing the legs in a straight state. It was believed that such swaddling straightens the legs, but in fact it only harms the baby and, as it turned out, significantly increases the risk of developing hip dysplasia in a newborn.

In some countries, it is customary for babies not to be swaddled, but to be carried on their backs, when the child's legs wrap around the mother's back, being in the correct position.

For wide swaddling, use a soft but dense fabric. Fold it in several layers and lay it between the baby's spread legs so that the side edges are in the area of the knees, and the upper ones completely cover the pelvis. It turns out something like a diaper, but much wider and more stable shape.