We often like to compare children to small saplings and expect them to grow into towering trees under the careful watering and cultivation of their parents. However, some orthopedic diseases with high incidence among children tend to "break" the tall and straight posture of young seedlings, making them appear "bow back with chest" or hip joint abnormalities at a young age. In this issue, we specially invite Professor Ying Hao, director of pediatric orthopaedics department of Children's Hospital Affiliated to Shanghai Jiaotong University, to analyze in detail the prevention and treatment of developmental dislocation of hip joint and idiopathic scoliosis, two common orthopaedic diseases in children.
Focus 1: Developmental dislocation of the hip
The bad habit of swaddling is easy to cause dislocation of hip joint in children
You know what? If the infant is nurtured in swaddling clothes or the lower limbs of the infant are not properly wrapped, it is easy to cause developmental dislocation of the hip joint in the newborn. You know what? The vaginal delivery of the newborn can keep the baby outside the hip joint, which is very beneficial to stabilize the child's hip joint. Professor Ying Hao, Director of Pediatric Orthopaedics Department of Children's Hospital Affiliated to Shanghai Jiaotong University, stressed that developmental dislocation of the hip, a common orthopedic disease in children, could have been prevented. Early diagnosis and treatment on the basis of normative criteria are the most critical.
Baby rearing habit+mode of production=potential incentives
Developmental dislocation of the hip is one of the common diseases in children's orthopedics. Among them, the probability of developing dislocation of the hip joint on the left side of children is twice as high as that on the right side, and bilateral dislocation is rare.
A large number of survey data have confirmed that the incidence of such children's common diseases varies greatly in different regions. This indicates that the occurrence of developmental dislocation of the hip is closely related to genetic factors, living habits and environment. For example, the incidence of this disease in some African countries, as well as North Korea and other countries, has significantly decreased among some ethnic groups who are accustomed to carrying babies on their backs. On the contrary, the incidence of developmental dislocation of the hip is significantly higher in areas that are accustomed to binding both lower limbs and swaddling babies, such as Italy, North American Indian and other places.
In addition, developmental dislocation of the hip is also related to fetal position. Clinical data show that breech delivery has the highest probability of this kind of disease, 10 times higher than head delivery. In addition, the risk of developmental dislocation of the hip joint of babies born by caesarean section is also significantly higher than that of babies born by vagina. It can be seen that keeping the abduction position of the hip joint is very beneficial to stabilizing the hip joint, which is also an important measure to prevent the occurrence of this disease.
Careful observation+early intervention=early diagnosis
Experts pointed out that developmental dislocation of the hip joint in children can be avoided and prevented. Early diagnosis and treatment after birth can prevent disease progression. This is because neonatal pathological changes are the lightest and easy to correct. In addition, in the first year after birth, the baby's pelvis develops fastest, and scientific intervention and treatment can improve the disease.
Objectively speaking, it is difficult to diagnose developmental dislocation of the hip in neonates. However, this does not mean that there is no trace at the early stage of the disease. Generally, infants with developmental dislocation of the hip are born with a loose joint capsule, but no other anatomical abnormalities. After that, the acetabulum will become shallower, and the direction will be upward backward. The glenoid lip composed of the joint capsule and acetabular cartilage will become thicker and varus. The femoral head will develop slowly and become smaller, and the femoral neck will have an increased anteversion angle. In the later stage, the joint capsule was pulled, thickened, deformed and adhered, and the iliopsoas, adductor and rectus abdominis muscles contracted.
Therefore, when diagnosing developmental dislocation of the hip in newborns and infants, we should carefully distinguish whether they have the following typical clinical symptoms:
◆ Appearance: The thighs and calves are asymmetric with the opposite side, which can be manifested as thickening, shortening or thinning, unilateral lateral rotation, and bilateral widening of buttocks.
◆ dermatoglyphs: dermatoglyphs on buttocks, groins and thighs increase, deepen, move upward and are asymmetric.
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