Experience in introducing ultrasound of the hip joints in children's clinic No. 31 in Volgograd.

Ultrasound of the hip joints in infants is carried out at the Health 365 clinics at the address: st. Bazhova, 68, Ekaterinburg.

An ultrasound of the hip joints is recommended when a newborn (age from birth to 4 weeks) becomes an infant (from 4 weeks to 1 year), i.e., when the baby is 1 month old. Ultrasound of the hip joints is a study that allows a baby to detect the presence of dysplasia (impaired formation), subluxation or dislocation of the hip joints using harmless ultrasound. Ultrasound diagnostics is highly informative, as it makes it possible to obtain an image of the cartilaginous structures of the hip joint, make a diagnosis at the right time, draw a precise line between neurological and orthopedic pathology, and determine treatment tactics, which in each of these cases has its own specifics.

Until recently, the leading role in the diagnosis of developmental disorders of the hip joints was given to the x-ray method. However, the radiation exposure that accompanies the X-ray method and the difficulty of correctly positioning the child for examination are its disadvantages.

The modern approach to the early diagnosis of developmental disorders of the hip joints involves the active identification of infants with this pathology using ultrasound, to solve the main problem - making the diagnosis as early as possible and starting treatment before 6 weeks of age.

Such an early start of treatment allows you to use the high growth potential of the structures of the hip joint, achieve complete anatomical and functional restoration in a short time, prevent possible complications such as necrosis of the head, early arthrosis, and eliminate the possibility of surgical intervention.

Indications for ultrasound of the hip joints in infants

The study is carried out to identify hip dysplasia, which, if left untreated, leads to congenital dislocation of the hip and disability of the child.

Symptoms and indications for ultrasound of the hip joints in a child may include:

• Different lengths of baby's legs;

• The presence of an additional fold on the thigh;

• Increased muscle tone in the legs;

• Restriction in movement, clicks in the hip joint when abducting or flexing the leg;

• Lack of symmetry of folds on the buttocks;

• A history of hip dysplasia in immediate family members;

• Birth trauma, the use of traumatic obstetric aids during childbirth;

• Breech presentation of the fetus, oligohydramnios, multiple pregnancies, rapid labor;

• Prevention, early detection of hip dysplasia

Tasks

Task. On ultrasound of the hip joint: ∠α=65° (1) and ∠β=60° (2). The other lines are not drawn correctly, so the angles are not correct. Conclusion: Transitional structure (type 1b) of the hip joint.

Task. On ultrasound of the hip joint: ∠α=56°, ∠β=59°; bone cover of the head 58%. Conclusion: a child under 3 months has physiological developmental delay (type 2a), and a child over 3 months has dysplasia (type 2b) of the hip joint.

Task. On ultrasound of the hip joint: ∠α=68°, ∠β=62°; bone coverage of the head <50%. Barlow's test moves the head outward and upward - ∠β=90-93°. Conclusion: Mature (type 1b) unstable hip joint.

Task. Ultrasound of the hip joint: on the right ∠α=60-62°, ∠β=66-70°; on the left ∠α=46-48°, ∠β=90-93°. Conclusion: Transitional structure (type 1b) of the hip joint structure on the right. Severe dysplasia (type 2d) of the hip joint, preluxation on the left.

Task. On ultrasound of the hip joint: ∠α=40°, ∠β=102°; bone coverage of the head <28%. Conclusion: Severe dysplasia (type 3a) of the hip joint, subluxation.

Task. Ultrasound of the hip joints, where ∠α<43°. Conclusion: Severe dysplasia (type 3a) of the hip joint, subluxation.

Task. Dysplasia of the hip joint type 4 is accompanied by dislocation: the head is displaced outward and upward, the covering of the bone roof is minimal (1); the Barlow test reveals the symptom of an empty acetabulum (2), the cartilaginous roof is wrapped inside the acetabulum and prevents reduction of the dislocation (3).

Task. Severe dysplasia (type 4) of the hip joints, dislocation on both sides. To determine the direction of femoral head displacement, evaluate the posterior and anterior margins of the acetabulum.

Task. A child aged 6 months, repeatedly examined by orthopedists, has excessive rotation of the left hip joint. Ultrasound of the hip joints: left ∠α=48°, ∠β=79°; on the right ∠α=50°, ∠β=60°. Conclusion: Severe dysplasia (type 2d) of the hip joint, preluxation on the left. Dysplasia (type 2b) of the hip joint, preluxation on the right. On the x-ray on the left, the head lies outside the joint - dislocation.

Task. Newborn with a positive Barlow-Ortolani test on both sides. Ultrasound of the hip joints: on the right ∠α=52°, ∠β=100°; left ∠α=49°, ∠β=95°; bone coverage of the head <9% on both sides. Conclusion: Severe dysplasia of the hip joints (type 2d), dislocation on both sides.

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Tags: lectures joints ultrasound

How is ultrasound of the hip joints performed in infants?

The examination is painless and does not require special preparation.

A special transparent gel is applied to the skin of the hip joint area, which is necessary to ensure close contact between the skin and the ultrasound sensor of the device. Having installed the ultrasound sensor in a certain position (at different angles), the doctor examines the images (“scans”) on the monitor. During the examination, the child is turned on the right and left sides. Upon completion of the study, parents clean the skin with a napkin and dress the baby.

Usually the conclusion is issued immediately after the end of the study. The ultrasound doctor interprets the results, and he can also discuss the results with you, but the final word remains with the doctor who referred the child for the study.

How is hip joint diagnosis performed for newborns?

The child is placed on the couch. During the examination, the doctor turns him from one side to the other and moves the sensor in the groin area.

It is desirable that the child moves as little as possible during the examination, so an ultrasound is performed when the baby is healthy, does not suffer from colic and is generally calm. The child should be fed no later than half an hour before the examination.

During the diagnostic process, the doctor pays attention to:

• condition of joints and adjacent soft tissues;
• angles of the hip joints and their relationships;
• development of the bone dome of the acetabulum;
• development of the cartilaginous zone of the acetabulum.

An orthopedic surgeon interprets the results obtained. He assesses the condition of the joints, makes a conclusion about the presence or absence of pathologies and, if necessary, proposes a treatment regimen.

Importance of hip ultrasound in newborns/infants

In recent years, there has been an increase in natal (obtained during childbirth) damage to the central nervous system with simultaneous pathology of the musculoskeletal system. The clinical picture (symptoms) in this case is varied and makes early diagnosis difficult, especially in newborns. The asymmetrical position of the torso with skew and rotation of the pelvis in such children corresponds to the clinical appearance of hip dysplasia; high muscle tone complicates clinical examination, but true dysplasia is detected only in 23 percent of cases.

In the first months of life, scoliosis in the lumbar region can simulate dysplasia or dislocation in the hip joint, due to pelvic distortion, accompanied by asymmetry of the gluteal folds and functional shortening of one of the lower extremities.

At the same time, with mild forms of dysplasia, clinical signs may be either completely absent or not specific to a particular pathology, which is why the effectiveness of screening is very low. More than 20 percent of dysplasias are not clinically detected, and in more than 40% of cases there is overdiagnosis.

A clearly organized preventive approach in the system for detecting dysplasia and congenital hip dislocation using ultrasound makes it possible to achieve an almost complete cure of this pathology before the child begins to stand on his feet.

DTS is a common disease of the musculoskeletal system. Its essence lies in the incorrect relative position of the elements of the hip joint (articular cavity, femoral head, articular capsule, ligamentous apparatus); depending on the degree of displacement of the femoral head in the acetabulum, dislocation, subluxation or pre-luxation of the hip are distinguished.

The hip joint of a newborn, even normally, is an immature biomechanical structure: its articular cavity is flattened, it is located more vertically, in comparison with the “adult joint,” and the ligaments of the joint are excessively elastic. The femoral head is held in the articular cavity due to the tension of the articular capsule, its own ligament (round ligament of the hip joint). The upward displacement of the femur is prevented by the cartilaginous plate of the acetabulum, which is called the “limbus” (acetabular lip - labrum - [lat.] lip, edge). With dysplasia, the shape, relationship and size of all structures of the hip joint change significantly.

The development of the hip joint occurs through the close interaction of the femoral head and the acetabulum. The distribution of load on the bone structures determines the shape of both the femoral head and acetabulum, as well as the geometry of the joint as a whole.

Until the first half of the last century, only severe forms of dysplasia (congenital hip dislocation) were taken into account. In those years, “mild forms” of dysplasia were not detected or treated. From the 70s - 90s. The term “hip dysplasia” is used, meaning not only dislocation, but also preluxation and subluxation of the hip joint. It should be noted that the lack of clear standards and the fear of missing severe orthopedic pathology is the reason for overdiagnosis. The dilemma of “immature hip joint and preluxation” is usually resolved in favor of dysplasia, which increases morbidity figures.

Risk groups for NTDs are:

– the presence of joint dysplasia in the parents (hereditary factor) – breech presentation of the fetus – large fetus – pregnancy pathology.

Several clinical symptoms of DTS can be identified:

– asymmetry of skin folds – limitation of hip abduction – shortening of the hip – clicking (or slipping) symptom

First of all, pay attention to the symmetry of the skin folds of the thigh (but you need to keep in mind that with bilateral pathology this sign may not be visible). Asymmetry of skin folds (gluteal, popliteal and inguinal folds have diagnostic significance) is more informative in children older than 2-3 months of age. Skin folds in congenital hip dislocation are located at different levels and differ in depth and shape. On the subluxated or dislocated side they are deeper and there are more of them.

The main symptom of hip dysplasia is the limitation of passive abduction of the hips: the child lies on his back, bend his legs at the hip and knee joints at a right angle and gently spread his hips to the sides, passive abduction is limited on the side of the affected joint. Sometimes, when a child does not allow the hips to abduct in a supine position, it is easy to determine the restriction of movement in the child’s position on his stomach when bending his legs, as when crawling.

The diagnosis of hip dysplasia is made primarily on the basis of clinical signs, ultrasound and x-ray results. Ultrasound and X-ray examinations are informative and extremely important diagnostic methods, but are secondary to clinical methods.

An orthopedic doctor should promptly suspect or make a diagnosis when examining newborns in the maternity hospital. Next, sick children and children at risk are observed by an orthopedist at their place of residence. All patients and children at risk are prescribed orthopedic treatment, which continues until the final diagnosis is clarified.

Completing a well-chosen course of treatment at a very early age stimulates further proper development of the joint - when the muscles work correctly, the joint is in the desired position. Exercise therapy for congenital hip dislocation using modern techniques in combination with massage and physiotherapy can restore full mobility to the leg, and the problems will go away once and for all.

It is much easier to treat hip dysplasia in infants, since their joints are still in the process of forming. With age, the tissues in this area become denser and stiffer - and the correction becomes more complicated and delayed. In addition, over time, the body adapts to the presence of such a defect, and many additional disorders arise in the body, which also need to be corrected separately .

The main principles of treatment for DTS are: early onset, the use of orthopedic means for long-term holding of the legs in abduction and flexion (various types of pillows, panties, stirrups, splints, devices and other devices), therapeutic massage and gymnastics (active movements in the hip joints within permissible range). The baby should be carried, supporting him with one hand behind the back, and the other under the buttocks. In this case, the child should, with his widely spaced legs, hug the adult’s torso. You should not carry a child “astride” on an adult’s side, because in this position, the child’s torso is located asymmetrically.

Massage and therapeutic exercises are carried out on the basis of a general strengthening complex appropriate to the age and development of the child, but only with the permission of an orthopedic doctor. Features of the massage - a more thorough and differentiated massage of the lumbar region, buttocks, and hip joint is used; the massage alternates with therapeutic exercises. With the child in the supine position, a massage is performed on the anterior outer surfaces of the legs (stroking and rubbing) in combination with techniques for relaxing the adductor muscles of the thigh, bending the child’s legs at the knee and hip joints and soft plastic spreading of the hips. Sudden movements should not be allowed so as not to cause pain during reflex contraction of the adductor muscles of the thigh and the child’s negative reaction to the procedure, therefore, to relax the adductor muscles of the thighs, acupressure (relaxation method) is performed with simultaneous abduction of the leg. Relaxation of the adductor muscles of the child’s hips (before spreading them) is also achieved by vibration massage of the hips, rocking the pelvis of the child lying on a support, in weight. Rotation of the hip along its axis inward is also carried out with the child in the position on his back: fix the hip joint with one hand, with the palm of the other hand gently clasp the leg below the child’s knee and, lightly pressing on it, gradually rotate the hip along its axis inward. This exercise achieves gentle pressure of the head of the femur on the articular (acetabular) cavity. With the child lying on his stomach, stroke and rub the posterior surfaces of the legs, then alternately move the baby’s bent legs to the sides (as when crawling), fixing his pelvis, then bend both legs, simultaneously spreading his knees to the sides.

Temporarily, until the orthopedist gives permission, you cannot do reflex walking exercises, “dancing,” or squats. Transfer the child to a squatting position while standing; failure to comply with this condition leads to even greater deformations of the hip joint. Reflex walking is possible during bathing, since in water the child’s body is much lighter and, therefore, the axial load on the hip joint is less. To train the support function of the feet, it is recommended to perform exercises with the child lying on his stomach and back, on a ball; support for the feet is created with a hand or a ball. The exercise of palming your feet is very useful and should become your baby’s favorite game. Therapeutic gymnastics techniques should be repeated 10-15 times during each swaddling; when treating a child in orthopedic splints, massage and exercises are carried out to the extent allowed by the positioning.

An example activity for hip dysplasia with a child aged two weeks to three months:

Starting position: the child lies on his back:

1. General stroking massage of arms and legs.
2. Stroking the abdomen - starting position: The child lies on his stomach.
3. Laying on the stomach with legs spread.
4. Stroking the back.
5. Massage of the lumbar region.
6. Massage of the gluteal muscles, hip joints.
7. Massage of the posterior surface of the legs.
8. Abduction of bent legs to the sides (as when crawling).
9. hovering – starting position: the child lies on his back.
10. Massage of the anterior surface of the legs.
11. Bent leg extension.
12. Internal rotation of the hip.
13. Foot massage.
14. Reflex exercises for the feet.
15. Exercises on the ball.

All of the above described manipulations should be performed only by a person with a medical education and an appropriate specialization. Only a specialist knows the characteristics of the baby’s body and knows how to give the baby’s joints and muscles exactly the load that is required. He has a good understanding of which muscles need to be relaxed and which ones to work so that the dislocation does not get worse as a result of the movement of these muscles in everyday life.

In addition, the practical skill of massage in a playful way is of great importance - children can easily tolerate any manipulation of their legs and arms only if it is interesting, fun and pleasant for them.

In our medical center, all massage specialists have extensive experience in treating hip dysplasia in infants. They are well prepared to work with young patients and know how to amuse and distract. Therefore, your baby will not only get rid of health problems, but also have fun playing. The prognosis of the disease is relatively favorable with early diagnosis and timely treatment.