Doctors under the term "dysplasia" means congenital maldevelopment of the joint, which leads to disruption of his work and can cause chronic dislocation of the hip.
It is clear that such a disease in the absence of treatment does not end well. Violation of gait, pain in the hip joints and a high risk of disability - these are the consequences of neglected dysplasia. Therefore, all moms and dads need to know the first symptoms of this ailment and understand the importance of timely visits to the orthopedist. Only early diagnosis and proper treatment will help to avoid complications!
What is the reason?
The common opinion of specialists about the dysplasia of the hip joint in the child is still not there. According to one of the versions, the main reason is the developmental defect of the articular tissues in the early stages of pregnancy (the first 2-3 months). To this predispose unfavorable ecology, exposure to toxic substances and some infectious diseases.
According to another theory, a high level of oxytocin, the hormone that causes the onset of labor, acts on the development of the joints of the crumbs. Accumulating to the III trimester, oxytocin increases the tone of the femoral muscles of the fetus, as a result of which the subluxation of the hip joints gradually develops. Perhaps this is the reason for the greater prevalence of dysplasia among girls (5 times more often than boys), which are more likely to be affected by the hormonal background of the mother.
Still increase the risk of an in vitro fetal position and prolonged heavy labor (in breech presentation).
The tendency to dysplasia is often inherited, so if some of your relatives already have such cases, you need to think about early diagnosis in advance.
be careful
Suspect the wrong parents can themselves, even before the orthopedist's consultation. Most often this occurs with a severe form of the disease, when the head of the femur completely exits from the joint cavity. In more mild cases, the presence of dysplasia can only be determined by a specialist, since the subluxation and pre-exertion of the hip joint externally practically does not manifest itself. Main features:
restriction of mobility (dilution) of the hips, often the baby begins to cry when trying to retract the leg
to the side;
asymmetry (incongruity) of inguinal and gluteal folds, which become more pronounced on the damaged side.
But the presence of only these symptoms in the dysplasia of the hip joint in a child is not an absolute sign of the disease and may be a consequence of a violation of muscle tone.
In case of dislocation, the hip joint practically loses its functions, and the affected leg is shortened. There is a "click symptom" - the slip of the femoral head from the surface of the joint when the legs of the child are bent in the knee and hip joints, as well as its direction when they are diluted.
Do not miss the time!
If dysplasia was not diagnosed in the first 6 months of life, then the joint injury progresses - the limb is further shortened, a pathological ("duck") gait or intermittent claudication is formed (with bilateral dislocation).
Diagnosis of dysplasia is often carried out in the hospital. If this did not happen (recently, ultrasound is done only if there are problems), then the mother herself can ask the pediatrician to conduct the examination. It is safe for kid's health and guarantees high accuracy of diagnosis.
Even if a single ultrasound has not revealed a pathology, remember that only constant supervision by an orthopedist and planned examinations will help the child avoid possible problems.
The first visit to the orthopedist should take place no later than 1 month, then the obligatory ultrasound of the hip joint is performed. This is an indispensable condition for early diagnosis of dysplasia. Re-examination is carried out by the end of the 3rd month, then the doctor can recommend X-rays. It is more informative than ultrasound. The most difficult for diagnosing a subluxation of the hip joint, which almost does not manifest itself and can be seen only on the X-ray.
Take it seriously to preventive care from the orthopedist - the timing of the examination is not random, each of them is associated with some important stage in child development.
If the dysplasia was detected in the first 3 months of the baby's life, then after the course of treatment (as a rule, by the 6-8th month) the joint's working capacity is completely restored and no remote consequences occur. But this is only possible with early detection and adequate treatment.
The younger the child, the easier it is to treat dysplasia. So, for example, in children of the first three months the joint can be restored independently, provided that the pedicels are always in the right position. That is why the main method of treatment in the early stages of the disease is a free swaddling, in which the legs of the child are in a dilute state.
In this respect, the experience of the countries of Asia and Africa is interesting, where mothers are traditionally most of the time worn by children on their stomachs or behind their backs and do not swaddle.
Cases of dysplasia are rare here, because joints are provided with ideal conditions for normal development. On the other hand, in European countries, it is common enough to swaddle newborns (clamping the legs against each other) - in this position, even the lightest forms of underdevelopment of joints can lead to the formation of dysplasia.
Hurray freedom!
Doctors believe that free swaddling not only allows the dislocation to self-recover at an early stage, but also stimulates the further development of joints, preventing the occurrence of complications. The meaning of the free swaddling is that the legs of the baby should always be in a dilute position, but at the same time have sufficient freedom of movement. The easiest way to achieve this is with a wide diaper and disposable diapers: after putting a clean diaper on the child, a dense diaper is rolled over it, folded into a wide band, so that the baby can not move the legs together. In this position, the small patient must be 24 hours a day. Often, this doctor adds a course of therapeutic massage and daily gymnastics (including offtake-circular movements in the hip joints). In most cases of mild forms (subluxation, pre-prefusion with a slight displacement of the femoral head), this treatment is sufficient.
Did not have time...
But if treatment and prevention were not carried out in the first 3 months of life, a more serious and long-term treatment will be required to fully recover. The danger of unrecognized dysplasia is that the bones of a toddler are very flexible and subject to various deformations due to their age characteristics. The skeleton of the baby is constantly growing, but this factor also explains its great propensity for developmental malformations. Most joints (including the hip) in the first months of life consist mainly of cartilaginous tissue, and any violations in the joint of bones lead to the formation of severe deformities. To stop the progression of the disease, you must return to normal position all parts of the joint. To do this, they usually use different types of outboard tires, they keep the legs of the baby in the right position. Thanks to this, after a while the joint is gradually "fixed" and begins to develop correctly.
At the age of 2-3 months, X-rays are usually not given to small patients with suspected dysplasia, since even with an unconfirmed diagnosis it is customary to prescribe a preventive course of treatment: the use of soft spreading tires, a curative gymnastics course (with abduction-circular motions) and a gluteus muscle massage. Mining and massage combine well with the methods of physiotherapy, speeding up recovery.
Using spreading tires, remember that their design should not interfere with the free movement of the legs of the baby, otherwise the effectiveness of treatment is reduced. It is impossible to remove the retaining structure without the permission of the doctor, the fixed position of the joints should be kept constantly. In the case of mild forms of the disease, the spreading tire is worn on the baby only at the time of sleep. The decision to discontinue treatment is made by the doctor on the basis of the results of several X-ray studies and the disappearance of symptoms.
If after 2-4 weeks of treatment there is no spontaneous adjustment of the dislocation, but complete relaxation of the femoral muscles is achieved, a more rigid fixation in combination with constant traction is prescribed. For this, a plaster bandage is applied, which allows to keep the child's hip joints completely dilated and bent at right angles. Such treatment is resorted to in case of severe forms or late diagnosis of dysplasia, when softer methods are no longer effective. Therefore, once again I want to draw the attention of parents to the importance of an early examination: in detecting dysplasia in the first 3 months, a complete restoration of the hip joints in 95% of children is achieved within 3-6 months of treatment.
Many such long-term treatment seems heavy and tedious, often parents try to find more effective methods and ... of course, make a mistake. Soft stage-by-stage treatment of the position for an infant is much more effective and, of course, more sparing than the use of a one-off closed dislocation under anesthesia, which can sometimes lead to severe complications.
Observation is compulsory
By the end of the first year of life, all the children are again undergoing a routine examination with an orthopedic surgeon. Then conditionally distinguish several groups:
children with dysplasia who did not receive any treatment;
children with severe, poorly corrected forms of dysplasia;
kids with residual dysplasia.
Each child, if necessary, is given further treatment - conservative (massage, gymnastics, physiotherapy) or surgical intervention. If the diagnosis of an "irreversible dislocation" is confirmed, then an operation is needed - an open repositioning of the joint under anesthesia.
If the dislocation was managed by conservative methods, surgery on the joint is not performed, but sometimes an extraarticular operation is required that will help to fix (stabilize) the joint. Most often, such interventions are carried out in children over 3 years of age, when the children's organism is easier to tolerate anesthesia. But the surgical treatment of the joint itself should be carried out as soon as possible! Therefore, it is optimal to form a joint by 12-13 months, when the baby starts walking.