The formation of the human skeleton begins with its individual parts in the womb and lasts almost up to 25 years. During this time, the body grows, and the bones gradually increase in length and width.
Feature of the formation of the skeleton is the uneven and gradual growth of its growth and the distal direction from top to bottom. Those parts of the musculoskeletal system that receive the maximum axial load mature faster than others. This refers to the tubular bones with their articular ends, where the muscles are attached. Here are the ossification nuclei, which also appear as the body develops. If this happens in a timely manner for age, then the development process is normal.
One of the most important segments are the bones of the TBS (hip joint). With developmental delay or ossification of the nuclei, congenital dislocation of the hip may occur.
Generalinsight into cores
The ossification nuclei are only a diagnostic sign, indicating the development of the joint. There are no external signs, but the result is the full maturation of all elements of the joint.
This process has its own peculiarities:
- Ossification first occurs where the first load occurs.
- The ossification nuclei in the head of the femur must appear before the baby can start crawling and sitting.
- The nuclei in the acetabulum are first formed along its upper part (anatomically, this is the roof of the joint). With its timely formation, the baby begins to stand freely on his feet, and then gradually learns to walk.
- The first nuclei of ossification of the hip joints should appear exactly in the head of the femur and the upper part of the acetabulum. Otherwise, TBS is delayed in its development and the risk of congenital dislocation in a child increases. The diagnosis becomes synonymous with hip dysplasia.
If there are no ossification nuclei in the hip joint on ultrasound, then this is called aplasia.
Statistics
Dysplasia is common in all countries (2-3%), but in different ways, depending on racial and ethnic characteristics. For example, in the United States, the likelihood of its occurrence is significantly reduced in African American children.
In Russia, in ecologically unfavorable regions, the probability of having a child with such a diagnosis reaches 12%. There was a direct connection between the occurrence of dysplasia and the tight swaddling of the baby's straightened legs.
At the population of tropical countriesnewborns are not swaddled, they are carried on the back, and the incidence rate is noticeably lower here.
Evidence is also that in Japan, for example, the tradition of tight swaddling was changed by a national project in 1975. As a result, the probability of congenital dislocation of the hip decreased from 3.5 to 0.2%.
Pathology is most common in girls (80%), a third of cases are family diseases.
Congenital dislocation of the hip is detected many times more often in breech presentation of the fetus, toxicosis. The left hip joint is most often affected (60%), less often the right hip joint (20%) or both (20%).
Bone cores of hip joint
Bone tissue is formed in the fetus in the womb, at 3-5 months of pregnancy. Then the formation of TBS begins. At the birth of a child, the size of the nuclei is 3-6 mm - this is the norm.
Premature babies have smaller hip ossification nuclei. But normal children can also have small nuclei. If the nuclei are absent, this is considered a pathology. If the nuclei do not appear within the first year of life, the functioning of the TBS will not be correct.
Pathologies of the nucleus
If the newborn does not have a dislocation in the pelvic area and the joint is working normally, then with the slow development of the nuclei, this is not considered a pathology. If violations of the skeletal system and dislocation are found, while there are no bone nuclei, then this is a pathology dangerous to he alth.
Normal process
There are 3 stages of normal development:
- From the laying of elements of HBS in the fetus to the first 3-4 months of life. Normcores of ossification of the hip joints in the first months of a child's life is 3-6 mm in diameter.
- The second stage takes place at the age of 6 months to 1.5 years. Bone nuclei develop at maximum speed, and cartilage begins to gradually be replaced by bone.
- The third stage lasts until adolescence. Here already individual nuclei merge into strong plates. The lower and central parts of the acetabulum are ossified.
Proper development of the hip ossification nuclei goes hand in hand with the development of the child, first he learns to crawl and sit, and soon he can stand and walk.
At the fetus
Ultrasound during this period can show only gross anomalies in the development of hip joint in the form of a complete absence of ossification nuclei or other deformities. Dysplasia is not defined on it.
In children
After the birth of a newborn, the processes of building a skeleton start. And this is due to the movements of the baby. Active movements of the legs develop the muscles of the thigh. This causes blood flow to the deep parts of the bone. Sleeping cells are put into operation, cartilage tissue destroyers and bone beam builders appear. The replacement mechanism is accelerated by the fact that several bone nuclei appear.
The largest ossification nuclei are in the head of the femur, in its central sections. Simultaneously with the head of the femur, the acetabulum begins to form. It acquires its final form when the child stands on its feet. The norms of the ossification nuclei, which, as already mentioned, are 3-6 mm, can be checked by ultrasound, but not earlier thanin the 4th month of a baby's life.
How to tell?
Such a diagnosis as hip dysplasia is made on the basis of clinical manifestations and the results of ultrasound, X-ray. These are extremely important and informative diagnostic methods, but they are secondary to the clinic.
In time to suspect dysplasia, an orthopedist should still be in the hospital and register the child. These children are given special treatment.
Proper joint formation can be determined by a number of tests:
- Skin folds on the thighs and under the buttocks are visually visible. Normally they are symmetrical.
- Hip abduction - the child's legs are bent with pressing to the stomach and then gently parted to the sides. Normally this happens easily. With dysplasia, dilution is limited - this is a pre-dislocation, while the tone of the thigh muscles is increased.
- At the same time, slipping is noted - when the legs are abducted from the affected side, a click is noted. This is a symptom of Ortolani-Marx, and he speaks of poor fixation of the head. It is a subluxation, and the dislocation itself is determined already when the child begins to walk. The baby may limp or have a duck walk.
- One limb shortening may occur. Even if one of these tests is positive, an ultrasound is required.
If there is no ossification on both sides, this is not considered a serious pathology, since osteogenesis is still noted. But the unilateral process of delaying the ossification nuclei requires immediate inpatient treatment.
Absencecores
In some cases, there is aplasia or absence of ossification nuclei in the components of the hip joint. In such cases, the body itself tries to exclude the joint from work. In this case, the violations are as follows: the legs are asymmetrical, any movements are sharply limited or impossible.
On ultrasound, the ossification nuclei of the femur are absent and the components of the joint remain at the level of cartilage. They do not contain dense inclusions and are homogeneous. The joint is deformed. The acetabulum gradually flattens and is no longer able to bear pressure.
The head of the femur comes out of the cavity and its roundness disappears. The outcome is arthrosis - the joint is destroyed. The cartilaginous tissue is scarred, a callus appears. Therefore, the only way out is joint prosthetics.
Etiology of ossification
Ossification usually occurs in 50% of rickets. This is due to a lack of nutrients, B vitamins and minerals (calcium, iron, iodine, phosphorus) in the tissues of muscles, ligaments and bones. The lack of formation of ossification nuclei in children is also connected with this.
The appearance of dysplasia may be associated with an incorrect presentation of the fetus; in children who are bottle-fed, when immunity is reduced. A lot depends on the he alth of the mother and father: for example, the presence of diabetes, thyroid disorders, hormonal disruptions. In this case, the child's metabolism is disturbed. The reason for the absence of bone nuclei can be a twin pregnancy, gynecological pathologies in the mother in the form of uterine hypertonicity, infections andviruses during pregnancy, mother's age over 40, severe toxicosis, heredity (every fifth case), premature birth, diseases of the mother's spine, large fetus.
Development of TBS
The formation of the nucleus of ossification of the femoral heads is noted at 5-6 months, and by 5-6 years the process accelerates tenfold. At the age of 15-17, cartilage is completely replaced by bone tissue. The femoral neck continues to grow until the age of 20, and only then is the cartilage replaced by bone.
Therapy for dysplasia
Therapy should be prescribed only by a doctor, and parents must strictly follow his recommendations. Parents need to be patient and strong because the healing process will be long.
The process of establishing the normal development of nuclei in the TBS area includes:
- treatment and prevention of rickets with UV radiation and vitamin D intake;
- use splint to reduce joint;
- electrophoresis with phosphorus and calcium, eufillin on the lower back, procedures with bischofite;
- paraffin applications;
- massage and therapeutic exercises.
After therapy, an ultrasound scan is repeated in order to evaluate the effectiveness of the treatment. During treatment, the baby can not sit down and put on his feet. The sooner therapy is started, the better the outcome will be. Exercise therapy and massage are used to strengthen and develop muscles.
Exercise therapy makes sense to apply even if the child does not have dysplasia as such, but there is a genetic predisposition. Then the exercises are carried out lying down, without putting a load on the joints.
Massage
It can be carried out even in the presence of tires without removing them. With aplasia, stroking and rubbing are shown.
Massage rules:
- baby should lie on a changing table with a flat surface;
- lay a table with a diaper because the baby might pee;
- baby's mood should be cheerful and calm;
- child should not be hungry;
- massage is performed once a day, a course of 10-15 procedures.
There should be only 3 courses, with breaks lasting 1.5 months.
The massage complex is selected individually by a specialist. After consultation with the doctor, the mother can massage the child on her own and at home. Massage is not performed if the child has:
- high temperature;
- ARVI;
- hernias;
- congenital heart defects.
Gymnastics
You can learn to do gymnastics yourself. The conditions are the same as for massage. Exercises are done during the day 3-4 times. Children usually love this kind of gymnastics.
Any exercise should be done very carefully. Gymnastics in the absence of ossification of the hip joint includes the following actions:
- Formation of the frog pose in the supine position. Ideally, the knees should reach the surface when spreading the legs.
- Imitate a crawling position by turning the baby on his stomach.
- Turn the baby back on its back, bend straight legs. They need to touch the baby's head.
- Straight, straightened legs spread apart.
- Straight legs pull up to the head and spread apart.
- Fold the child's legs in the lotus position, placing the left leg on top.
- Alternately bend the legs at the knees and at the pelvis.
Paraffin applications
They warm the tissues and remove toxins. For the procedure, only special processed paraffin is used. The duration of the first procedure does not exceed 1/4 hour, then the application time can be gradually increased up to 30 minutes. Sea s alt baths are also helpful.
Orthopedic splints
- Koshlya Splint - helps to fix the head of the femur in the center, fixes the hips in a divorced state, but does not limit the movements of the pelvic joints.
- Pavlik's stirrups - fabric chest brace, strengthens the ligaments of the hip joint. The legs do not straighten, but other movements are possible. Effective up to a year.
- Shina Freyka - used for mild dysplasia under the age of 6 months. Do not use for dislocation. The splint holds the hips at a 90-degree angle.
- In the treatment of other types of pathology, tires of Koshl, Vilensky, Mirzoeva, Orlett, Gnevkovsky's apparatus, plastering are used.
- After a year, gypsum is more often used to fix the legs. If the child is 1.5 years old, and the dysplasia has not been cured, an operation is usually prescribed (according to S alter). The essence of S alter's pelvic osteotomy is that they change the spatial position of the acetabulum without changing its size.
Forecast
Forecast with early access togood doctor. In case of insufficient prevention, dysplastic coxarthrosis is formed, the treatment of which will require joint arthroplasty.
Maternal Prevention
A woman should eat well both during pregnancy and lactation. At 7 months, the baby's diet should already include additional foods.
In addition to nutrition, regular walks in the fresh air, massage, exercise and hardening are of great importance. In autumn and winter, to prevent hypovitaminosis of vitamin D, the child should receive it in drops. Also, preventive measures include wide swaddling of the baby so that the child can freely move his legs.
