[STUDY OF THE RESULTS IN THE CONSERVATIVE TREATMENT OF CONGENITAL HIP DISLOCATION].
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Despite the introduction of clinical screening and early treatment of congenital dislocation of the hip (CDH), the prevalence of subluxated/luxated hips in later infancy is still reported to be as high as 1-3 per 1,000 infants. Using ultrasound, it is possible to evaluate both hip morphology and hip stability. Hip morphology is best evaluated using Graf's coronal section through the deepest part of the acetabulum. Classification of the hips into different categories can then be based on measuring the angle of inclination of the acetabulum (alpha-angle) or femoral had coverage. Hip stability can be assessed by a Barlow-equivalent provocation test during the ultrasound examination. In the Norwegian newborn population approximately 85% of the infants have morphologically normal hips (based on the alpha-angle) while 12% have immature and 3% dysplastic hips. About 80-90% of infants with dysplastic acetabula show only minor changes, and many of the hips may normalize without treatment. Several studies indicate that universal ultrasound screening might reduce the occurrence of late diagnosed congenital dislocation of the hip.
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The author presents his experience of surgical treatment of 63 high congenital dislocations of the hip in schoolchildren. Osteotomy of the pelvis after Salter in combination with shortening osteotomy and open reduction of the hip has been used. Aseptic necrosis of the femoral head in the postoperative period has been revealed in almost 80% of the cases; the results were good during the first 10 years of observations in 28.5% and bad in 31% of the cases; after 10 and more years the percentage of good results fell to 18%. However, the patients gave a higher estimation of the treatment results as the period of clinical compensation of the operated joints lasted 10 to 12 pears, which made easier their contacts with schoolmates and family creation in future.
Spina bifida is commonly associated with hydrocephalus and feet malformations, however its association with congenital dislocation of the hip is not well document. We retrospectively analyzed the medical records of 120 children aged 6 months to 15 years old, admited to a rehabilitation center with the diagnosis of spina bifida. Fifty six children (55.4%) had dislocation of the hip (36 of 53 women and 20 of 48 men). These figures are higher than those reported for newborns by the Latin-American Collaborative Stud of Congenital Malformations. We conclude that congenital dislocation of the hip is frequent in children with spina bifida.
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