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Shirov Bobur Furkatovich,
Trainer-Assistant of the department of radiation diagnostic and treatment
Samarkand State Medical Institute
Samarkand, Uzbekistan
Yanova Elvira Umarjonovna,
Assistant of the department of radiation diagnostic and treatment
Samarkand State Medical Institute
Samarkand, Uzbekistan
Turdumatov Jamshed Anvarovich,
Assistant of the department of radiation diagnostic and treatment
Samarkand State Medical Institute
Samarkand, Uzbekistan
ULTRASOUND ASSESSMENT OF VARYING DEGREES OF HIP DYSPLASIA IN NEONATES
ANNOTATION
Congenital hip disorders such as hip dysplasia, hip subluxation, and hip dislocation are among the most
common musculoskeletal disorders, accounting for up to 15% of orthopaedic pathology, leading to statico-dynamic
disturbances and limitation of vital functions and early disability. The incidence of these diseases according to different
authors ranges from 5.3 to 50 and even 200 cases per 1000 newborns. Treatment initiated in the first month of a child's
life is most effective and leads to complete anatomical and functional restoration of the joint in 88% to 98% of cases. In
cases of late treatment, 10-60% of children develop one of the severe diseases - dysplastic coxarthrosis, aseptic necrosis
of the femoral head, compensatory scoliosis of the spine or other anatomical and functional changes.
Key words:
ultrasound, hip joint, dislocation, dysplasia, newborns, femoral head
Широв Бобур Фуркатович,
Стажер-ассистент кафедры лучевой диагностики и терапии
Самаркандского государственного медицинского института
Самарканд, Узбекистан
Янова Эльвира Умаржоновна,
Ассистент кафедры лучевой диагностики и терапии
Самаркандского государственного медицинского института
Самарканд, Узбекистан
Турдуматов Жамшед Анварович,
Ассистент кафедры лучевой диагностики и терапии
Самаркандского государственного медицинского института
Самарканд, Узбекистан
УЛЬТРАЗВУКОВАЯ ОЦЕНКА РАЗЛИЧНЫХ СТЕПЕНЕЙ ДИСПЛАЗИИ ТАЗОБЕДРЕННОГО
СУСТАВА У НОВОРОЖДЕННЫХ
АННОТАЦИЯ
Врожденные заболевания тазобедренного сустава, такие как дисплазия тазобедренного сустава,
подвывих бедра и вывих тазобедренного сустава, являются одними из наиболее частых нарушений опорно-
двигательного аппарата, составляя до 15% ортопедической патологии, приводя к статодинамическим
нарушениям и ограничению жизненно важных функций и ранней инвалидизации. Распространенность
патологии, по данным разных авторов, колеблется от 5,3 до 50 и даже 200 случаев на 1000 новорожденных.
Лечение, начатое в первый месяц жизни ребенка, наиболее эффективно и приводит к полному анатомо-
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функциональному восстановлению сустава в 88–98% случаев. При несвоевременном лечении у 10-60% детей
развивается ряд тяжелых осложнений, таких как диспластический коксартроз, асептический некроз головки
бедренной кости, компенсаторный сколиоз позвоночника или другие анатомо-функциональные изменения.
Relevance
Hip dysplasia of varying degrees in
newborns According to various authors, this pathology
occurs in 3-5% of newborns, and in some countries, such
as Italy, Czechoslovakia, Hungary, Georgia, 5-6 times
more frequently [9,13,21]. Clinical practice shows that
treatment has a positive effect when initiated in the first
months after birth. Early clinical diagnosis was developed
as early as the middle of the last century, but in most
cases, the results of orthopaedic examination require
confirmation or exclusion by one of the imaging
techniques: radiological or ultrasonography. According to
both domestic and foreign literature, the age-related
features of the hip joint in children and adolescents are
poorly studied. The features of the structure of the hip
joint in newborns have been most extensively studied
[10,14,32], which is due, on the one hand, to the urgency
of the problem of hip dysplasia and congenital dislocation
of the hip. Features of the structure of the hip joint of
older age groups have been studied by some authors,
where data from radiological studies are given and are
reduced to indicating the timing of the appearance of the
main and additional ossification nuclei of the hip joint
area. These studies only examine the shape and size of
the acetabulum and proximal femur and their spatial
position. In our opinion, this gives an idea, so to speak, of
the external shape of the components of the hip joint and
does not reflect the essence of the processes occurring in
the acetabulum and proximal femur. However, the
diagnostic capabilities of these methods in the light of the
specific structure of the hip joint in children in the
visualization
of
these
structures
are
currently
understudied, which also determines the relevance of the
present study. Early diagnosis of hip joint abnormalities
already in the maternity home is of paramount
importance.
The lack of absolute clinical criteria requires
the use of objective methods of examination, the
traditional one being radiography. In children, especially
before the age of 3 months, the interpretation of X-rays is
difficult because of the predominance of cartilaginous
components of the hip joint that do not give an image on
the radiograph, which does not allow the evaluation of
the ratio of the femoral head to the acetabulum, to
identify a variety of disorders in the structure of
cartilaginous components of the joint. According to most
authors, radiological examination of the hip joints is
informative at the age of 3 months at the earliest, when
the effectiveness of functional treatment techniques
decreases [16, 23, 26, 35]. Finally, because of the
radiation exposure of the child, frequent use of
radiography for dynamic monitoring of treatment
outcomes is precluded. Ultrasonography is a method that
extends the diagnostic possibilities in the assessment of
hip formation in children in the first year of life. It has a
number of advantages over radiography: it makes it
possible to visualise cartilage, connective tissue
structures of the joint, and adjacent muscles. It is non-
invasive, highly informative, radiobased, real-time,
capable of assessing metric parameters, can be used
repeatedly to assess treatment progression, is inexpensive
and accessible, and can be used for mass examinations at
the earliest time possible. There are several techniques
for sonographic assessment of hip joints in children in the
first year of life N.T. Harcke [18], S. Suzuki [21], T.
Terjesen [4,25], etc. The method developed by Austrian
orthopedist R. Graf [19, 22, 36] is the most widely used.
Its advantage is the standardization of the study, a
detailed classification that considers 11 degrees of
maturity of the hip joint in the age aspect. A disadvantage
of the method, according to some authors [7,27], is that it
only involves assessing abnormalities of the bony
structures of the hip joint, without paying due attention to
the cartilage elements that make up most of the hip joint
of newborns and children in the first year of life. Other
researchers [29, 30, 37] agree that the landmarks
suggested by R. Graf are not always clearly defined and
the error in the construction of angles is at least ± 10. To
date, there are no methods for specifying bony landmarks
for sonometry in those diagnostic cases where the lower
edge of the iliac bone is represented by a wide echo due
to interposition of the fatty tissue of the acetabular bed or
the round ligament of the head. One of the most common
reasons for prescribing a hip radiograph in children in
their first year of life is suspicion of congenital joint
dysplasia, subluxation or dislocation of the hip.
Radiological examination of the hip joints is still the
traditional method of examination. A large number of
ways of assessing joint development based on
radiological findings have been proposed. The above-
mentioned schemes are graphical in nature, while
radiography does not allow evaluation of the cartilage
and connective tissue structures of the joints in question.
In addition, it must be taken into account that the gonads
of the child, especially in girls, cannot be fully protected
in hip radiography because they are relatively high at the
level of the wings of the iliac bones.
Research objective:
Study of the main criteria
for ultrasound assessment of various degrees of hip
dysplasia in neonates
Research materials and methods.
250 children
(127 boys and 123 girls) aged 1 to 3 months were
examined for hip dysplasia of various degrees of severity.
All patients were tested on a Toshiba xario 200 hip
ultrasound machine with a 5-8 mHz linear transducer.
Research results:
Ultrasound examination of
the hip joints of children in the first months of life is a
diagnostic standard. The main indication for this method
is the clinical signs of joint dysplasia in children in the
first months of life. In 70% of cases, mothers during
pregnancy had various pathologies (acute respiratory
infections, nephropathy, toxicosis) in the first trimester of
pregnancy. The most characteristic and permanent sign of
hip dysplasia is the shortening (relative) of one or both
legs of the child, the presence of a crease on the back
surface of the hip, and restricted mobility of the affected
joint. In the course of the study, indications for ultrasound
were restricted hip joint mobility, the presence of this
pathology in close relatives, and the presence of a
characteristic skin fold in the children we examined. At
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the frontal ultrasound, the picture roughly matched the
image of the anterior posterior radiography. The
ultrasound examination determined the displacement of
the femoral head during movement. Of all the examined
hip dysplasia was detected in 60 children, which was
24%. Of these, bilateral joint lesions were found in 30
(50%); left joint in 12 (20%); right joint in 18 (30%). The
number of boys was 33 (55%) and girls 27 (45%). When
conducting the survey, we paid attention to the angles α
and β. "Angle α" is the angle of inclination of the
acetabulum, which characterises the degree of bone roof
development and is normally <60. As the child grows up
- the α angle increases. "angle β" - characterises the
degree of development of the cartilaginous roof, and is
normally - >55. Depending on the size of these angles, all
patients surveyed were divided into 3 groups:
- Group 1 (immature joint) - 36 patients (60%),
whose angle α was 50-59 and - β>55;
- Group 2 (joint subluxation) - 15 patients (25%)
with an angle α of 43-49 and an angle β of 55-77;
- Group 3 (with complete dislocation of the
joint) - 9 patients (15%), whose angle α was <43, β - >77.
As we can see, sonography makes it possible to
assess the condition of a child's hip joint fairly accurately,
quickly and without harming it.
Conclusions:
Thus, ultrasonography will make
it possible to detect congenital hip pathology at an earlier
stage, to start treatment in time and achieve recovery in
the shortest possible time without surgery. 60 children
with DTBS have been screened. Of these, 60 children:
Ultrasound of the hip joint - more effective in the first 3
months of a child's life compared to X-ray examination,
as cartilage tissue is better visualised by ultrasound
sonography.
The ultrasound method is precise and almost
harmless for the child.
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