Developmental dysplasia of the hip

Developmental dysplasia of the hip in childrenDepartment of Pediatrics; Medical University Of ChongqingAssociate Professor LuoI. overview:&#

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Developmental dysplasia of the hip in children

Department of Pediatrics; Medical University Of Chongqing

Associate Professor Luo

I. overview:

• DDH (Development of the Hip) is one of the three major congenital malformations in pediatric department of orthopedics. In 1992, the American Academy of pediatric orthopaedic surgeons changed CDH to DDH. (Dislocation)

1. DDH: the most common deformity of limbs in children.

2, the incidence of white yellow black > >

The United States from 9.1 to 13.3 per thousand in foreign countries:

Italy, France 9 per thousand to 12 per thousand

British Southampton 2.3 per thousand

China (Shanghai: 0.91 per thousand, 3.8 per thousand in Beijing, Shenyang 1.75. Hongkong 0.07 Sichuan, Chongqing 1 1000%), 0.91 per thousand -8.2%, with an average of 3.9 per thousand.

Male: female =1:5.36

Unilateral: bilateral =1.45:1

Left: right =1.55:1

Regional differences, living habits, living environment

South: habit back baby

North High (about 4 per thousand): cold weather, bundled baby

Two, etiology: a variety of theories, the reasons are not clear, there are generally four factors:

Genetic factors: polygenic inheritance, familial clustering. Hormone induction: estrogen - ligament laxity.

Acetabular dysplasia: the birth of the acetabular depth, hip instability, easy to fall off.

Mechanical factors: malposition, 16% DDH for breech delivery (first pregnancy higher chance)

Three, pathology

1, bone changes:

The separation of the pelvic tuberosity and the pubic symphysis

Femoral head (small, irregular)

Spine compensatory bending, bilateral DDH lordosis

2, soft tissue changes:

The labrum, thickening, involution

Joint capsule - elongated, deformed, Hu Luzhuang

H garden ligament thickening, hypertrophy, growth

The contracture of muscle and fascia was obvious.

Four, classification:

Developmental dysplasia of the hip: acetabular dysplasia, after treatment in June to return to normal;

Subluxation of hip: acetabular maldevelopment;

The dislocation of the hip: the most common head, acetabular development even worse.

Five, clinical examination and performance:

DDH general features: 60% on the left, on the right side of the 20%, bilateral 20%

(a) newborn: < June

Symptom:

1, double lower limbs asymmetry

2, double leg length difference

3, hip snapping (abduction external rotation)

4, the lower limb activity is limited or one side of the limb movement

Check:

1, femoral artery pulsation weakened

2, the abduction test positive

3, Allis or Galeazzi sign

4, Ortolani sign: entrance bounce

5, Barlow sign: export bounce

6, Thomas test

(two), older children: June -12 months or more

1, limping gait (duck step, drop step)

2, stack test (telescope test)

3, Sichuan derenburg test (Trendelenburg)

4, Ni Ladenza (Nelaton line)

Six, auxiliary examination:

1, X-ray examination:

Purpose and significance:

 there is no dislocation: unilateral or bilateral subluxation or dislocation

 observation of acetabulum

 to observe the development and deformation of the femoral head

Measurements are as follows:

The Bochim Quadrant: (Perkin Square)

Bilateral dislocation

Acetabular index acetabular index

Acetabular index

Normal: 20 degrees to 250 degrees

Subluxation: 25 degrees to 30 degrees

Total dislocation: > 30 degrees

Center edge angle (C.E angle)

Center edge angle

(normally about 20 degrees, 15 degrees, < subluxation; mainly used for diagnosis of subluxation in children)

The Xingdeng's line (Shenton line)

Shenton line discontinuous or interrupt

Luo Yan (Von Rosen) film method: small baby

DDH is located at the intersection of the L5 plane above the lower limb abduction of 45 degrees and extremely internal rotation of the film

Check 2, B: early diagnosis of DDH is of great significance, < June

3, arthrography (arthroscopy)

1.CT examination

2.MRI examination: soft tissue and cartilage were intra articular (epiphysis).

Seven, diagnosis diagnosis:

According to the double leg length discrepancy and Ortolani (+), the diagnosis can be confirmed. Older children painless limp or duck step, double limb length, abduction test (+), Allis syndrome (+), X-ray can determine the degree of dislocation.

Eight, differential diagnosis:

1. Congenital coxa varus congenital coxa vara;

2, pathological dislocation of the hip;

3, multi joint contracture with hip dislocation;

4, other paralytic hip dislocation;

5, traumatic dislocation of the hip.

Nine, treatment:

General principles: early diagnosis, early treatment

That is:

The choice to maintain a stable posture of hip joint;

According to the different age choose fixed brace;

The choice of the development of hip joint of the most appropriate age;

The femoral head was commensurate or consistent;

For a certain period of time after the reset;

Steps and requirements:

(1) effective traction;

(two) effective anesthesia and reduction;

(three) effective fixation.

1, non-surgical treatment: < age 3

(A), 1 ~ June: Pavlik hanging bag or with a variety of support;

(B), June - 36 months: closed reduction and plaster fixation, the specific operation is:

Tractive force;

The anesthesia reset, adductor release;

The plaster fixation, March / time, 3 times.

Preoperative preparation:

1) brace traction;

2) skin traction;

3) bone traction;

2, surgical treatment:

Indication:

The 3 year old age >

The failure of conservative treatment (age < 3 years)

Preoperative preparation:

Limb traction, distal femoral bone traction or skin traction 3-6 weeks, traction weight = weight x (1/6 - 1/8)

Operation mode:

1 Salter: 3-5 years old

Acetabular index < 45 degrees

3 year old manual reset failure

The Chiari operation: 6-10 years old

Acetabular dysplasia

The Pemberton operation: 6 ~ 10 years old

Acetabular dysplasia

The palliative operation:

> 10, the hip joint function in children could not resume normal operation, can only improve gait, relieve symptoms, such as the Schanz osteotomy

Postoperative complications:

The avascular necrosis of the femoral head;

The redislocation after operation;

The restricted motion of the hip joints, stiffness;

In short, the early diagnosis of CDH or DDH is very important, and early treatment to improve the cure rate and reduce the occurrence of residual deformity is crucial, clinicians should pay high attention to!

 

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