congenital abduction hip contracture
Introduction
Introduction to congenital abductive acetabular contracture Congenitalab reduction contraction of the hip (CACOH) is a posture deformity, which is caused by congenital factors and features specific gait and signs of hip abduction external rotation and adduction and internal rotation dysfunction. The clinical syndrome is mainly characterized by unequal length of both lower limbs. Although the incidence is high, it is often ignored by parents and there are not many visits. basic knowledge The proportion of illness: 0.002% Susceptible people: young children Mode of infection: non-infectious Complications: scoliosis torticollis
Cause
Congenital abductor palsy
The etiology of this disease has not yet been fully clarified. Most people believe that the fetal position in the uterus is not correct, so that the abductor muscle group (mainly tensor fascia lamina, gluteus maximus, gluteus medius, gluteal muscle) and external rotator muscles The hip capsule is caused by contracture, and it is not found after birth. It is only taken seriously after walking. Some people think that it is because of abduction and external rotation muscle congenital muscular dystrophy, or multiple intramuscular injections, anatomically The tensor fascia is from the anterior superior iliac spine and the external iliac crest. The muscle abdomen is fusiform and its fibers are downward and backward in the middle and upper part of the femur, and the tendon bundle is moved. The deep layer is in the tensor fascia lata. Deeply facing up, attached to the outside of the joint capsule, the gluteus medius muscle starts from the tibial buttocks, forming a flat fan-shaped muscle bundle, ending in the greater trochanter, covered by the tensor fascia lata, and covered by the gluteus maximus at the back. The gluteus maximus pulls the tendon bundle backwards, the gluteal muscles, the small muscles upward, and the upper rim of the greater trochanter are pulled inside, and the lower extremity outer stent appears, and there is a corresponding clinical manifestation.
Prevention
Congenital abductor acetabular prevention
Failure to treat in time after birth can lead to hip abductor muscle and external rotation muscle contracture. However, in some cases, the abductor muscle shortening changes can disappear on their own. It is also necessary to pay attention to the postoperative patients, should pay attention to early exercise, but Early functional exercise may cause children to suffer from fear of pain and refuse functional exercise. Therefore, it is necessary to choose the right time according to the characteristics of the child to ensure that the child can recover as soon as possible without leaving sequelae.
Complication
Congenital abductor acetabular complications Complications scoliosis torticollis
Due to the contraction of the buttocks, the pulling of the small muscles causes the affected limb to be abducted for a long time. When the position of the external rotation and the healthy limb are in the adducted position, the femoral head and the acetabulum are in a non-concentric position, resulting in concentricity of the femoral head. The pressure is reduced, the acetabular dysplasia can occur on the healthy side, and even the femoral head subluxation occurs in severe cases. At the same time, due to the pulling of the pelvis by the contracture tissue, the pelvis is tilted to the affected side, thereby causing secondary scoliosis. Postural torticollis and foot valgus deformity.
Symptom
Congenital abductor acetabular symptoms common symptoms hip dislocation deflection pelvic hip dysplasia
Normal infants are prone. When the hip joints are placed in neutral, the sputum on both sides is at the same level. In infants with abductor acetabular contracture, pelvic tilt occurs when the prone position and the double hip joint remain in neutral position. The affected side is significantly lower than the healthy side, the affected side lower limb is also longer than the healthy side, the lumbar spinous process protrudes to the affected side, and there are hip lines, and the transverse stripes are asymmetrical, but if the affected lower limb is placed in the abduction 30° Above, these signs can completely disappear.
Some scholars have concluded that the disease is divided into three types:
(1) Straightening type: The anterior fascia lata and the anterior border of the gluteus medius are thickened, the contracture is the main, and the knee is stretched. When the hip is extended, the knees cannot be close together as the main performance.
(2) Flexion type: The gluteus medius and the tensor fascia lata muscle are mainly composed of the posterior gluteal muscle contracture. When the lower limbs bend the hip and bend the knee, the knees cannot be tightened as the main performance.
(3) Mixed type: clinical manifestations of both straight and flexed types.
Examine
Congenital abductor acetabular examination
First, physical examination
Normal infants are prone. When the hip joints are placed in neutral, the sputum on both sides is at the same level. In infants with abductor acetabular contracture, pelvic tilt occurs when the prone position and the double hip joint remain in neutral position. The affected side is significantly lower than the healthy side, the affected side lower limb is also longer than the healthy side, the lumbar spinous process protrudes to the affected side, and there are hip lines, and the transverse stripes are asymmetrical, but if the affected lower limb is placed in the abduction 30° Above, these signs can completely disappear.
Second, X-ray inspection
X-ray examination can find the ossification delay of the acetabular apical wall on the pelvic anteroposterior, which is related to the reduction of the pressure of the femoral head acting on the center of the acetabulum. Without early correction, it can cause subluxation of the contralateral hip. X-ray examination can also exclude some deformities that cause pelvic tilt, such as lumbosacral vertebral body and congenital scoliosis.
Diagnosis
Diagnosis and diagnosis of congenital abductor acetabular contracture
The disease is differentiated from gluteal muscle contracture and congenital hip dislocation.
(1) gluteal muscle contracture due to multiple intramuscular injections, the performance of the patient's gluteal muscles shrink, the lateral skin sag, showing "tip hip sign", mostly gluteus maximus, gluteus medius contracture, surgical dissection In the majority of patients with contracted gluteal muscle fascia and gluteal muscle contracture, good results can be obtained by partial resection of the contracture.
(2) There are many etiology of congenital dislocation of the hip, and the pathology tends to be close to the expansion of the fetal joint capsule at birth. After birth, the femoral head is loosened in the joint, and then the acetabulum becomes shallow, and the iliac fills the fat tissue. Moved outside the sputum, the head is smaller than the humeral wing and deformed with each other, followed by muscle atrophy, lumbar lordosis, oscillating gait after the hips, different treatments due to age, and congenital dislocation of the hip Most of them have limited abduction, and the nesting test is positive, and the hip abduction activity of this disease is increased, and the Ober test is positive, which is easy to distinguish from congenital dislocation of the hip.
