“人类发展”, synonymous with congenital hip dysplasia and often simplified to hip dysplasia, is one of the most commonly treated leg conditions in Paediatric Orthopaedics.
髋关节由大腿骨(股骨头)顶部的一个球组成，它位于骨盆骨(髋臼)的一个窝内。. Hip dysplasia essentially means that the socket of the hip joint is shallow. 这是一种谱系疾病，出生时髋关节完全脱位是最严重的表现. 最轻微的形式是球在窝里，但在成年后窝仍然很浅，导致疼痛的关节炎. Early diagnosis is crucial to improve outcomes. 先锋diagnosis, the greater the chances of success with less invasive treatment methods and the better the outcome. Diagnosis may be shortly after birth on ultrasound assessment, at walking age as a late presentation or later in adult life when mild hip dysplasia becomes symptomatic.
" p dysplasia网络. One in a hundred babies receive treatment for hip dysplasia. One in 500 babies is born with completely dislocated hips. 摇头丸包括在内.
However, up to 50% of children diagnosed with hip dysplasia may not have any of the above risk factors. 髋关节发育不良在女孩中比男孩更常见，在第一个出生的孩子中比晚出生的孩子更常见. 然而，这些被认为是软风险因素，因为绝大多数头胎女婴的臀部都是正常的.
Ultrasound of a baby's hips is the best clinical tool we have for detecting hip dysplasia early. The recommendation is that a baby’s hips are scanned at 4-6 weeks of age. 在生命最初几天进行的超声评估(特别是早产儿)经常过度诊断髋关节发育不良. 原因是髋部在出生后的前几周发育得相当快(这是建议在4-6周之间进行髋部扫描的基础)。. Although a few countries practice universal ultrasound screening of all newborn babies' hips, most countries adopt selective screening based on the presence of risk factors for hip dysplasia. 筛查的主要危险因素是在一级亲属中有髋关节发育不良的家族史和妊娠末期的臀位.
Hip sonographers are usually the best operators for undertaking hip ultrasound assessment in newborns. The sonographer will usually scan the baby on their side, scanning each hip in turn. They will save an image of each hip in a defined plane, assess stability and measure the Alpha angle (used to define a threshold for treatment with <60 degrees viewed as abnormal). Alpha angle and stability are the key assessments on which a decision to treat is based. If these parameters are normal the baby can often be safely discharged from further follow up.
亚美航空航天馆, 任何有关的扫描通常由儿科骨科平台首页进行检查，他将与超声医师实时检查扫描结果. 是否治疗的决定是基于超声图像的实时解释，以确保发育不良得到适当的诊断和治疗.
In other centres, 通常扫描是由超声医师完成的，然后由放射科平台首页检查静态图像，放射科平台首页可能很难解释图像. The report is then often passed on to the Orthopedic Surgeon to make a decision about treatment. 在美国医院，我们提供最高标准的护理，结合超声医师-儿科骨科平台首页诊所，根据实时图像解释做出治疗决定.
Figure 1 Ultrasound scan of a normal hip looks like a ball sitting in a socket shaped like a cup.
图2髋关节发育不良的超声显示球位于一个更像碟状的窝内.
你怎么怎么看到一个人在生活里??
If the scan findings are abnormal, the doctor may choose to treat your child in a Pavlik harness. Pavlik harnesses are "dynamic flexion abduction orthoses." They work best in hip dysplasia diagnosed under 6 months of age.安全带的工作原理是鼓励婴儿的臀部在休息时向外放置，这是髋部稳定的最佳位置，同时允许一些运动. They are low profile and babies will sleep comfortably in them. 帕夫利克束带通常由我们在迪拜美国医院的专业儿科矫形师应用和安装，然后由儿科矫形外科平台首页检查. The straps are marked so that parents know the settings when re-applying. We recommend 23 hours a day (off for 1 hour for bath and stretch) until the next visit. 《条约的分配情况, adjustment of straps and looking for any complications is undertaken at each visit. 就诊频率是根据每次就诊的超声检查结果来判断对治疗的反应.
What if my child is too old for a harness or it doesn’t work?
Unfortunately, 并不是所有的髋部对帕夫利克套具治疗都有反应，特别是当治疗开始时孩子年龄较大时. In such cases, 如果髋部脱臼，长时间使用有损伤股骨头的危险，因此可以停止使用安全带治疗. In cases where the Pavlik harness is ineffective, 当孩子稍大一点时，我们建议在全身麻醉下对髋关节进行关节造影(染料注射)评估. This is usually done around the age of 6 months. 染色注射研究(关节摄影)包括向髋关节注射造影剂以显示股骨头(通常在x线上看不到软骨股骨头)。. 摇摇摇摇摇欲坠, 我们可以确定它与插座的关系，以及它在插座中放置的容易程度和满意程度. 关节造影(染色研究)用于评估髋关节发育不良以及是否可以不经开放手术治疗. Sometimes the hip can be manually placed in to its normal position by moving the leg (closed reduction). If this is possible, 会诊平台首页会在孩子的髋部(髋臼)打石膏，使髋部保持在这个位置，使其进一步发育. The hip spica is usually removed at 6 weeks and an arthrogram is done to assess if the hips are stable. If the hips are still unstable a further spica cast may be applied for 6 weeks.
如果发现髋关节非常不稳定(容易滑进或滑出)或不能以良好的位置放回关节, the doctor”不apply the hip spica. 最好让髋关节自由活动，当孩子长大后再进行手术，将髋关节放回原位. The problem with the hip being unstable is that it will come out of the joint even with the cast on. We also avoid forcing the head into the joint and applying a cast. This can cause a serious complication - avascular necrosis of the femoral head. In this complication, the femoral head is injured from the pressure of being squashed into the joint. The damage leads to the development of an abnormally shaped femoral head as the child grows older. Avascular necrosis is a serious problem for the hip and can not be reversed with surgery. A core principle of hip dysplasia treatment is to avoid causing avascular necrosis. 因此，最好的矫正髋关节脱位手术，而不是使用石膏本身.
Fig 1. 在这里，放一种关于独白。. 在脱臼的髋关节中，我们可以看到球没有发育成骨头，仍然是软骨，所以在x光片中看不到.
Fig 2. 髋关节关节造影术:在x线引导下，在麻醉状态下将针插入髋关节. 对比染料(黑色)注入关节，勾勒出髋关节球(股骨头)及其与窝的关系.
Fig 3: The hips are moved around with the child under anaesthetic to see if they dislocate. On one side the hip remains in place with a thin rim of dark dye between the ball and the socket. On the other side we can see that the ball dislocates and the empty socket fills up with dye
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