发育性髋关节脱位(英文)课件

DevelopmentalDysplasiaoftheHipHeatherRocheApril4,2002DevelopmentalDysplasiaofthePreviouslyknownascongenitaldislocationofthehipimplyingaconditionthatexistedatbirthdevelopmentalencompassesembryonic,fetalandinfantileperiodsincludescongenitaldislocationanddevelopmentalhipproblemsincludingsubluxation,dislocationanddysplasiaPreviouslyknownascongenitalNormalGrowthandDevelopmentEmbryologicallytheacetabulum,femoralheaddevelopfromthesameprimitivemesenchymalcellscleftdevelopsinprecartilaginouscellsat7thweekandthisdefinesbothstructures11wkhipjointfullyformedacetabulargrowthcontinuesthroughoutintrauterinelifewithdevelopmentoflabrumbirthfemoralheaddeeplyseatedinacetabulumbysurfacetensionofsynovialfluidandverydifficulttodislocateinDDHthisshapeandtensionisabnormalinadditiontocapsularlaxityNormalGrowthandDevelopmentThecartilagecomplexis3Dwithtriradiatemediallyandcup-shapedlaterallyinterposedbetweeniliumaboveandischiumbelowandpubisanteriorlyacetabularcartilageformsouter2/3cavityandthenon-articularmedialwallformbytriradiatecartilagewhichisthecommonphysisofthesethreebonesfibrocartilaginouslabrumformsatmarginofacetabularcartilageandjointcapsuleinsertsjustaboveitsrimThecartilagecomplexis3DwiarticularcartilagecoversportionarticulatingwithfemoralheadoppositesideisagrowthplatewithdegeneratingcellsfacingtowardsthepelvicboneitopposestriradiatecartilageistriphalangedwitheachsideofeachlimbhavingagrowthplatewhichallowsinterstitialgrowthwithinthecartilagecausingexpansionofhipjointdiameterduringgrowthIntheinfantthegreatertrochanter,proximalfemurandintertrochantericportioniscartilage4-7monthsproximalossificationcenterappearswhichenlargesalongcartilaginousanlageuntiladultlifewhenonlythinlayerofarticularcartilagepersistsarticularcartilagecoverspor发育性髋关节脱位(英文)课件发育性髋关节脱位(英文)课件Developmentcpn’tExperimentalstudiesinhumanswithunreducedhipssuggestthemainstimulusforconcaveshapeoftheacetabulumispresenceofsphericalheadfornormaldepthofacetabulumtoincreaseseveralfactorsplayarolesphericalfemoralheadnormalappositionalgrowthwithincartilageperiostealnewboneformationinadjacentpelvicbonesdevelopmentofthreesecondaryossificationcentersnormalgrowthanddevelopmentoccurthroughbalancedgrowthofproximalfemur,acetabulumandtriradiatecartilagesandtheadjacentbonesDevelopmentcpn’tExperimentalDDHTightfitbetweenheadandacetabulumisabsentandheadcanglideinandoutofacetabulumhypertrophiedridgeofacetabularcartilageinsuperior,posteriorandinferioraspectsofacetabulumcalled“neolimbus”oftenatroughorgroveinthiscartilageduetopressurefromfemoralheadorneck98%DDHthatoccuraroundoratbirthhavethesechangesandarereversibleinthenewborn2%newbornswithteratologicorantenataldislocationsandnosyndromehavethese

changesDDHTightfitbetweenheadand发育性髋关节脱位(英文)课件DevelopmentintreatedDDHdifferentfromnormalhipgoalistoreducethefemoralheadasaptoprovidethestimulusforacetabulardevelopmentifconcentricreductionismaintainedpotentialforrecoveryandresumptionofnormalgrowthageatwhichDDHhipcanstillreturntonormaliscontroversialdependsonageatreductiongrowthpotentialofacetabulumdamagetoacetabulumfromheadorduringreductionaccessorycentersseenin2-3%normalhipshoweverintreatedDDHseenupto60%appearingages6monthsto10years(shouldlookfortheseonradiographstoindicatecontinuedgrowth)DevelopmentintreatedDDHdifEpidemiology1in100newbornsexaminedhaveevidenceofinstability(positiveBarloworOrtolani)1in1000livebirthstruedislocationmostdetectableatbirthinnurseryBarlowstatedthat60%stabilizein1stweekand88%stabilizeinfirst2monthswithouttreatmentremaining12%truedislocationsandpersistwithouttreatmentColeman26%becomedislocated,13%partialcontact39%locatedbutdysplaticfeatures22%normalEpidemiology1in100newbornsEtiologyGeneticandethnicincreasednativeAmericansbutverylowinsouthernChineseandAfricanspositivefamilyhistory12-33%10xriskifaffectedparent,7Xifsiblingintrauterinefactorsbreechposition(normalpop’n2-4%,DDH17-23%)oligohydroamniosneuromuscularconditionslikemyelomeningocelehighassociationwithintrauterinemoldingabnormalitiesincludingmetatarsusadductusandtorticollisfirstbornfemalebaby(80%cases)lefthipmorecommonEtiologyGeneticandethnicDiagnosisClinicalriskfactorsPhysicalexamOrtolaniTesthipflexionandabduction,trochanterelevatedandfemoralheadglidesintoacetabulumBarlowTestprovocativetestwherehipflexedandadductedandheadpalpatedtoexittheacetabulumpartiallyorcompletelyoverarimsomebasetheretreatmentonwhetherortolani+versusBarlow+feelingBarlow+morestableLovellandWintermakenodistinction2%extremecompleteirreducibleteratologicdisloactionsassocwithotherconditionslikearthrogyposisDiagnosisClinicalriskfactors发育性髋关节脱位(英文)课件LateDiagnosisSecondaryadaptivechangesoccurlimitationofabductionduetoadductorlongusshorteningGalleazisignflexbothhipsandonesideshowsapparentfemoralshorteningasymmetrygluteal,thighorlabialfoldslimb-lengthinequailtywaddlinggaitandhyperlordosisinbilateralcasesLateDiagnosisSecondaryadapti发育性髋关节脱位(英文)课件发育性髋关节脱位(英文)课件RadiographyUltrasoundmorphologicassessmentanddynamicanatomicalcharacteristicsalphaangle:slopeofsuperioraspectbonyacetabulumbetaangle:cartilaginouscomponent(problemswithinterandintraobservererror)dynamicobservewhatoccurswithBarlowandortolanitestingindicationscontroversialduetohighlevelsofoverdiagnosisandnotcurrentlyrecommendedasaroutinescreeningtoolotherthaninhighriskpatientsbestindicationistoassesstreatmentguidedreductionofdislocatedhiporcheckreductionandstabilityduringPavlikharnesstreatmentRadiographyUltrasoundRadiographycon’tnewbornperiodDDHnotaradiographicdiagnosisandshouldbemadebyclinicalexamafternewbornperioddiagnosisshouldbeconfirmedbyxrayseveralmeasurementstreatmentdecisionsshouldbebasedonchangesinmeasurementsRadiographycon’tnewbornperioRadiologicalDiagnosisclassicfeaturesincreasedacetabularindex(n=27,>30-35dysplasia)disruptionshentonline(afterage3-4shouldbeintactonallviews)absentteardropsigndelayedappearanceossificnucleusanddecreasedfemoralheadcoveragefailuremedialmetaphysealbeakofproximalfemur,secondaryossificationcentertobelocatedinlowerinnerquadrantcenter-edgeangleusefulafterage5(<20)whencanseeossificnucleusRadiologicalDiagnosisclassicPePe发育性髋关节脱位(英文)课件NaturalHistory

inNewbornsBarlow1in60infantshaveinstability(positiveBarlow)60%stabilizein1stweek88%stabilizein2monthswithouttreatment12%becometruedislocationsandpersistColeman23hips<3months26%becamedislocated13%partialcontactwithacetabulum39%locatedbutdysplasticfeature22%normalbecausenotpossibletopredictoutcomeallinfantswithinstabilityshouldbetreatedNaturalHistory

inNewbornsBarAdultsVariabledependson2factorswelldevelopedfalseacetabulum(24%chancegoodresultvs52%ifabsent)bilateralityinabsenceoffalseacetabulumpatientsmaintaingoodROMwithlittledisabilityfemoralheadcoveredwiththickelongatedcapsulefalseacetabulumincreaseschancesdegenerativejointdiseasehyperlordosisoflumbarspineassocwithbackpainunilateraldislocationhasproblemsleglengthinequality,kneedeformity,scoliosisandgaitdisturbanceAdultsVariable发育性髋关节脱位(英文)课件发育性髋关节脱位(英文)课件发育性髋关节脱位(英文)课件DysplasiaandSubluxationDysplasia(anatomicandradiographicdef’n)inadequatedevofacetabulum,femoralheadorbothallsubluxatedhipsareanatomicallydysplasticradiologicallydifferencebetweensubluxatedanddysplastichipisdisruptionofShenton’slinesubluxation: linedisrupted,headissuperiorly, superolaterallyarlaterally displacedfromthemedialwalldysplasia: lineisintactimportantbecausenaturalhistoryisdifferentDysplasiaandSubluxationDyspl发育性髋关节脱位(英文)课件NaturalHistoryCon’tSubluxationpredictablyleadsto

degenerativejointdiseaseandclinicaldisabilitymeanagesymptomonset36.6infemalesand54inmenseverexraychanges46infemaleand69inmalesCooperman32hipswithCEangle<20withoutsubluxation22yearsallhadxrayevidenceofDJDnocorrelationbetweenangleandrateofdevelopmentconcludedthatradiologicallyapparentdysplasialeadstoDJDbutprocesstakesdecadesNaturalHistoryCon’tSubluxatiTreatment0to6monthsGoalisobtainreductionandmaintainreductiontoprovideoptimalenv’tforfemoralheadandacetabulardevelopmentLovellandWintertreatmentinitiatedimmediatelyondiagnosisAAOS(July,2000)subluxationoftencorrectsafter3weeksandmaybeobservedwithouttreatmentifpersistsonclinicalexamorUSbeyond3weekstreatmentindicatedactualdislocationdiagosedatbirthtreatmentshouldbeimmediateTreatment0to6monthsGoalisTreatmentcon’tPavlikHarnesspreferredpreventshipextensionandadductionbutallowsflexionandabductionwhichleadtoreductionandstabilizationsuccess95%ifmaintainedfulltimesixweeks>6monthssuccess<50%asdifficulttomaintainactivechildinharnessTreatmentcon’tPavlikHarnessPavlikHarnessCheststrapatnipplelineshoulderstrapssettoholdcrossstrapatthislevelanteriorstrapflexeship100-110degreesposteriorstrappreventsadductionandallowcomfortableabductionsafezonearcofabductionandadductionthatisbetweenredislocationandcomfortableunforcedabductionPavlikHarnessCheststrapatnPavlikcon’tIndicationsincludepresenceofreduciblehipfemoralheaddirectedtowardtriradiatecartilageonxrayfollowweeklyintervalsbyclinicalexamandUSfortwoweeksifnotreducedothermethodspursuedoncesuccessfullyreducedharnesscontinuedforchildsageatstability+3monthswornfulltimeforhalfintervalifstabilitycontinuesandthenweanedoffendofweaningprocessxraypelvisobtainedandifnormaldiscontinueharness

Pavlikcon’tIndicationsincludComplications

Failurepoorcompliance,inaccuratepositionandpersistenceofinadequatetreatment(>2-3-weeks)subgroupwherefailuremaybepredictableViereetalabsentOrtolanisignbilateraldislocationstreatmentcommencedafterage7weekTreatmentclosedreductionandSpicaCastingFemoralNerveCompression2tohyperflexionInferiorDislocationSkinbreakdownAvascularNecrosisComplications

Failure6monthsto2yearsageClosedreductionandspicacastimmobilizationrecommendedtractioncontroversialwiththeoreticalbenefitofgradualstretchingofsofttissuesimpedingreductionandneurovascularbundlestodecreaseAVNskintractionpreferredhowevervarywithsurgeonusually1-2weeksscientificevidencesupportingthisislacking6monthsto2yearsageClosedTreatmentcon’tclosedreductionpreformedinORundergeneralanestheticmanipulationincludesflexion,tractionandabductionpercutaneousoropenadductortenotomynecessaryinmostcasestoincreasesafezonewhichlessenincidenceofproximalfemoralgrowthdisturbancereductionmustbeconfirmedonarthrogramaslargeportionofheadandacetabulumarecartilaginousdynamicarthrographyhelpswithassessingobstaclestoreductionandadequacyofreductionTreatmentcon’tclosedreductioTreatmentreductionmaintainedinspicacastwellmoldedtogreatertrochantertopreventredislocationhumanpositionofhyperflexionandlimitedabductionpreferredavoidforcedabductionwithinternalrotationasincreasedincidenceofproximalfemoralgrowthdisturbancecastinplacefor6weeksthenrepeatCtscantoconfirmreductioncastingcontinuedfor3monthsatwhichpointremovedandxraydonethenplacedinabductionorthoticdevicefulltimefor2monthsthenweanedTreatmentreductionmaintained发育性髋关节脱位(英文)课件发育性髋关节脱位(英文)课件FailureofClosedMethodsOpenreductionindicatediffailureofclosedreduction,persistentsubluxation,reduciblebutunstableotherthanextremesofabductionvarietyofapproachesanteriorsmithpetersonmostcommonallowsreductionandcapsularplicationandsecondaryproceduresdisadv->bloodloss,damageiliacapophysisandabductors,stiffnessFailureofClosedMethodsOpengreatestrateofacetabulardevelopmentoccursinfirst18monthsafterreduction发育性髋关节脱位(英文)课件OpenReductioncon’tmedialapproach(betweenadductorbrevisandmagnus)approachdirectlyoversiteofobstacleswithminimalsofttissuedissectionunabletodocapsularplicationsodependoncastforpostopstabilityanteromedialapproachLudloff(betweenneurovascularbundleandpectineus)directexposuretoobstacles,minimalmuscledissectionnoplicationorsecondaryproceduresincreasedincidenceofdamagetomedialfemoralcircumflexarteryandhigherAVNriskOpenReductioncon’tmedialappFollow-up

Abductionorthoticbracescommonlyuseduntilacetabulardevelopmentcaughtuptonormalsideinassessingdevelopmentlookforaccessoryossificationcenterstoseeifcartilageinperipheryhaspotentialtoossifysecondaryacetabularprocedurerarelyindicated<2yearsaspotentialfordevelopmentafterclosedandopenproceduresisexcellentandcontinuesfor4-8yearsmostrapidimprovementmeasuredbyacetabularindex,developmentofteardropoccursinfirst18monthsaftersurgeryfemoralanteversionandcoxavalgaalsoresolveduringthistimeFollow-up

AbductionorthoticObstaclestoReductionExtra-articularIliopsoastendonadductorsIntra-articularinvertedhypertrophiclabrumtranverseacetabularligamentpulvinar,ligamentumteresconstrictedanteromedialcapsuleespecinlatecasesneolimbusisnotanobstacletoreductionandrepresentsepiphysealcartilagethatmustnotberemovedasthisimpairsacetabulardevelopmentObstaclestoReductionExtra-aAgegreaterthan2yearsOpenreductionusuallynecessaryage>3femoralshorteningrecommendedtoavoidexcesspressureonheadwithreduction54%AVNand32%redislocationwithuseofskeletaltractioninages>3age>3recommendopenreductionandfemoralshorteningandacetabularprocedureAgegreaterthan2yearsOpenrTreatmentcon’t2-3-yearsgrayzonepotentialforacetabulardevelopmentdiminishedthereforemanysurgeonsrecommendaconcomitantacetabularprocedurewithopenreductionor6-8weeksafterJBJSFeb,2002SalterInnominateOsteotomy…Bohm,BrzuskeincidenceofAVNisgreaterwithsimultaneousopenreductionandacetabularprocedureTreatmentcon’t2-3-yearsgrayTreatmentcon’tLovellandWinterjudgestabilityattimeofreductionandifstableobserveforperiodoftimefordevelopmentifnotdevelopingproperlywithdecreasedacetabularindex,teardropthenconsidersecondaryproceduremostcommonosteotomyisSalterorPembertonanatomicdeficiencyisanteriorandSalterprovidesthiswhilePembertonprovidesanteriorandlateralcoverageTreatmentcon’tLovellandWintNaturalSequelaeGoaloftreatmentistohaveradiographicallynormalhipatmaturitytopreventDJDafterreductionachievedpotentialfordevelopmentcontinuesuntilage4afterwhichpotentialdecreaseschild<4minimaldysplasiamayobservebutifseverethansubluxationsandresidualdysplasiasshoildbecorrectedwhenevaluatingpersistentdysplasialookatfemurandacetabulumDDHdeficiencyusuallyacetabularsideNaturalSequelaeGoaloftreatResidualDysplasiaplainxraywithmeasurementofCEangleandacetabularindexyoungchildrendeficiencyanteriorandadolescentscanbeglobaldeformitiesoffemoralnecksignificantifleadtosubluxationlateralsubluxationwithextremecoxavalgaoranteriorsubluxationwithexcessiveanteversion(definedonCT)usuallyDDHpatientshaveanormalneckshaftangleResidualDysplasiaplainxraywDysplasiafor2-3-yearsafterreductionproximalfemoralderotationorvarusosteotomyshouldbeconsideredifexcessiveanteversionorvalguspriortoperformingthesebesureheadcanbeconcentricallyreducedonAPviewwithlegabducted30andinternallyrotatedvarusosteotomydonetoredirectheadtocenterofacetabulumtostimulatenormaldevelopmentmustbedonebeforeage4asremodelingpotentialgoesdownafterthisDysplasiafor2-3-yearsafterAdolescentorAdultFemoralosteotomyshouldonlybeusedinconjunctionwithpelvicprocedureasnopotentialforacetabulargrowthorremodelingbutchangingorientationoffemurshiftstheweightbearingportionPelvicosteotomyconsiderationsagecongruentreductionrangeofmotiondegenerativechangesAdolescentorAdultFemoralostPelvicProceduresRedirectionalSalter(hingesonsymphysispubis)SutherlanddoubleinnominateosteotomySteel(Tripleosteotomy)Ganz(rotational)Acetabuloplasties(decreasevolume)hingeontriradiatecartilage(thereforeimmaturepatients)PembertonDega(posteriorcoverageinCPpatients)SalvagedependonfibrousmetaplasiaofcapsuleshelfandChiariPelvicProceduresRedirectionalComplicationsofTreatmentWorstcomplicationisdisturbanceofgrowthinproximalfemurincludingtheepiphysisandphysealplatecommonlyreferredtoasAVNhowever,nopathologytoconfirmthismaybeduetovascularinsultstoepiphysisorphysealplateorpressureinjuryoccurrsonlyinpatientsthathavebeentreatedandmaybeseeninoppositenormalhipComplicationsofTreatmentWorsNecrosisofFemoralHeadExtremesofpositioninabduction(greater60degrees)andabductionwithinternalrotationcompressiononmedialcircumflexarteryaspassestheiliopsoastendonandcompressionoftheterminalbranchbetweenlateralneckandacetabulum“froglegposition“uniformlyresultsinproximalgrowthdisturbanceNecrosisofFemoralHeadExtremextremepositioncanalsocausepressurenecrosisonfepiphysealcartilageandphysealplateseverinmethodcanobtainreductionbutveryhighincidenceofnecrosismultipleclassificationsystemswithSaltermostpopularextremepositioncanalsocausSalterClassification1 failureofappearanceofossificnucleus within1yearofreduction22 failureofgrowthofanexistingnucleus within1year3 broadeningoffemoralneckwithin1 year4 increasedxraydensitythen fragmentationofhead5 residualdeformityofheadwhenre- ossificationcompleteincludingcoxa magna,varaandshortneckSalterClassification1 failurKalamachiClassifiedgrowthdisturbancesassocwithvariousdegreesofphysealarrest1 alldisturbancesnotassocwithphysis2 lateralphysealarrest(mostcommon)3 centralphysealarrest4 medialphysealarrestlongtermfollowupshowsthatnecrosisoffemoralheaddecreaseslongevityofhipKalamachiClassifiedgrowthdisTreatmentFemoraland/oracetabularosteotomytomaintainreductionandshiftareasofpressuretrochantericovergrowthcausinganabductorlurchtreatedwithgreatertrochanterphysealarrestifdonebeforeage8otherwisedistaltransferearlydetectioniskeywith95%successrateoftreatmentidentifygrowthdisturbancelinesTreatmentFemoraland/oracetabDevelopmentalDysplasiaoftheHipHeatherRocheApril4,2002DevelopmentalDysplasiaofthePreviouslyknownascongenitaldislocationofthehipimplyingaconditionthatexistedatbirthdevelopmentalencompassesembryonic,fetalandinfantileperiodsincludescongenitaldislocationanddevelopmentalhipproblemsincludingsubluxation,dislocationanddysplasiaPreviouslyknownascongenitalNormalGrowthandDevelopmentEmbryologicallytheacetabulum,femoralheaddevelopfromthesameprimitivemesenchymalcellscleftdevelopsinprecartilaginouscellsat7thweekandthisdefinesbothstructures11wkhipjointfullyformedacetabulargrowthcontinuesthroughoutintrauterinelifewithdevelopmentoflabrumbirthfemoralheaddeeplyseatedinacetabulumbysurfacetensionofsynovialfluidandverydifficulttodislocateinDDHthisshapeandtensionisabnormalinadditiontocapsularlaxityNormalGrowthandDevelopmentThecartilagecomplexis3Dwithtriradiatemediallyandcup-shapedlaterallyinterposedbetweeniliumaboveandischiumbelowandpubisanteriorlyacetabularcartilageformsouter2/3cavityandthenon-articularmedialwallformbytriradiatecartilagewhichisthecommonphysisofthesethreebonesfibrocartilaginouslabrumformsatmarginofacetabularcartilageandjointcapsuleinsertsjustaboveitsrimThecartilagecomplexis3DwiarticularcartilagecoversportionarticulatingwithfemoralheadoppositesideisagrowthplatewithdegeneratingcellsfacingtowardsthepelvicboneitopposestriradiatecartilageistriphalangedwitheachsideofeachlimbhavingagrowthplatewhichallowsinterstitialgrowthwithinthecartilagecausingexpansionofhipjointdiameterduringgrowthIntheinfantthegreatertrochanter,proximalfemurandintertrochantericportioniscartilage4-7monthsproximalossificationcenterappearswhichenlargesalongcartilaginousanlageuntiladultlifewhenonlythinlayerofarticularcartilagepersistsarticularcartilagecoverspor发育性髋关节脱位(英文)课件发育性髋关节脱位(英文)课件Developmentcpn’tExperimentalstudiesinhumanswithunreducedhipssuggestthemainstimulusforconcaveshapeoftheacetabulumispresenceofsphericalheadfornormaldepthofacetabulumtoincreaseseveralfactorsplayarolesphericalfemoralheadnormalappositionalgrowthwithincartilageperiostealnewboneformationinadjacentpelvicbonesdevelopmentofthreesecondaryossificationcentersnormalgrowthanddevelopmentoccurthroughbalancedgrowthofproximalfemur,acetabulumandtriradiatecartilagesandtheadjacentbonesDevelopmentcpn’tExperimentalDDHTightfitbetweenheadandacetabulumisabsentandheadcanglideinandoutofacetabulumhypertrophiedridgeofacetabularcartilageinsuperior,posteriorandinferioraspectsofacetabulumcalled“neolimbus”oftenatroughorgroveinthiscartilageduetopressurefromfemoralheadorneck98%DDHthatoccuraroundoratbirthhavethesechangesandarereversibleinthenewborn2%newbornswithteratologicorantenataldislocationsandnosyndromehavethese

changesDDHTightfitbetweenheadand发育性髋关节脱位(英文)课件DevelopmentintreatedDDHdifferentfromnormalhipgoalistoreducethefemoralheadasaptoprovidethestimulusforacetabulardevelopmentifconcentricreductionismaintainedpotentialforrecoveryandresumptionofnormalgrowthageatwhichDDHhipcanstillreturntonormaliscontroversialdependsonageatreductiongrowthpotentialofacetabulumdamagetoacetabulumfromheadorduringreductionaccessorycentersseenin2-3%normalhipshoweverintreatedDDHseenupto60%appearingages6monthsto10years(shouldlookfortheseonradiographstoindicatecontinuedgrowth)DevelopmentintreatedDDHdifEpidemiology1in100newbornsexaminedhaveevidenceofinstability(positiveBarloworOrtolani)1in1000livebirthstruedislocationmostdetectableatbirthinnurseryBarlowstatedthat60%stabilizein1stweekand88%stabilizeinfirst2monthswithouttreatmentremaining12%truedislocationsandpersistwithouttreatmentColeman26%becomedislocated,13%partialcontact39%locatedbutdysplaticfeatures22%normalEpidemiology1in100newbornsEtiologyGeneticandethnicincreasednativeAmericansbutverylowinsouthernChineseandAfricanspositivefamilyhistory12-33%10xriskifaffectedparent,7Xifsiblingintrauterinefactorsbreechposition(normalpop’n2-4%,DDH17-23%)oligohydroamniosneuromuscularconditionslikemyelomeningocelehighassociationwithintrauterinemoldingabnormalitiesincludingmetatarsusadductusandtorticollisfirstbornfemalebaby(80%cases)lefthipmorecommonEtiologyGeneticandethnicDiagnosisClinicalriskfactorsPhysicalexamOrtolaniTesthipflexionandabduction,trochanterelevatedandfemoralheadglidesintoacetabulumBarlowTestprovocativetestwherehipflexedandadductedandheadpalpatedtoexittheacetabulumpartiallyorcompletelyoverarimsomebasetheretreatmentonwhetherortolani+versusBarlow+feelingBarlow+morestableLovellandWintermakenodistinction2%extremecompleteirreducibleteratologicdisloactionsassocwithotherconditionslikearthrogyposisDiagnosisClinicalriskfactors发育性髋关节脱位(英文)课件LateDiagnosisSecondaryadaptivechangesoccurlimitationofabductionduetoadductorlongusshorteningGalleazisignflexbothhipsandonesideshowsapparentfemoralshorteningasymmetrygluteal,thighorlabialfoldslimb-lengthinequailtywaddlinggaitandhyperlordosisinbilateralcasesLateDiagnosisSecondaryadapti发育性髋关节脱位(英文)课件发育性髋关节脱位(英文)课件RadiographyUltrasoundmorphologicassessmentanddynamicanatomicalcharacteristicsalphaangle:slopeofsuperioraspectbonyacetabulumbetaangle:cartilaginouscomponent(problemswithinterandintraobservererror)dynamicobservewhatoccurswithBarlowandortolanitestingindicationscontroversialduetohighlevelsofoverdiagnosisandnotcurrentlyrecommendedasaroutinescreeningtoolotherthaninhighriskpatientsbestindicationistoassesstreatmentguidedreductionofdislocatedhiporcheckreductionandstabilityduringPavlikharnesstreatmentRadiographyUltrasoundRadiographycon’tnewbornperiodDDHnotaradiographicdiagnosisandshouldbemadebyclinicalexamafternewbornperioddiagnosisshouldbeconfirmedbyxrayseveralmeasurementstreatmentdecisionsshouldbebasedonchangesinmeasurementsRadiographycon’tnewbornperioRadiologicalDiagnosisclassicfeaturesincreasedacetabularindex(n=27,>30-35dysplasia)disruptionshentonline(afterage3-4shouldbeintactonallviews)absentteardropsigndelayedappearanceossificnucleusanddecreasedfemoralheadcoveragefailuremedialmetaphysealbeakofproximalfemur,secondaryossificationcentertobelocatedinlowerinnerquadrantcenter-edgeangleusefulafterage5(<20)whencanseeossificnucleusRadiologicalDiagnosisclassicPePe发育性髋关节脱位(英文)课件NaturalHistory

inNewbornsBarlow1in60infantshaveinstability(positiveBarlow)60%stabilizein1stweek88%stabilize